Potassium Dilemma

azrn22 · Dec 13, 2005

Lowest I've seen is 1.5. That pt received a lot of kcl but not over safe protocol. The pt lived.

LCRN · Dec 13, 2005

Have you ever had a K+ level so low that the doctor order the infusion rate on the IV to be higher than the hospital allows? And if so, how low was the K+ level?

Hello- I've had a DKA patient with a K+ level of 2.0 on admission to MICU. The previous K+ 4 hours earlier was 3.3. Our intensivists after conferring with cardiology and endocrine--> ordered K+ beyond our "electrolyte protocol". Usually at our facility 20meq K riders are administered over 1 hour per policy. We were infusing double that to = 40meq per hour plus 80meq in a liter bag running at 200cc/hr. With this regiment we checked serum K+ samples every 2 hours via an Istat machine and were able to normalize his K+ once we corrected his metabolic acidosis.

In the meantime we intubated him, lined him, managed his pain and sedated him. And for this 32 year old male it was all "new" onset.

Our protocol is set forth for the general population of patients however there is a "stipulation" in our "electrolyte protocol" that states specific orders must be written out (no verbals/telephone) if electrolytes are to infuse at a faster rate per the Intensivist.

Hope this helps!

Lisa

passing thru · Dec 28, 2005

The Big Difference Here Is One Pt Was In The Icu.

For A Non Icu Patient.... The Patient Would Get The Infusion Per Protocols.

Editorial Team / Admin · Dec 28, 2005

Just curious here, would anyone give the K+ powder (po) as well, and what dose? Or is it considered more "accurate" to give only the IV K+? I thought it might be well-absorbed, and a quicker way to get the K+ in. Thoughts??

suzanne4, RN · Dec 28, 2005

You can give 40 meq over four hours, as per usual standard protocols, as well as give the 40 meq po.

TennRN2004 · Jan 6, 2006

Just curious here, would anyone give the K+ powder (po) as well, and what dose? Or is it considered more "accurate" to give only the IV K+? I thought it might be well-absorbed, and a quicker way to get the K+ in. Thoughts??

Our elyte protocols actually state to give PO if possible as it is the preferred route for K administration at my hospital. Several different reasons, they will absorb more of the med, K is very hard on the veins, and not all of our patients have central lines, and pts all c/o the burning when K infuses to a peripheral, and many times you need to slow the infusion rate to make it more tolerable. If you need to get it in quickly, PO can be better. The lowest K I've seen is 2.8. Alot of our patients have fluids with K in them, and also if we're giving diuretics or have metabolic situation we try to anticipate the effects of those on K levels, and check them frequently to replace K as needed.

royreba · Jan 7, 2006

Hello! Where I work we give 10MeQ/hr to nontele pts, 20MEQ/hr to floor pts on tele and 40MEQ/hr to unit pts with central lines. We ususally replace po and IV at the same time if the patient is very low. The lowest K I have treated was around 1.8, I gave 80 PO and 40 IV and he still was in the low 3's. So, he got another 40 po and 40 IV and was around 4.