PLACE LABEL HERE
ELECTROLYTE REPLACEMENT
CARDIOVASCULAR SURGERY
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
1.
This order is for use in Cardiovascular Care Unit (CVC). Discontinue when transferred out of CVC.
2.
Notify physician prior to use if GFR < 30 ml/min, creatinine is > 2, or urine output < 30 ml/hr.
3.
MEDICATIONS:
Potassium Replacement:
Serum Potassium
3.8 - 3.9
3.5 - 3.7
3 - 3.4
<3
Replacement as Potassium Chloride
(oral route preferred)
20 mEq oral or IVPB x 1 dose
40 mEq oral or 40 meq IVPB over 2 hours x 1 dose
40 mEq oral, wait 2 hours then give 20 mEQ oral for a
total of 60 mEq
or
40 mEQ IVPB, wait 2 hours then give 20 mEq IVPB for
a total of 60 mEq
40 mEQ IVPB, wait 2 hours then give 20 mEq IVPB for
a total of 60 mEq and call physician
Magnesium Replacement:
Serum Magnesium
Replacement as Magnesium Sulfate
1.7 - 2
2 gms IVPB over 1 hr x 1 dose
1.2- 1.7
3 gms IVPB over 2 hrs x 1 dose
< 1.2
4 gms IVPB over 2 hrs and call physician
Phosphate Replacement:
Replacement as sodium phosphate IV or potassium
& sodium phosphate oral
Serum Phosphate
(oral route preferred)
Neutra-Phos (potassium phosphate, sodium phosphate)
1 packet po q 6 hrs x 48 hrs
2 - 2.4
or
Sodium phosphate 15 mM IVPB over 3 hrs x 1 dose
Neutra-Phos (potassium phosphate, sodium phosphate)
2 packet po q 6 hrs x 48 hrs
1.5 – 1.9
or
Sodium phosphate 20 mM IVPB over 4 hrs x 1 dose
< 1.5
Sodium phosphate 30 mM IVPB over 6 hrs x 1 dose
______________
Date
___________________
Time
Laboratory
Repeat serum
potassium
2 hours after dose
completed
Laboratory
Repeat serum
magnesium
2 hours after infusion
completed
Laboratory
Repeat serum
phosphate
level in AM
_________________________________
Physician Signature
__________
PID Number
Send copy to pharmacy
*1-40036*
FORM 1-40046 REV. 07/2012
Page 1 of 1
PLACE LABEL HERE
ELECTROLYTE REPLACEMENT
CARDIOVASCULAR SURGERY
REFERENCE PAGE
(For use with Form 40046)
PLACE THIS COPY IN MAR SECTION OF CHART DURING EPISODE OF CARE.
Potassium Replacement:
Serum Potassium
3.8 - 3.9
3.5 - 3.7
3 - 3.4
<3
Replacement as Potassium Chloride
(oral route preferred)
20 mEq oral or IVPB x 1 dose
40 mEq oral or 40 meq IVPB over 2 hours x 1 dose
40 mEq oral, wait 2 hours then give 20 mEQ oral for
a total of 60 mEq
or
40 mEQ IVPB, wait 2 hours then give 20 mEq IVPB
for a total of 60 mEq
40 mEQ IVPB, wait 2 hours then give 20 mEq IVPB
for a total of 60 mEq and call physician
Magnesium Replacement:
Serum Magnesium
Replacement as Magnesium Sulfate
1.7 - 2
2 gms IVPB over 1 hr x 1 dose
1.2- 1.7
3 gms IVPB over 2 hrs x 1 dose
< 1.2
4 gms IVPB over 2 hrs and call physician
Laboratory
Repeat serum
potassium
2 hours after dose
completed
Laboratory
Repeat serum
magnesium
2 hours after infusion
completed
Phosphate Replacement:
Serum Phosphate
2 - 2.4
1.5 – 1.9
< 1.5
Replacement as sodium phosphate IV or
potassium & sodium phosphate oral
(oral route preferred)
Neutra-Phos (potassium phosphate, sodium phosphate)
1 packet po q 6 hrs x 48 hrs
or
Sodium phosphate 15 mM IVPB over 3 hrs x 1 dose
Neutra-Phos (potassium phosphate, sodium phosphate)
2 packet po q 6 hrs x 48 hrs
or
Sodium phosphate 20 mM IVPB over 4 hrs x 1 dose
Sodium phosphate 30 mM IVPB over 6 hrs x 1 dose
Laboratory
Repeat serum
phosphate
level in AM
Nurse: Write a new order for each dose needed and corresponding lab. Date, time and sign as - “per protocol
Dr XX / Your Name, RN”
REFERENCE USE ONLY. NOT PART OF MEDICAL RECORD.
(For use with Form 40046)