Electrolyte Repletion Electrolyte Repletion
Magnesium: Magnesium:
Replace Mg before K, PO is preferred if the patient can tolerate Replace Mg before K, PO is preferred if the patient can tolerate
Expect low Mg in patients with GI losses (v/d/NG tubes), EtOH, amioglycocides, amphotericin, etc. Expect low Mg in patients with GI losses (v/d/NG tubes), EtOH, amioglycocides, amphotericin, etc.
Serum Mg Replace with Recheck level Serum Mg Replace with Recheck level
1.6-1.8 mEq/L 2 grams MgSO4 IVPB with next labs or in am 1.6-1.8 mEq/L 2 grams MgSO4 IVPB with next labs or in am
(8mEq) or 400mg (8mEq) or 400mg
magnesium oxide PO magnesium oxide PO
1.2-1.5 mEq/L 4 grams MgSO4 IVPB with next labs or in am 1.2-1.5 mEq/L 4 grams MgSO4 IVPB with next labs or in am
(16mEq) (16mEq)
0.8 -1.2 mEq/L 6 grams MgSO4 IVPB recheck in 4h 0.8 -1.2 mEq/L 6 grams MgSO4 IVPB recheck in 4h
<0.8 mEq/L 8 grams MgSO4 IVPB recheck in 4h <0.8 mEq/L 8 grams MgSO4 IVPB recheck in 4h
If there are sx of bronchospasm, EKG changes, can give 2 grams over 15 min. If there are sx of bronchospasm, EKG changes, can give 2 grams over 15 min.
If asymptomatic, give no faster than 2gm MgSO4 in 50 cc D5W over 30 minutes If asymptomatic, give no faster than 2gm MgSO4 in 50 cc D5W over 30 minutes
Potassium: Potassium:
also check Mg level and correct, Goal is >4 in cardiac patients. also check Mg level and correct, Goal is >4 in cardiac patients.
DO NOT replete or careful repletion in patients with ESRD, crush injuries, burns, rhabdo, DKA DO NOT replete or careful repletion in patients with ESRD, crush injuries, burns, rhabdo, DKA
- every 10mEq of KCl should increase K level by 0.1 - every 10mEq of KCl should increase K level by 0.1
Serum K Replace with Recheck level Serum K Replace with Recheck level
3.3-3.5 mEq/L 40mEq KCl PO or IVPB with next labs or in am 3.3-3.5 mEq/L 40mEq KCl PO or IVPB with next labs or in am
3.0-3.2 mEq/L 50mEq KCl PO or IVPB with next labs or in am 3.0-3.2 mEq/L 50mEq KCl PO or IVPB with next labs or in am
2.5-2.9 mEq/L 60mEq KCl PO or IVPB immediately after 2.5-2.9 mEq/L 60mEq KCl PO or IVPB immediately after
< 2.5 mEq/L 80mEq KCl PO or IVPB immediately after < 2.5 mEq/L 80mEq KCl PO or IVPB immediately after
- if Cl is > 110mEq/L, use potassium acetate - if Cl is > 110mEq/L, use potassium acetate
- if Phos is < 3, use potassium phosphate - if Phos is < 3, use potassium phosphate
- preferred route is oral, but giving > 40mEq/L can give GI side effects (consider 40mg PO q 2-3hrs) - preferred route is oral, but giving > 40mEq/L can give GI side effects (consider 40mg PO q 2-3hrs)
- if K <3.0mEq, replace Mg as well 2gm MgSO4 IV - if K <3.0mEq, replace Mg as well 2gm MgSO4 IV
- IV replacement max rate is 10mEq/hr. If painful for the patient, slow down the rate - IV replacement max rate is 10mEq/hr. If painful for the patient, slow down the rate
Calcium: Calcium:
DO NOT replete or careful repletion in patients on digoxin DO NOT replete or careful repletion in patients on digoxin
Central line: IV replacement should be with calcium chloride (272mg elemental calcium/1gm CaCl2) Central line: IV replacement should be with calcium chloride (272mg elemental calcium/1gm CaCl2)
Peripheral IV: use calcium gluconate (94mg elemental calcium/1gm calcium gluconate) Peripheral IV: use calcium gluconate (94mg elemental calcium/1gm calcium gluconate)
Serum Ca Replace with Recheck level Serum Ca Replace with Recheck level
8.0-8.5 and alb > 3.5 (or 1 gram Ca gluconate with next labs or in am 8.0-8.5 and alb > 3.5 (or 1 gram Ca gluconate with next labs or in am
ionized Ca 3.5-4.0) (4.5mEq) over 15-30min ionized Ca 3.5-4.0) (4.5mEq) over 15-30min
< 8.0 and alb > 3.5 (or 2 grams Ca gluconate recheck in 2hrs < 8.0 and alb > 3.5 (or 2 grams Ca gluconate recheck in 2hrs
ionized Ca < 3.5) (9mEq) over 30 min ionized Ca < 3.5) (9mEq) over 30 min
If albumin is < 3.5: Ca (corrected) = (4 – serum albumin) x 0.8 + Ca(measured) If albumin is < 3.5: Ca (corrected) = (4 – serum albumin) x 0.8 + Ca(measured)
Phosphate: Phosphate:
DO NOT replete or careful repletion in patients with ESRD, rhabdo and DKA DO NOT replete or careful repletion in patients with ESRD, rhabdo and DKA
Serum Phos Replace with Recheck level Serum Phos Replace with Recheck level
2.0-2.5 and K < 3.5-4.0 K-phos 15mmol IVPB (= with next labs or in am 2.0-2.5 and K < 3.5-4.0 K-phos 15mmol IVPB (= with next labs or in am
22mEq of phos) 22mEq of phos)
2.0-2.5 but K > 4.0 Na-phos 15mmol IVPB (= with next labs or in am 2.0-2.5 but K > 4.0 Na-phos 15mmol IVPB (= with next labs or in am
22mEq of phos) 22mEq of phos)
1.5-1.9 and K < 3.5 Na-phos or K-phos 1.5-1.9 and K < 3.5 Na-phos or K-phos
30mmol IVPB 30mmol IVPB
< 1.5 Na-phos or K-phos check all lytes, recheck < 1.5 Na-phos or K-phos check all lytes, recheck
30mmol IVPB immediately after 30mmol IVPB immediately after
Max phosphate is 5mmol/hr or can cause decrease in Mg, Ca and EKG changes Max phosphate is 5mmol/hr or can cause decrease in Mg, Ca and EKG changes
-can also give packets of Neutra-phos or Neutra-phos-potassium orally (NB both contain sodium) -can also give packets of Neutra-phos or Neutra-phos-potassium orally (NB both contain sodium)
