PLACE LABEL HERE

ELECTROLYTE REPLACEMENT

CARDIOVASCULAR SURGERY

PROTOCOL

The following orders will be implemented

per physician order of this protocol.

  1. This order is foruse in Cardiovascular Care Unit (CVC). Discontinue when transferred out of CVC.
  2. Notify physician prior to use if GFR or CrCl < 30 ml/min, creatinine is > 2, or urine output < 30 ml/hr.
  3. D/C magnesium replacement in patients with acute exacerbation of Myasthenia Gravis
  4. MEDICATIONS:

Potassium Replacement:

Serum Potassium
(mmol/L) / Replacement as Potassium Chloride(KCL)
(oral route preferred) / Laboratory
3.8 - 3.9 / KCl 20 mEq poor IVPB x 1 dose / Repeat serum potassium
2 hrs after dose
completed
3.5 - 3.7 / KCL 20 mEq po q 2 hrs x 2 doses
or
40 mEq IVPB over 2 hrsx 1 dose
3 - 3.4 / KCl 40 mEq po, wait 2 hrs then give 20 mEqpofor a total of 60 mEq
or
KCl 40 mEq IVPB over 2 hrs, then give 20 mEq IVPB over 1 hr for a total of 60 mEq
< 3 / KCl 40 mEq IVPB over 2 hrs, then give 20 mEq IVPB over 1 hr for a total of 60 mEq and call physician

Magnesium Replacement: D/C magnesium replacement in patients with acute exacerbation of Myasthenia Gravis

Serum Magnesium
(mg/dL) / Replacement as Magnesium Sulfate / Laboratory
1.7 - 2 / 2 gms IVPB over 1 hr x 1 dose / Repeat serum magnesium
2 hrs after infusion completed
1.2- 1.6 / 3 gms IVPB over 2 hrs x 1 dose
< 1.2 / 4 gms IVPB over 2 hrs and call physician

Phosphate Replacement:

Serum Phosphate
(mg/dL) / Replacement as
potassium & sodium phosphate oral / Laboratory
2 - 2.4 / Neutra-Phos (potassium phosphate, sodium phosphate)
1 packet po q6hrs x 48 hrs / Repeat serum phosphate
level in AM
1.5 - 1.9 / Neutra-Phos (potassium phosphate, sodium phosphate)
2 packet po q6hrs x 48 hrs
< 1.5 / Call physician for phosphate replacement.

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

*1-40046* FORM 1-40046 REV.06/2015 Page 1 of 1

ELECTROLYTE REPLACEMENT

CARDIOVASCULAR SURGERY

PROTOCOL

Reference Page

(For use with form 40046)

PLACE THIS COPY IN MAR SECTION OF CHART FOR DURATION OF CARE.

Potassium Replacement:

Serum Potassium
(mmol/L) / Replacement as Potassium Chloride (KCL)
(oral route preferred) / Laboratory
3.8 - 3.9 / KCl 20 mEq po or IVPB x 1 dose / Repeat serum potassium
2 hrs after dose
completed
3.5 - 3.7 / KCL 20 mEq po q 2 hrs x 2 doses
or
40 mEq IVPB over 2 hrs x 1 dose
3 - 3.4 / KCl 40 mEq po, wait 2 hrs then give 20 mEq po for a total of 60 mEq
or
KCl 40 mEq IVPB over 2 hrs, then give 20 mEq IVPB over 1 hr for a total of 60 mEq
< 3 / KCl 40 mEq IVPB over 2 hrs, then give 20 mEq IVPB over 1 hr for a total of 60 mEq and call physician

Magnesium Replacement: D/C magnesium replacement in patients with acute exacerbation of Myasthenia Gravis

Serum Magnesium
(mg/dL) / Replacement as Magnesium Sulfate / Laboratory
1.7 - 2 / 2 gms IVPB over 1 hr x 1 dose / Repeat serum magnesium
2 hrs after infusion completed
1.2 -1.6 / 3 gms IVPB over 2 hrs x 1 dose
< 1.2 / 4 gms IVPB over 2 hrs and call physician

Phosphate Replacement:

Serum Phosphate
(mg/dL) / Replacement as
potassium & sodium phosphate oral / Laboratory
2 - 2.4 / Neutra-Phos (potassium phosphate, sodium phosphate)
1 packet po q 6 hrs x 48 hrs / Repeat serum phosphate
level in AM
1.5 - 1.9 / Neutra-Phos (potassium phosphate, sodium phosphate)
2 packet po q 6 hrs x 48 hrs
< 1.5 / Call physician for phosphate replacement.

Nurse: Write a new order for each needed dose and lab, sign “per Dr. XX’s order / Your Name, RN”

Reference Use Only. Not Part of Medical Record.

(For use with form 40046)