Interim lsu public hospital adult electrolyte replacement. If elemental magnesium supplied as magnesium oxide or milk of magnesia is. Intended for intermittent dosing of deficient electrolytes requiring iv replacement. Jun 23, 2016 electrolyte replacement protocols june 23, 2016 09. Electrolyte replacement practice management guideline. Two tertiary care intensive care units in calgary, canada. Potassium should not be added to intravenous fluid bags as this is dangerous. Pdf the intensive care unit is a dynamic environment, where high numbers of patients cared for by health care workers of different. The protocol modification sought more aggressive potassium replacement. Calibri arial office theme protocols, electrolyte replacement, and decision support references for heowiz downtime powerpoint presentation powerpoint presentation powerpoint presentation powerpoint presentation heowiz downtime pediatric sodium phosphate replacement protocol consider.
Phosnak is po formulation of phos replacement louisiana state university health care services division interim lsu public hospital adult electrolyte replacement protocol for use in icus only mcln 0006 j r 309 physicians stamp doctors printed name. Electrolyte replacement practice management guidelines. Standardized electrolyte supplementation and fluid. Renal insufficiency scr 2 andor crcl 30 mlhr an infusion pump is required for all electrolyte infusions only the selected electrolytes will be replaced per protocol. Renal insufficiency scr 2 andor crcl replacement if gi tract available oralenteral replacement is preferred in asymptomatic patients. Unitspecific protocols for electrolyte disturbances take precedence over these. Extravasation protocol extravasation protocol peripheral vasopressors. Eirmc hospitalist service electrolytes to be assessed and appropriate correction administered as follows with every electrolyte panel not to be used for patients file.
Design retrospective cohort study patients with arf needing dialysis april 1, 1996, march 31, 1999. Replace electrolytes only once daily based on sameday am labs. The electrolyte replacement protocols, magnesium sulfate, or potassium chloride, may be ordered individually or in combination. Adult electrolyte replacement protocols pdf book manual. Dont skip any of the ingredientsthe orange juice may seem like too much sugar but it actually replaces lost potassium. Hospitalist services evidencebased protocols eastern. Lowdose magnesiumpotassium replacement protocol if crcl electrolyte replacement protocol patients on hd, pd, crrt, therapeutic hypothermia are excluded from crcl cutoffs the electrolyte replacement protocols, calcium chloride icued only or calcium gluconate all levels. Continuous renal replacement therapy columbia nephrology. Phos in tpn will be increased per pharmacists discretion based on lab value and total phos replaced per protocol.
Identify and understand basic fluid and electrolyte abnormalities in critically ill patients. K replacement protocol will be ordered at the initiation of. Significant electrolyte depletion can result in serious complications for patients. These doses do not reflect recommended daily electrolyte maintenance requirements. Overtime is a great tasting, precisely formulated, sugarfree electrolyte replacement beverage. This site is independently owned and operated and not affiliated with the george washington university, george washington university hospital, or medical faculty associates.
Protocol electrolyte protocol x electrolyte protocol x electrolyte replacement protocol. Bedside nurses were responsible for following the protocol and for preparing and administering the electrolyte replacement doses. Fluids, electrolytes and hydration diana heiman, md associate professor, family medicine residency director east tennessee state university. If infiltration, elevate extremity above heart, use warm compress, and notify the physician in charge immediately. Discontinue protocol and contact physician if any of the protocol or patient requirements are not met. Pharmacists will monitor fluid, electrolyte, acidbase status and blood glucose in patients using standard laboratory values. Although electrolyte abnormalities are a common amphotericin toxicity, before february 2011 electrolyte supplementation had been given only as reactive, physiciandependent ad hoc responses to laboratory abnormalities. Patients requiring mechanical ventilation with a netpositive or even cumulative fluid or clinical signs of fluid overload determined via chest xray or physical exam between april 1, 2018, and april 1, 2019, received the diuresis protocol see additional file 1. Cost of acute renal failure requiring dialysis in the intensive care unit. Note replacement per protocol is only for patients on a monitored unit telemetry. This site is like a library, you could find million book here by using search box in the header. One standard level to replace k or mag back to normal limits on normal adults. Med surg or med surgtele rn to order specific medication needed based on lab result. At eirmc, hospitalists treat patients based on the most current evidencebased practices.
Standardized electrolyte supplementation and fluid management. Figure 1 depicts the multidisciplinary electrolyte replacement protocol including the replacement medication types, dosing, and monitoring. Pharmacist will leave a progress note if one of the criteria below is met. Protocol this trial protocol has been provided by the authors to give readers additional information about their work. Guidelines for electrolyte replacement intravenous potassium replacement recommendations for patients with normal renal function serum potassium recommended iv recommended meql kcl supplementation followup monitoring 3. If creatinine greater than 2 mgdl andor documentation of renal failure or dialysis, contact physician for specific replacement orders. Lowdose magnesiumpotassium replacement protocol if crcl oralenteral electrolyte replacement. In the first month of the twomonth study, potassium. Impact of protocolized diuresis for deresuscitation in the. Prescribing electrolyte disturbances in adults queensland health. Eirmc hospitalist service electrolytes to be assessed and appropriate correction administered as follows with every electrolyte panel not to be used for patients protocol for holding enteral feeds for patients going to operating room.
Hello, i was wondering how many physicians have use electrolyte replacement protocols in the acute setting. Institute protocols upon written order by a physician. Differentiate between the types of fluids used for fluid replacement in different disease states commonly seen in the intensive care unit. Jul 27, 2017 save money and make your own sports drink to replace lost electrolytes.
Explain the uses of iv therapy, the role of red and white blood cells, platelets, plasma, and the six major electrolytes in intracellular and. The tiered kcl replacement protocol td was associated with a decreased need for. Overtime provides a healthier rehydration solution which is low in sodium and high in potassium, replacing all your body loses during hard work and play. Standard potassium and magnesium replacement protocol.
Potassium chloride 60 meq in 250 ml of diluent, and give by infusion pump over. Electrolyte replacement critical care icupcu 30400716. Objectives having completed this session you will be able to. Colloids colloids contain solutes in the form of large proteins or other similar sized molecules. Rapid administration of electrolytes or correction of severe derangements may. When both serum magnesium and serum potassium are low, replace magnesium first. Critical care icupcu rn to order specific medication needed based on lab result. Electrolyte replacement protocols june 23, 2016 09. Infusion line type weight based calculation is required. All books are in clear copy here, and all files are secure so dont worry about it. Save money and make your own sports drink to replace lost electrolytes. Water replacement conditions where some nutrition with glucose is required monitor blood sugar levels.
Algorithms for iv fluid therapy in adults weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24hour period. Po potassium orders potassium chloride kdur 60 meq po prn potassium 2. Phos replacement protocol will be ordered at the initiation of tpn for all patients with the exception of dialysis patients. Evaluation of an electrolyte repletion protocol for cardiac.
The electrolyte replacement protocols, calcium chloride level i areas only or calcium gluconate all levels of care, magnesium sulfate. Evaluation of an electrolyte repletion protocol for. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Aug 25, 2014 a standardized electrolyte supplementation protocol was thereafter implemented as a quality improvement initiative. Electrolyte replacement orders lsu school of medicine. A multidisciplinary protocol improves electrolyte replacement. Further of note, changes to the institutional nursingdriven electrolyte replacement protocol occurred midimplementation see additional file 1. Critical care protocol for falls and treatment interuption screening and risk reduction strategies. The primary objective was to evaluate the efficacy of the electrolyte repletion protocol by. Calcium andor phosphorus replacement needs to be ordered individually as required low dose potassium replacement protocol intravenous recommended rate of infusion is 10 meqhr. Maximum infusion duration monitoring comments concentration kcl.
I was looking to establish a policy for replacing potassium and magnesium on 2 levels. Intravenous electrolyte replacement can produce lifethreatening complications, serious arrhythmias and phlebitis. This was a pilot study to evaluate a service line level change in diuresis practice. These are instituted upon the written order of a physician. Find a doctor at the johns hopkins hospital, johns hopkins bayview medical center or johns hopkins community physicians. If pt unable to take po or ng potassium chloride, give iv if ordered. The multidisciplinary electrolyte replacement protocol allowed the bedside nurse to initiate the electrolyte replacement once a low level was identified. Impact of protocolized diuresis for deresuscitation in.
Fluid and electrolyte management billie bartel and elizabeth gau le a r n i n g objectives 1. Burn electrolyte replacement vanderbilt university medical. Electrolyte guideline all patients with chronic kidney disease scr greater than 2. If resistant, check magnesium and replace if necessary, check for medications. Monitored unit electrolyte replacement protocols summary standing electrolyte replacement protocols are available for use in the adult intensive care units. Renal insufficiency scr 2 andor crcl electrolyte replacement protocol erp implementation in the medical intensive care unit micu setting. A standardized electrolyte supplementation protocol was thereafter implemented as a quality improvement initiative. We hypothesized that a protocol would reduce the time of replacement dose administration and increase provider satisfaction with the process of electrolyte replacement. Ensure hypomagnesaemia is also corrected as this will assist in the retention of potassium.
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