What's the lowest potassium you would feel comfortable not supplementing?

Nurses Medications

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I'm just curious on this one. We typically supplement under 4, which I understand is quite high, but I have always thought that under 3.5 should definitely be supplemented. Recently I have been seeing some docs ignoring potassiums in the low 3s- 3.3, 3.2, 3.1. I strongly feel these need supplementation. Thoughts?

Generally, if the potassium is >3, and patient is asymptomatic, otherwise well (eg no ongoing diarrhoea, no renal dysfunction etc.), with no ECG changes and not on a K-lowering drug, I don't get terribly excited. Just give the patient an extra banana or something :)

As a general rule, you will need to intake 100mmol (mEq) of K to raise the serum concentration by 0.3mmol/L, assuming no ongoing losses.

Specializes in ER, progressive care.

On the floors, we have standing protocols for K, Mg and Phos. We do not supplement K unless it is

In the ER, we do not have those standing protocols. I've went to ER docs for a K of 3.4-3.3 and they looked at me like I was crazy. Yeah, it's not that low but I came from a place where we would always supplement.

I saw a potassium of 2 the other day that was only treated with PO meds. I was like uhhhhhh, really?! The doc felt that was acceptable treatment before sending them to the floor, and guess what? Huge shocker, they got to the floor and started having arrhythmias! I'm still shaking my head over that. So to answer the question: depends on how much of a dingbat the doc is.

Actually, oral supplementation is the better (and quicker and SAFER) way of bringing up potassium levels as opposed to IV. Potassium is better absorbed through the gut than parenterally. And think about it, we get our potassium from our diet, so that's the natural way. And you can't give 40 or 60mEq all at once IV like you can orally. If I had a patient with a K of 2.0 and they could tolerate PO I would have gone for our KCl elixirs which are great for bringing up the potassium quickly. I don't want to be giving 60mEq IV over the next 6 hours.

This! Also if they're less than 4 (trending down) and on a diuretic.

I hate it when doctors put a patient on Lasix and they do not order daily KCl supplements!!!

Actually, oral supplementation is the better (and quicker and SAFER) way of bringing up potassium levels as opposed to IV. Potassium is better absorbed through the gut than parenterally.

This is true. I wanted to make this point but for a potassium of 2, it is recommended to supplement with BOTH PO and IV

Specializes in Psych.

I had a potassium of 2.8 once. I felt like hell, like I was having a heart attack. I was taking chlorthalidone at the time. I am just fine with hctz (have hypertension). The supplemented me PO in the ED and I took 20 mEQ of K Dur per day for a week after. My K went up to 3.7 after a week. It was horrible, the worst I ever felt. I work psych and we don't accept pts who have a K+ of 3.4 or less and aren't supplemented in the ED. We are not equipped to deal with someone who ends up with dysrhythmias due to low K+.

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