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Electrolyte Replacement - Critical Care ICU/PCU (30400716)

This document provides guidelines for electrolyte replacement for patients in the critical care ICU or PCU. It includes orders for replacing potassium, calcium, magnesium, and phosphorus based on lab results. It states that if a patient's serum creatinine is greater than 2 mg/dL or they have documentation of renal failure or are on dialysis, the RN should contact the physician for specific replacement orders. It also notes that the pharmacist at Highline hospital should be consulted if replacing multiple electrolytes.

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Lubna Ali
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142 views7 pages

Electrolyte Replacement - Critical Care ICU/PCU (30400716)

This document provides guidelines for electrolyte replacement for patients in the critical care ICU or PCU. It includes orders for replacing potassium, calcium, magnesium, and phosphorus based on lab results. It states that if a patient's serum creatinine is greater than 2 mg/dL or they have documentation of renal failure or are on dialysis, the RN should contact the physician for specific replacement orders. It also notes that the pharmacist at Highline hospital should be consulted if replacing multiple electrolytes.

Uploaded by

Lubna Ali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 7

Electrolyte Replacement - Critical Care ICU/PCU [30400716]

Height_____________________
Weight_____________________
Allergies____________________

If serum creatinine greater than 2mg/dL and/or documentation of renal failure or dialysis, RN will contact physician for
specific replacement orders. Consult pharmacist at Highline hospital.

Protocol
Electrolyte Protocol

[X] Electrolyte Protocol


[X] Electrolyte Replacement Protocol: Critical Care (ICU/PCU) RN to order specific medication needed based on lab result.
If creatinine greater than 2 mg/dL and/or documentation of Renal
Failure or Dialysis, contact physician for specific replacement
orders.
Use ORAL when able. If multiple electrolytes to be replaced,
please consult pharmacist.
[X] Potassium As needed, Starting today
PRN. Check level 1 hour post infusion or 4 hours after oral
dose(s) and replace per order.
[X] Calcium, ionized As needed, Starting today
PRN. Check level 2 hour post infusion or 4 hours after oral
dose(s) and replace per order.
[X] Magnesium As needed, Starting today
PRN. Check level 2 hour post infusion or 4 hours after oral
dose(s) and replace per order.
[X] Phosphorus As needed, Starting today
PRN. Check level 2 hour post 50 mEq IV infusion and replace
per order. Check level in AM after ORAL or 20 mEq or 30 mEq IV
infusion and replace per orders.

[] Other

Highline Only Pharmacy Consult for patients with SCr >=2, renal failure, or receiving dialysis.

[] Highline Only Pharmacy Consult for Electrolyte Replacement Routine, Once, Starting today
[] Other

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 1 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
Potassium Replacement
If serum creatinine over 2 mg /dL and/or Documentation of Renal failure or Dialysis, contact MD for specific orders.
If multiple IV electrolytes to be replaced, please consult pharmacist

POTASSIUM LEVEL 3.5 - 4 (Single Response)

( ) potassium ORAL tablet 40 mEq, Oral, Once, For 1 Doses


For Potassium level 3.5 - 4 mmol/L
Recheck level 4 hours after oral doses and replace per order.
Routine
( ) potassium ORAL liquid 40 mEq, Oral, Once, For 1 Doses
For Potassium level 3.5 - 4 mmol/L
Recheck level 4 hours after oral doses and replace per order.
Routine
( ) potassium CENTRAL IV 40 mEq, IntraVENous, for 2 Hours, Once, Starting today, For 1
Doses
For Potassium level 3.5 - 4 mmol/L
Recheck level 1 hour post total infusion and replace per order.
Routine
( ) potassium PERIPHERAL IV 40 mEq, IntraVENous, for 4 Hours, Once, For 1 Doses
40 mEq for Potassium level 3.5 - 4 mmol/L
Recheck level 1 hour post total infusion and replace per order.
Routine
[ ] Other

POTASSIUM LEVEL 2.2 - 3.4 (Single Response)

( ) potassium ORAL tablet 40 mEq, Oral, Every 2 hours, For 2 Doses


For Potassium level 2.2 - 3.4 mmol/L
Recheck level 4 hours after oral doses and replace per order.
Routine
( ) potassium ORAL liquid 40 mEq, Oral, Every 2 hours, For 2 Doses
For Potassium level 2.2 - 3.4 mmol/L
Recheck level 4 hours after oral doses and replace per order.
Routine
( ) potassium CENTRAL IV 40 mEq, IntraVENous, for 2 Hours, Every 2 hours, Starting today,
For 2 Doses
For Potassium level 2.2 - 3.4 mmol/L
Recheck level 1 hour post total infusion and replace per order.
Routine
( ) potassium PERIPHERAL IV 40 mEq, IntraVENous, for 4 Hours, Every 4 hours interval, For 2
Doses
40 mEq for Potassium level 2.2 - 3.4 mmol/L
Recheck level 1 hour post total infusion and replace per order.
Routine
[] Other

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 2 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
POTASSIUM LEVEL LESS THAN 2.2 (Single Response)

( ) potassium CENTRAL IV 40 mEq, IntraVENous, for 2 Hours, Every 2 hours, Starting today,
For 2 Doses
For Potassium level less than 2.2 mmol/L and notify MD if
symptomatic.
Recheck level 1 hour post total infusion and replace per order.
Routine
( ) potassium PERIPHERAL IV 40 mEq, IntraVENous, for 4 Hours, Every 2 hours, For 2 Doses
40 mEq for Potassium level less than 2.2 mmol/L and notify MD if
symptomatic.
Recheck level 1 hour post total infusion and replace per order.
Routine
[] Other

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 3 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
Magnesium Replacement
If serum creatinine over 2 mg /dL and/or Documentation of Renal failure or Dialysis, contact MD for specific orders.
If multiple IV electrolytes to be replaced, please consult pharmacist

MAGNESIUM LEVEL 1.4 - 1.7 (Single Response)

( ) magnesium ORAL liquid 30 mL, Oral, Daily as needed, other, give MOM or Magnesium oxide
tablets once for Magnesium level 1.4 - 1.7 mg/dL
For Magnesium level 1.4 - 1.7 mg/dL
Recheck level 4 hours after oral dose and replace per order.
Routine
( ) magnesium ORAL tablet 800 mg, Oral, Once, For 1 Doses
For Magnesium level 1.4 - 1.7 mg/dL
Recheck level 4 hours after oral dose and replace per order.
Routine
( ) magnesium IV 2 g, IntraVENous, for 0.5 Hours, Once, For 1 Doses
For Magnesium level 1.4 - 1.7 mg/dL
Recheck level 2 hours post infusion and replace per orders.
Routine
[ ] Other

MAGNESIUM LEVEL LESS THAN 1.4 (Single Response)

( ) magnesium IV 4 g, IntraVENous, for 1 Hours, Once, For 1 Doses


For Magnesium level less than 1.4 mg/dL
Recheck level 2 hours post infusion and replace per orders.
Routine
[] Other

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 4 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
Calcium Replacement
If serum creatinine over 2 mg/dL and/or Documentation of Renal failure or Dialysis, contact MD for specific orders.
If multiple IV electrolytes to be replaced, please consult pharmacist

Ionized CALCIUM LEVEL 1 - 1.11 (Single Response)

( ) calcium ORAL 1,250 mg, Oral, Every 4 hours interval, First Dose Today, For 2
Doses
For ionized Calcium level 1 - 1.1 mmol/L
Recheck level 4 hours after oral doses and replace per order.
1250 mg calcium carbonate (equivalent to 500mg elemental
calcium).
Routine
( ) calcium CENTRAL IV 1 g, IntraVENous, for 10 Minutes, Once, For 1 Doses
For ionized Calcium level 1 - 1.11 mmol/L
Recheck level 2 hours post infusion and replace per order.
If calcium chloride not available, pharmacist will change order to
calcium gluconate 3 g over 1 hour once.
Do NOT infuse in HAND or Small Veins. Do NOT infuse in same
line WITH potassium or sodium PHOSPHATE, Max 200 mg
(1mEq)/min
Routine
( ) calcium PERIPHERAL IV 3 g, IntraVENous, for 1 Hours, Once, For 1 Doses
For ionized Calcium level 1 - 1.11 mmol/L
Recheck level 2 hours post infusion and replace per order.
If calcium gluconate not available, pharmacist will change order to
calcium chloride 1 g/50 ml over 1 hour once.
Routine
[ ] Other

Ionized CALCIUM LEVEL LESS THAN 1 (Single Response)

( ) calcium CENTRAL IV 2 g, IntraVENous, for 30 Minutes, Once, For 1 Doses


For ionized Calcium level less than 1 mmol/L
Recheck level 2 hours post infusion and replace per order.
If calcium chloride not available, pharmacist will change order to
calcium gluconate 3 g every 1 hour for 2 doses.
Do NOT infuse in HAND or Small Veins. Do NOT infuse in same
line WITH potassium or sodium PHOSPHATE, Max 200 mg
(1mEq)/min
Routine
( ) calcium PERIPHERAL IV 3 g, IntraVENous, for 1 Hours, Every 1 hour, For 2 Doses
For ionized Calcium level less than 1 mmol/L
Recheck level 2 hours post infusion and replace per order.
If calcium gluconate not available, pharmacist will change order to
calcium chloride 2 g/50 ml over 1 hour once.
Routine
[ ] Other

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 5 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
Phosphate Replacement
If serum creatinine over 2 mg /dL and/or Documentation of Renal failure or Dialysis, contact MD for specific orders.
If multiple IV electrolytes to be replaced, please consult pharmacist

PHOSPHORUS LEVEL 1.6 - 2.5 (Single Response)

( ) Phosphate ORAL 2 packet, Oral, Every 2 hours, For 2 Doses


For Phosphorus level 1.6 - 2.5 mg/dL
Recheck level in AM and replace per order.
Routine
( ) Phosphate CENTRAL IV 20 mEq, IntraVENous, for 4 Hours, Once, For 1 Doses
For Phosphorus level 1.6 - 2.5 mg/dL
Recheck level in AM and replace per order.
Routine
( ) Phosphate PERIPHERAL IV 20 mEq, IntraVENous, for 4 Hours, Once, For 1 Doses
For Phosphorus level 1.6 - 2.5 mg/dL
Recheck level in AM and replace per order.
Routine
[ ] Other

PHOSPHORUS LEVEL 1 - 1.5 (Single Response)

( ) Phosphate IV 35 mEq, IntraVENous, for 4 Hours, Once, For 1 Doses


For Phosphorus level 1 - 1.5 mg/dL
Recheck level in AM and replace per order.
Routine
[ ] Other

PHOSPHORUS LEVEL LESS THAN 1 (Single Response)

( ) Phosphate IV 50 mEq, IntraVENous, for 6 Hours, Once, For 1 Doses


For Phosphorus level less than 1 mg/dL
Recheck level 2 hours post infusion and replace per order.
Routine
[ ] Other

Date / Time _______ Print Provider Name________________ Provider Signature ___________________________

Date/Time ________________________ RN Signature Acknowledgement _______________________________

DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 6 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS
DATE/TIME________________________ PROVIDER INITIALS __________________________

PATIENT INFORMATION
Page 7 of 7
Electrolyte Replacement – Critical Care
ICU/PCU [30400716]

PHYSICIAN ORDERS

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