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ATTENTION CE PROTOCOLE N'EST PAS ADOPTÉ POUR USAGE À L'HÔTEL-DIEU DE LÉVIS
Adopté: NON
Potassium ReplacementSURGICAL CRITICAL CARE
Potassium ReplacementSURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
** Always look at phosphorus level to determine appropriate potassium product **
*** Consider PO/PT replacement if GI tract available ***
*** Consider PO/PT replacement if GI tract available ***
• If central line present and continuous cardiac monitoring, infuse at 20 meq/hr (max = 40 meq/hr).
• If peripheral access only, infuse at 10 meq/hr.
• Serum potassium may be expected to increase by ~0.25 meq/L for each 20 meq IV KCl infused.
Approved: ____________________________Dr. Addison K. May, MD, FACS, FCCM
October 2010
Magnesium Replacement
Magnesium Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
IV Administration:
· Magnesium replacement will now be one-time doses.
· All doses will be comprised of the appropriate number of 2g/50mL premixed piggybacks. Infuse at a rate of 2gm per hour.
Oral Administration:
· Applies to patients with magnesium level > 1.5 mg/dL who are asymptomatic and able to tolerate PO or PT meds.
· ** Elemental magnesium (supplied as magnesium oxide) or Milk of Magnesia may be initiated; however, diarrhea may be a limiting factor. Separate order must beentered into Wiz/HEO for oral replacement.
Approved: Dr. Addison K. May, MD, FACS, FCCM October 2010
Phosphorus Replacement
Phosphorus Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
** always look at phosphorus level to determine appropriate potassium product **
· Pharmacy will no longer accept verbal phosphorus replacement orders. ALL orders must be entered into Wiz/HEO.
· Always look at potassium level to determine appropriate IV phosphorus product: use
K Phos if K < 4.0 and Na Phos if K ³ 4.0.
K Phos if K < 4.0 and Na Phos if K ³ 4.0.
· For IV replacement: Pharmacy will dilute in 250mL NS or D5W. Infuse over 4-6 hours.
· For PO/PT replacement: Neutra-Phos / Neutra-Phos K packets are no longer manufactured. K-Phos Neutral tablet is the formulary alternative.
Approved: Dr. Addison K. May, MD, FACS, FCCM October 2010
Calcium Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
Approved: Dr. Addison K. May, MD, FACS, FCCM
October 2010
Zaloga GP, K.R., Bernards WC, Layons AJ, Fluids and Electrolytes.
Critical Care, ed. T.R. Civetta JM, Kirby P.Vol. 1. 1997, Philadelphia: Lippincott-Raven. 23.63. Panello JE, Delloyer RP, Critical Care Medicine 2nd Edition 2002; St. Louis: Mosby, Inc. 1169 Polderman, et al. CCM 2000 June; 28(6) 2022-2025
Polderman et al. J. Neurology 2001 May; 94(5): 697-705
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