Adult Potassium Replacement Protocol

Nursing Instructions: Yes No To be initiated by physician order. Yes No

1) Safety check for exclusions: Does the patient have any of the following conditions?
Condition Serum creatinine over 1.9mg/dL Diabetic Ketoacidosis (DKA) Condition Dialysis treatments

Severe cachexia or weight loss over 20kg in past 6 months

2) Inform pharmacy of patients current access for potassium supplementation by checking the appropriate boxes: Taking medications by mouth Peripheral IV access only Central IV access without telemetry Enteral access via nasogastric or feeding tube Central IV access with telemetry 3) Continue all current potassium orders unless otherwise ordered by the physician. 4) Draw serum potassium if level not already available within past 6 hours. 5) Locate the potassium level on the first column of Table 1 and order supplement according to access and labs per guidelines. 6) If potassium level is less than 3 mEq/L request telemetry if not already on. 7) If potassium level is less than 3.3 mEq/L check a magnesium level (once daily) and notify physician if it is abnormal. 8) Redraw serum potassium level per guidelines in the fourth column of Table 1 and repeat steps 5 through 7. Table 1: Potassium Level Below 2.6 mEq/L (2.6 mmol/L) 2.6 to 2.9 mEq/L (2.6-2.9 mmol/L) 3 to 3.2 mEq/L (33.2 mmol/L) 3.3 to 3.5 mEq/L (3.3-3.5 mmol/L) 3.6 to 4 mEq/L (3.6-4 mmol/L) 4.1 to 5.5 mEq/L (4.1-5.5 mmol/L) Over 5.5 mEq/L (over 5.5mmol/L) Oral/Gastric Access: **Preferred** Potassium Chloride tablets or solution 40 mEq every 2 hours x 2 doses PLUS 40 mEq IV in divided doses per Table 2 Potassium Chloride tablets or solution 40 mEq every 2 hours x 2 doses PLUS 20 mEq IV in divided doses per Table 2 Potassium Chloride tablets or solution 20 mEq every 2 hours x 3 doses Potassium Chloride tablets or solution 20 mEq every 2 hours x 2 doses Potassium Chloride tablet or solution 20mEq x 1 dose No supplementation No supplementation IV Access: Reserve for specific levels or when no enteral access is available Potassium Chloride 100 mEq IV in divided doses per Table 2 Potassium Chloride 80 mEq IV in divided doses per Table 2 Potassium Chloride 40 mEq IV in divided doses per Table 2 Potassium Chloride 20 mEq IV in divided doses per Table 2 Potassium Chloride 20 mEq IV in divided doses per Table 2 No supplementation No supplementation Next potassium level after last dose/further management Potassium level 2 hours after last dose Potassium level 2 hours after last dose Potassium level 4 hours after last dose Potassium level with AM labs Potassium level with AM labs Potassium level with AM labs Inform physician, hold potassium

Call physician and do not proceed if "Yes" is checked for any of the conditions above

9) These orders expire at 1200 on Day 2 of protocol use (today is considered Day Zero), contact physician for further orders.

Table2: IV administration guidelines for potassium chloride: Patient Criteria Maximum concentration Maximum rate of administration Peripheral Line Potassium Chloride 10 mEq per 100mL No faster than 10 mEq per hour Central line without telemetry Potassium Chloride 20 mEq per 100mL No faster than 10 mEq per hour Central line with telemetry Potassium Chloride 20 mEq per 100mL No faster than 20 mEq per hour Pain/Irritation at the site of administration: The preferred method of treating pain/irritation is to slow the infusion and/or dilute the potassium. Order a PICC line per potassium protocol if pain/irritation is intolerable with peripheral administration. Adding lidocaine is not recommended. A separate order is required to add 20 mg of lidocaine to the bag of potassium.

Physician Signature:_____________________________ Date/Time__________