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The Adult Electrolyte Infusion Guidelines serve as suggested
rates for intravenous electrolyte infusions. Endorsed by the Pharmacy and
Therapeutics Committee, the guidelines include recommendations for patients in
both ICU and non-ICU settings. Rates faster or slower than those suggested may
be indicated in specific patient situations, under the direct supervision of a
physician.
Adult Electrolyte Infusion Guidelines - ICU
|
|
Calcium (Ca) |
Magnesium (Mg) |
Phosphate (PO4) |
Potassium (K) |
|
Infusion rate |
1 g over 30 min. |
1 g over 30 min. |
1 mM/hr |
PL = 10 mEq/hr
CL = 10 mEq/hr |
|
Maximum rate |
Chloride = 1 g over 10 min.
Gluconate=1 g over 3 min. |
1 g over 7 min. or
150 mg/mina
|
3 mM/hr if serum PO4 >1 mg/dl 0.06 mM/kg/hr if serum PO4 = 0.5-1.0 mg/dl
0.125 mM/kg/hr if serum PO4 < 0.5 mg/dl |
PL = 10 mEq/hr
CL = 40 mEq/hr |
|
Infusion device indicated |
No |
No, single dose Yes, multiple dose or continuous infusion
|
Yes |
PL = No
CL = Yesb |
|
Maximum concentration |
Dilute to 2-10% to minimize peripheral chloride irritation |
1 g Mg diluted in > 10 ml NS or D5W before
infusing |
6 mM/100 ml |
PL = 40 mEq/L
CL = 80 mEq/L (large volumes)
|
PL = peripheral line; CL = central line
a Requires ECG monitoring; cases involving potentially lethal
ventricular arrhythmias may require higher
doses under close medical
supervision.
b For concentrations greater than 40 mEq/liter and
rates greater than 10 mEq/hour
Adult Electrolyte Infusion Guidelines - Ward Patients
|
|
Calcium (Ca) |
Magnesium (Mg) |
Phosphate (PO4) |
Potassium (K) |
|
Infusion rate |
1 g over 30 min. |
1 g over 30 min. |
1 mM/hr |
10 mEq/hr |
|
Maximum rate |
1 g over 10 min. |
1 g over 10 min. |
3 mM/hr |
10 mEq/hr |
|
Infusion device indicated |
No |
No, single dose Yes, multiple dose or continuous infusion
|
Yes |
No |
|
Maximum concentration |
Dilution to 2-10% to minimize irritation with peripheral chloride |
1 g Mg diluted in > 10 ml NS or D5W before
infusing |
6 mM/100 ml |
40 mEq/L |
Injectable Electrolyte Products
|
|
Vial Concentration |
Administration Tips |
|
Calcium (Ca) |
Chloride 1 g/10 ml (10%)
1 ml = 27 mg Ca = 1.36 mEq Ca
Gluconate 1 g/10 ml (10%)
1 ml = 9 mg Ca = 0.46 mEq Ca
|
Gluconate salt is less irritating, yet contains less Ca per ml than
chloride salt
|
|
Magnesium (Mg) |
Sulfate 1 g/2 ml (50%)
1 g = 8 mEq Mg
|
Administration guidelines differ when used in obstetrical patients
for tocolysis
|
|
Phosphate (PO4) |
K 1 ml = 3 mM PO4 = 4.4 mEq K Na 1 ml = 3 mM PO4 = 4.0 mEq Na
|
Should be diluted before administration
|
|
Potassium (K) |
Cl 1 ml = 2 mEq K = 149 mg KCl
|
Should be diluted before administration
|
CHILDREN’S HOSPITAL POTASSIUM GUIDELINES
The policy for administration, distribution, and labeling of
potassium chloride (KCl) injection in the UK Children’s Hospital serves to
reduce the risk for medication errors and subsequent patient morbidity.
Potassium Administration Guidelines – UK Children’s
Hospital
Floor (Ward) Patients
Potassium chloride intravenous boluses cannot be administered for general use in
the Children's Hospital. Low serum potassium levels may be replaced either by
increasing the potassium concentration in maintenance fluids (maximum dose of
0.25 mEq/kg) or by providing oral replacement. Overzealous replenishment of
potassium is a definite risk for fatal medication errors, and slow replacement
should be sufficient for patients that do not require intensive care.
ICU Patients
Often known as potassium runs, IV boluses are permitted in the pediatric
intensive care unit and the neonatal intensive care unit. Under such situations,
potassium chloride may be administered at a dose of 0.25 - 0.5 mEq/kg, at a rate
of up to 10 mEq/hour, not to exceed 1 mEq/kg/hr.
Hematology/Oncology Patients
IV boluses are permitted on the hematology/oncology service for orders written
by the senior resident or attending physician. Under such situations, potassium
chloride may be administered at a dose of 0.25 - 0.5 mEq/kg, at a rate of up to
10 mEq/hour, not to exceed 1 mEq/kg/hr.
Distribution Guidelines
-
No KCl vials are stocked in floorstock, code carts, or kits in the Children’s
Hospital.
-
Pharmacy dispenses KCl doses in a syringe to be added to the buretrol or IV
fluid.
-
For fluid-restricted unit patients, Pharmacy uses a 2 mEq/ml vial to prepare
doses, which are then diluted with normal saline to a concentration of 0.5 mEq/ml.
The nurse is notified that the dose is drawn with the concentrated KCl.
-
A premixed KCl minibag (10 mEq/50 ml, concentration = 0.2 mEq/ml) is used
by Pharmacy to provide most doses.
Labeling Guidelines
A "Potassium Added" label is affixed to any IV fluid with KCl
additives.
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_________________________________________________________________________________________________________
Approved by P&T
Committee: 11/99
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Posted on: 8/02
|
For Internal University of Kentucky Chandler Medical Center Use Only
Comments to
Kelly Smith, Pharm.D.,
Last Modified:
August 13, 2006
Copyright © 2002, University of Kentucky Chandler Medical Center
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