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

[blondy2061h, MSN, RN]

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?

[Assailants]

I dont think that our hopsital has a standing protocol for K replacement, but at the hospital where I precepted we had a standing k/mag replacement depending on the patient's lytes. 3.2 and 3.1 seems low. Are the patient's symptomatic? I'd probally do a 12 lead just in case if there the docs are okay with those numbers

[applewhitern, BSN, RN]

I would have to know more about the particular patient with the low potassium level, such as their renal function, what meds are they taking, etc., as these can influence potassium levels. Yes, normally you would replace the potassium. Wouldn't it be easier to just ask the doctor? Could be as simple as an oversight.

[blondy2061h, MSN, RN]

The one patient I'm thinking of had normal renal function and was having diarrhea. I noticed potassium after docs had left for evening and covering doc said he wasn't concerned if service wasn't. Not sure what happened the next day.

[AMR21, BSN, RN]

I work in a PIcU. We replace for k less then 3. When I did a short stent in the adult world we replaced for less then 4.

[carolinapooh, BSN, RN]

I work BMT and we replace 3.5 or less.

[Penelope_Pitstop, BSN, RN]

We replace less than 3.5 in the patient with normal renal activity. For me personally, if a patient is having diarrhea, vomiting (or gastric emptying) or EKG changes and a K less than 4 I'm going to push for replenishment. If none of the above is true and the K is 3.4, I'm not too worried. If it's 3.3 and the patient gets any sort of K supplementation or has some K rich foods, I'm not too worried there, either.

[Racer15, BSN, RN]

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.

[RoyalPrince]

Less than 3.. most of the time 3.2/3.3 turn into 3.8s the next day after dinner

[Vespertinas]

The one patient I'm thinking of had normal renal function and was having diarrhea. I noticed potassium after docs had left for evening and covering doc said he wasn't concerned if service wasn't. Not sure what happened the next day.

Sounds like a typical evening response. Don't question your knowledge too much over the way things are run at night.

[Penelope_Pitstop, BSN, RN]

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

Whoops, I can't believe I forgot that! :)

[KelRN215, BSN, RN]

My potassium was 3.1 before I was started on supplementation. I was on 10 mEq/day with no change, on 20 mEq/day it only went to 3.2, 40 mEq/day brought it to 3.3 and 60 mEq/day finally normalized it and it only stayed in the 3.5-3.8 range the whole time I took this dose. At my first appointment with a Nephrologist he had me stop taking the supplement for something like 2-3 days and my level immediately dropped to 3.1. I knew what the problem was immediately- in fact, I had asked for the original labs at my physical because I had started taking a new medication a few months earlier and I knew it could case electrolyte imbalances. For months no one listened to me- not my primary, not my neurologist, not my nephrologist. Once I finally got a second opinion from a different nephrologist and he confirmed the diagnosis of renal tubular acidosis, he agreed the medication was the likely culprit. A week later I was off that medication AND off potassium and my K+ level was 3.9. Since then, I've been perfectly normal in the 3.5-4.0 range.