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Adult ICU Electrolyte Replacement

Purpose

To define patients eligible for the electrolyte replacement protocol; to define the process for a provider to order the electrolyte replacement protocol; for a  nurse to order and administer electrolyte replacement using this protocol; for a pharmacist to ensure safe dosing of electrolyte replacement; and for when the provider should be contacted when a patient has the electrolyte replacement protocol order set placed. 

Policy

Standardized electrolyte replacement will be available for eligible adult ICU patient using an interdisciplinary approach. This includes but is not limited to medication management and monitoring. 

Exclusion criteria are as follows: 

  • Pediatric patients (less than 19 yrs of age)
  • Weight < 40 kg
  • Renal dysfunction (serum creatinine 1.5 mg/dL or greater or increase in serum creatinine by 50% or renal replacement therapy) within the past 3 days 
  • pH <7.2 or pH >7.5 within the past 24 hours 
  • Diabetic ketoacidosis 

Procedure

  1. The ICU Electrolyte Replacement Order Set will be initiated by the ordering provider. The provider will select which electrolytes (magnesium, potassium) they would like to have replaced via protocol, as well as the goal electrolyte level and preferred route of replacement. 
      • NOTE: if exclusion criteria has been met, the provider will be unable to place the order. 
  2. The ICU Electrolyte Replacement Order Set will be continued perpetuity and should be evaluated daily to ensure appropriateness of continuation. If a patient develops exclusion criteria and the electrolyte protocol is still ordered, the nurse will be notified of the exclusion criteria that the patient has met and will be instructed to contact the provider regarding replacement. 
  3. With the provider initiating and signing the ICU Electrolyte Replacement order, this allows the nurse to enter appropriate replacement and laboratory monitoring orders. 
  4. When entering subsequent orders the nurse will enter those orders using the appropriate provider name and "Per protocol: cosign required". 
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