Overtime is a great tasting, precisely formulated, sugarfree electrolyte replacement beverage. Critical care icupcu rn to order specific medication needed based on lab result. If pt unable to take po or ng potassium chloride, give iv if ordered. The electrolyte replacement protocols, magnesium sulfate, or potassium chloride, may be ordered individually or in combination. These are instituted upon the written order of a physician. Renal insufficiency scr 2 andor crcl electrolyte replacement protocol erp implementation in the medical intensive care unit micu setting. Water replacement conditions where some nutrition with glucose is required monitor blood sugar levels. Continuous renal replacement therapy columbia nephrology. 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. 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. Note replacement per protocol is only for patients on a monitored unit telemetry. If elemental magnesium supplied as magnesium oxide or milk of magnesia is. Impact of protocolized diuresis for deresuscitation in the.
Discontinue protocol and contact physician if any of the protocol or patient requirements are not met. Potassium chloride 60 meq in 250 ml of diluent, and give by infusion pump over. Further of note, changes to the institutional nursingdriven electrolyte replacement protocol occurred midimplementation see additional file 1. Intended for intermittent dosing of deficient electrolytes requiring iv replacement. I was looking to establish a policy for replacing potassium and magnesium on 2 levels. A standardized electrolyte supplementation protocol was thereafter implemented as a quality improvement initiative. Hello, i was wondering how many physicians have use electrolyte replacement protocols in the acute setting. Standard potassium and magnesium replacement protocol. Potassium should not be added to intravenous fluid bags as this is dangerous. If infiltration, elevate extremity above heart, use warm compress, and notify the physician in charge immediately.
If resistant, check magnesium and replace if necessary, check for medications. This was a pilot study to evaluate a service line level change in diuresis practice. At eirmc, hospitalists treat patients based on the most current evidencebased practices. Significant electrolyte depletion can result in serious complications for patients. Electrolyte replacement practice management guideline. Evaluation of an electrolyte repletion protocol for. When both serum magnesium and serum potassium are low, replace magnesium first. Eirmc hospitalist service electrolytes to be assessed and appropriate correction administered as follows with every electrolyte panel not to be used for patients file. Two tertiary care intensive care units in calgary, canada. These doses do not reflect recommended daily electrolyte maintenance requirements.
Figure 1 depicts the multidisciplinary electrolyte replacement protocol including the replacement medication types, dosing, and monitoring. Explain the uses of iv therapy, the role of red and white blood cells, platelets, plasma, and the six major electrolytes in intracellular and. 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. Fluids, electrolytes and hydration diana heiman, md associate professor, family medicine residency director east tennessee state university. Electrolyte replacement practice management guidelines. Electrolyte replacement orders lsu school of medicine. Colloids colloids contain solutes in the form of large proteins or other similar sized molecules. Lowdose magnesiumpotassium replacement protocol if crcl oralenteral electrolyte replacement. One standard level to replace k or mag back to normal limits on normal adults. 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. 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. Replace electrolytes only once daily based on sameday am labs.
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. In the first month of the twomonth study, potassium. Renal insufficiency scr 2 andor crcl replacement if gi tract available oralenteral replacement is preferred in asymptomatic patients. The protocol modification sought more aggressive potassium replacement. Electrolyte replacement protocols june 23, 2016 09.
Impact of protocolized diuresis for deresuscitation in. Standardized electrolyte supplementation and fluid management. The electrolyte replacement protocols, calcium chloride level i areas only or calcium gluconate all levels of care, magnesium sulfate. 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. Save money and make your own sports drink to replace lost electrolytes. Intravenous electrolyte replacement can produce lifethreatening complications, serious arrhythmias and phlebitis. The primary objective was to evaluate the efficacy of the electrolyte repletion protocol by. If creatinine greater than 2 mgdl andor documentation of renal failure or dialysis, contact physician for specific replacement orders. Jun 23, 2016 electrolyte replacement protocols june 23, 2016 09. Interim lsu public hospital adult electrolyte replacement. All books are in clear copy here, and all files are secure so dont worry about it.
The tiered kcl replacement protocol td was associated with a decreased need for. 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. K replacement protocol will be ordered at the initiation of. Standardized electrolyte supplementation and fluid. Dont skip any of the ingredientsthe orange juice may seem like too much sugar but it actually replaces lost potassium. Find a doctor at the johns hopkins hospital, johns hopkins bayview medical center or johns hopkins community physicians. Pdf the intensive care unit is a dynamic environment, where high numbers of patients cared for by health care workers of different. Protocol electrolyte protocol x electrolyte protocol x electrolyte replacement protocol. Adult electrolyte replacement protocols pdf book manual. This site is independently owned and operated and not affiliated with the george washington university, george washington university hospital, or medical faculty associates. Prescribing electrolyte disturbances in adults queensland health. Bedside nurses were responsible for following the protocol and for preparing and administering the electrolyte replacement doses. Differentiate between the types of fluids used for fluid replacement in different disease states commonly seen in the intensive care unit. Monitored unit electrolyte replacement protocols summary standing electrolyte replacement protocols are available for use in the adult intensive care units.
Electrolyte replacement critical care icupcu 30400716. Evaluation of an electrolyte repletion protocol for cardiac. Electrolyte guideline all patients with chronic kidney disease scr greater than 2. Phos in tpn will be increased per pharmacists discretion based on lab value and total phos replaced per protocol. The multidisciplinary electrolyte replacement protocol allowed the bedside nurse to initiate the electrolyte replacement once a low level was identified. Read online adult electrolyte replacement protocols book pdf free download link book now. Protocol this trial protocol has been provided by the authors to give readers additional information about their work.
Institute protocols upon written order by a physician. Phos replacement protocol will be ordered at the initiation of tpn for all patients with the exception of dialysis patients. This site is like a library, you could find million book here by using search box in the header. 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. 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. Burn electrolyte replacement vanderbilt university medical. Infusion line type weight based calculation is required. 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. Objectives having completed this session you will be able to. Extravasation protocol extravasation protocol peripheral vasopressors. Calcium andor phosphorus replacement needs to be ordered individually as required low dose potassium replacement protocol intravenous recommended rate of infusion is 10 meqhr. Critical care protocol for falls and treatment interuption screening and risk reduction strategies. Pharmacist will leave a progress note if one of the criteria below is met.
Rapid administration of electrolytes or correction of severe derangements may. Jul 27, 2017 save money and make your own sports drink to replace lost electrolytes. Fluid and electrolyte management billie bartel and elizabeth gau le a r n i n g objectives 1. Cost of acute renal failure requiring dialysis in the intensive care unit.
Po potassium orders potassium chloride kdur 60 meq po prn potassium 2. Identify and understand basic fluid and electrolyte abnormalities in critically ill patients. A multidisciplinary protocol improves electrolyte replacement. Unitspecific protocols for electrolyte disturbances take precedence over these. Maximum infusion duration monitoring comments concentration kcl. Pharmacist will decrease phos in next tpn per hisher discretion. Med surg or med surgtele rn to order specific medication needed based on lab result. Design retrospective cohort study patients with arf needing dialysis april 1, 1996, march 31, 1999. Hospitalist services evidencebased protocols eastern.
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