k protocol

8/4/2019 K Protocol

1/1

Yes No Condition Yes No Condition

Serum creatinine over 1.9mg/dL Dialysis treatments

Diabetic Ketoacidosis (DKA) Severe cachexia or weight loss over 20kg in past 6 months

Adult Potassium Replacement ProtocolTo be initiated by physician order.

Nursing Instructions:

1) Safety check for exclusions: Does the patient have any of the following conditions?

Call physician and do not proceed if "Yes" is checked for any of the conditions above2) Inform pharmacy of patients current access for potassium supplementation by checking the appropriate boxes:

Taking medications by mouth Peripheral IV access only Central IV access without telemetry

Enteral access via nasogastric or feeding tube Central IV access with telemetry

3) Continue all current potassium orders unless otherwise ordered by the physician.4) Draw serum potassium if level not already available within past 6 hours.5) Locate the potassium level on the first column of Table 1 and order supplement according to access and labs per

guidelines.

6) If potassium level is less than 3 mEq/L request telemetry if not already on.7) If potassium level is less than 3.3 mEq/L check a magnesium level (once daily) and notify physician if it is abnormal.8) Redraw serum potassium level per guidelines in the fourth column of Table 1 and repeat steps 5 through 7.9) These orders expire at 1200 on Day 2 of protocol use (today is considered Day Zero), contact physician for further orders.

Table 1:

Potassium Level

Oral/Gastric Access: **Preferred** IV Access:Reserve for specific

levels or when no enteral

access is available

Next potassium level

after last dose/further

management

Below 2.6 mEq/L

(2.6 mmol/L)

Potassium Chloride tablets or solution

40 mEq every 2 hours x 2 doses PLUS

40 mEq IV in divided doses per Table 2

Potassium Chloride 100 mEq

IV in divided doses per Table 2

Potassium level 2

hours after last dose

2.6 to 2.9 mEq/L

(2.6-2.9 mmol/L)


40 mEq every 2 hours x 2 doses PLUS

20 mEq IV in divided doses per Table 2

Potassium Chloride 80 mEq IV

in divided doses per Table 2

Potassium level 2


3 to 3.2 mEq/L

(33.2 mmol/L)


20 mEq every 2 hours x 3 doses



Potassium level 4


3.3 to 3.5 mEq/L(3.3-3.5 mmol/L)

Potassium Chloride tablets or solution20 mEq every 2 hours x 2 doses

Potassium Chloride 20 mEq IVin divided doses per Table 2

Potassium level withAM labs

3.6 to 4 mEq/L

(3.6-4 mmol/L)

Potassium Chloride tablet or solution

20mEq x 1 dose



Potassium level with

AM labs

4.1 to 5.5 mEq/L

(4.1-5.5 mmol/L)No supplementation No supplementation

Potassium level with

AM labs

Over 5.5 mEq/L

(over 5.5mmol/L)No supplementation No supplementation

Inform physician,

hold potassium

Table2: IV administration guidelines for potassium chloride:

Patient Criteria Maximum concentration Maximum rate of administration

Peripheral Line Potassium Chloride 10 mEq per 100mL No faster than 10 mEq per hour

Central line without telemetry Potassium Chloride 20 mEq per 100mL No faster than 10 mEq per hour

Central line with telemetry Potassium Chloride 20 mEq per 100mL No faster than 20 mEq per hour

Pain/Irritation at the site of administration:

The preferred method of treating pain/irritation is to slow the infusion and/or dilute the potassium. Order a PICC line per potassium protocol if pain/irritation is intolerable with peripheral administration. Adding lidocaine is not recommended. A separate order is required to add 20 mg of lidocaine to the bag of potassium.

Physician Signature:_____________________________ Date/Time__________

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