On Call: Electrolyte Replacement General Approach LyteReplacementDoseWill RaiseNotesKKCl10 mEq0.05-0.1 mEq/LPreferred Over K-PhosCaCa-Gluconate1 g0.15 mg/dLIf Mild CaCl1 g0.45 mg/dLIf Severe/SymptomaticMgMg-Sulfate1 g0.2 mg/dLIV PreferredPhosNa-Phos15 mmol0.4 mg/dLPreferred Over K-Phos K-Phos15 mmol0.4 mg/dLAlso Gives 22 mEq K Goal of ReplacementGoal: Normal Serum Electrolyte LevelsGenerally Attempt to Achieve Middle of the Normal Range, Not Lower Limit, to Allow for Ongoing Losses (Ex: K Goal 4.0, Not 3.5)RouteEnteral (PO) Replacement:Generally Preferred if Able to Tolerate Oral Intake (Not Magnesium)Slower CorrectionIntravenous (IV) Replacement:Preferred Route if Deficiency SevereMore Rapid Correction Replacement Potassium*See Fluids, Electrolytes & Nutrition: Potassium (K)Potassium Chloride (KCl)Correction: 10 mEq will Increase Serum K 0.05-0.1 mEq/LIV & PO are EquivalentRechecking:IV – Immediately After Final DosePO – Wait One-Hour to Allow AbsorptionCalcium*See Fluids, Electrolytes & Nutrition: Calcium (Ca)Calcium GluconateIV Correction: 1 g will Increase Ionized Ca 0.15 mg/dLPreferred for Mild Asymptomatic DeficienciesCalcium Chloride (CaCl2)IV Correction: 1 g will Increase Ionized Ca 0.45 mg/dLProvides Three Times the Amount of Elemental Calcium per Gram as Calcium GluconatePreferred for Severe or Symptomatic DeficienciesCorrosive to Veins & Requires a Central LineMagnesium*See Fluids, Electrolytes & Nutrition: Magnesium (Mg)Magnesium Sulfate (MgSO4)Correction: 1 g will Increase Serum Mg 0.2 mg/dLIV Preferred – Enteral Absorption Has Variable BioavailabilityRechecking: Wait 8-12 Hours to Allow Gradual Redistribution to TissuesPhosphate*See Fluids, Electrolytes & Nutrition: Phosphate (PO4)Sodium Phosphate (Na Phos)IV Correction: 15 mmol with Increase Serum PO4 0.4 mg/dLPreferred Choice Over K PhosRechecking: Wait 2-4 HoursEnteral Dosing:Variable Bioavailability – Dose Should Be Tripled250 mg PO is Equivalent to 8 mmolGenerally Given in 3-4 Doses Over the DayPotassium Phosphate (K Phos)Same Correction as Na PhosAlso Provides 22 mEq K per 15 mmol Normal Requirements Requirements Per Day Mn Potassium (K): 0.5-1 mEq/Kg/DaySodium (Na): 1-2 mEq/kg/DayChloride (Cl): 2-3 mEq/Kg/DayNormal LevelsSodium (Na): 135-145 mEq/LChloride (Cl): 96-106 mmol/LPotassium (K): 3.5-4.5 mEq/LCalcium (Ca): 9.0-11.0 mg/dLIonized Calcium: 4.5-5.5 mg/dLPhosphate (PO4): 3.0-4.5 mg/dLMagnesium (Mg): 1.5-2.5 mEq/L Mnemonics Daily Chemical RequirementsK-Na-Cl: 1-2-3