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Discussion

Potassium supplementation

Just wondering what everyone's policy is regarding supplementing potassium where you work. I work in a large hospital and there is one nurse in particular that insists that everyone's potassium should be at least 4. My thought is that as long as they are 3.5 to 5 and their magnesium is 1.6 to 2 then that should be good. The only exception I see is if they are on tele and have a significant cardiac history then their potassium should be at least 4.

I'm curious about how other nurses feel about this.

Leesha BSN, RN-BC

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    No interventions are given for K greater than 3.5 or Mag greater than 1.7 at my facility (with or without cardiac history). I guess if an arrhythmia was present that might be different. I have not run in to this scenario yet. This question has definitely gotten the wheels turning in my head for next time I have a cardiac patient with borderline K or Mag. I'm very interested to read the other responses!

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    I work critical care, but the same concepts apply. In patients with adequate renal function, we routinely replace potassium starting at 3.7 and magnesium starting at 2.0. That's slightly more aggressive than the med-surg tele unit where I used to work.

    The renal function is an important part of the consideration though. If a patient can't excrete electrolytes normally, then you should be careful about the possibility of hyperkalemia, for example. Likewise, if a patient is on potassium wasting medications (lasix is the most obvious example) or newly receiving high doses of insulin, it might be a good idea to replace potassium more aggressively than usual.

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    A nephrologist where I work said that an ideal potassium is 4, but I don't replace it unless it's less than 3.5 because that's what the order says.

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