Electrolyte Corrections ; Koreksi Elektrolit

A. Hypocalcemia

• Normal Values: Total 8.5-10.5 mg/dl.

(Ionized 4.5-5.3 mg/dl. Use Ionized Calcium Levels before treating or Calculate Albumin Levels)

• Inj:  Calcium Chloride, Calcium Gluconate PO: Calcium Carbonate, Calcium Gluconate
• Dosing: 

1. Ionized Ca. 4.0-4.4 give  0.5-1 g Ca-Gluc, IVP over 5-10 min. Repeat 8-12 hr. prn.
2. Ionized Ca. 3.5-3.9 give 1-2 g Ca-Gluc. IVP/IVPB over 15-30 min. Repeat a4-8 hr. prn.
3. Ionized Ca < 3.5 or symptomatic, give 1-2 gm Ca-Gluc. IVP/IVPB over 5-10 min. Repeat q1-2 hr.prn.

• WARNING: Correct Hypomagnesia and Hyperphosphatemia. Wait min. of 30 min. before rechecking.

B. HypoMagnesia

• Normal Values: 1.8-2.3 mg/dl
• Inj: MgS04 PO: MgS04/Mg02.
• Dosing: 

1. If between 1.0-1.8 give 1-2 gm MgSo4 IVPB over 1 hr. Repeat q 6-12 hr. prn
2. If <1.0 give 4 gm MgS04 over 2 hrs. then 2 gm MgS04 IVPB over 1 hr q 2 hrs.

• WARNING:

1. Hypomagnesia may cause hypokalemia and hypocalcemia.
2. Rapid Infusion may cause hypotension and flushing. 1 gm= 8.12 meq

C. Hypokalemia (potassium)

• Normal Values:  3.5-5.4 mEq/L
• Inj. KCL, K-phos, PO: KCL, (K-Lyte®, K-Dur®, liquid KCL)
• Dosing: 

1. If 3.0-3.5 give 40mEq/L over 1 hr. (40mEq/250 ml over 2 hr.)
2. If  <3.0, give 40mEq/100 ml IVPB q2-4 hr until depletion is corrected.

• WARNING: Infuse through central line with continuous EKG monitoring. Don’t give more than 80 mEq before rechecking levels. Correct Concurrent Hypocalcemia

D. Hyperkalemia (potassium)

• Normal Values: 3.5-5.4 mEq/L
• Dosing:

1.  If K >5.5, consider 15gm PO qd-qid  of Kayexalate (mix in water or sorbitol) to decrease levels.
2. Stop K- IV fluids.

E. Hypophosphatemia (Phosphorus)

• Normal Values:  2.0-4.6 mg/dl
• Inj: K-Phos, Na-Phos: PO: Phospho-soda (20.8 mmol/5ml)
• dosing:

1. If between 1.5-1.9 give 0.125 mmol/kg IVPB over 4 hrs. ( max 15 mmol) or Phospho-soda 5 ml PO bid-tid.
2. If between 1.0-1.4 give 0.25 mmol/kg (IVPB over 4 hrs. (max 25 mmol). If <1.0, give 0.375-0.5 mmol/kg (max dose 40 mmol)

• WARNING: Avoid use of phosphate in severe hypocalcemia.. Wait 30 minutes before rechecking.

* BID- Twice a day, TID- Three times a day, PRN- as needed, Inj-Injection, PO- By Mouth, hr- hours