OUTPATIENT ELECTROLYTE REPLACEMENT		version 11/7/2022		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		No details available for preview		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

Outpatient Electrolyte Replacement Protocol 	

	
	Interval	Defer Until	Duration	
	☑	Potassium Replacement Protocol	Once	S	1 treatment	
		The protocol applies only if the following is met. 
	1. SCr LESS than 1.5; 
	2. Potassium level LESS than 3.5 mEq/L; 
	3. Recent pre-infusion labs.   
	
	Dosing is based on lab value.
	o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
	o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
	o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
	o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 
	
	If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
	Sign electrolyte replacement order as Per protocol: cosign required.		
	☑	Magnesium Replacement Protocol	Once	S	1 treatment	
		The protocol applies only if the following is met. 
	1. SCr LESS than 1.5; 
	2. Magnesium level LESS than 1.6 mg/dL; 
	3. Recent pre-infusion labs. 
	
	Dosing is based on lab value. 
	o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
	o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
	o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
	o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 
	
	If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
	Sign electrolyte replacement order as Per protocol: cosign required.		

Potassium Replacement Protocol 	

	
	Interval	Defer Until	Duration	
	☐	potassium chloride (K-DUR) CR tablet 40 mEq	Once	S	1 treatment	
		40 mEq, oral, once, Starting when released
	FOR PATIENTS THAT ARE ABLE TO SWALLOW ORAL TABLETS
	Do not crush, split, or chew.		
	☐	potassium chloride (K-DUR) CR tablet 20 mEq	Once	S	1 treatment	
		20 mEq, oral, once, Starting when released
	FOR PATIENTS THAT ARE ABLE TO SWALLOW ORAL TABLETS
	Do not crush, split, or chew.		
	☐	potassium chloride (KAYCIEL) 20 mEq/15 mL solution 40 mEq	Once	S	1 treatment	
		40 mEq, oral, once, Starting when released
	FOR PATIENTS WITH SWALLOWING DIFFICULTIES		
	☐	potassium chloride (KAYCIEL) 20 mEq/15 mL solution 20 mEq	Once	S	1 treatment	
		20 mEq, oral, once, Starting when released
	FOR PATIENTS WITH SWALLOWING DIFFICULTIES		
	☐	potassium chloride (KLOR-CON) packet 40 mEq	Once	S	1 treatment	
		40 mEq, oral, once, Starting when released
	Dissolve the contents of 1 packet in 4 ounces of water or other beverage		
	☐	potassium chloride (KLOR-CON) packet 20 mEq	Once	S	1 treatment	
		20 mEq, oral, once, Starting when released
	Dissolve the contents of 1 packet in 4 ounces of water or other beverage		
	☐	potassium chloride 20 mEq in 100 mL IV premix (FOR CENTRAL LINE ONLY)	Once	S	1 treatment	
		20 mEq, intravenous, Administer over: 60 Minutes, every 1 hour, Starting when released, for 2 doses
	FOR CENTRAL LINE ONLY. 
	IF PATIENT CAN NOT SWALLOW ORAL TABLETS OR LIQUID.
	FOR CENTRAL LINE ONLY		
	☐	potassium chloride 20 mEq in 100 mL IV premix (FOR CENTRAL LINE ONLY)	Once	S	1 treatment	
		20 mEq, intravenous, Administer over: 60 Minutes, once, Starting when released
	FOR CENTRAL LINE ONLY. 
	IF PATIENT CAN NOT SWALLOW ORAL TABLETS OR LIQUID.
	FOR CENTRAL LINE ONLY		
	☐	potassium chloride 10 mEq in 100 mL sterile water IVPB	Once	S	1 treatment	
		10 mEq, intravenous, at 100 mL/hr, Administer over: 60 Minutes, every 1 hour, Starting when released, for 4 doses
	Http://www.tmh.tmc.edu/dept/pharmacy/physorders/rx230.pdf. 
	FOR PERIPHERAL LINE ONLY (IF PATIENT CAN NOT SWALLOW ORAL TABLETS OR LIQUID)
	Rate of administration should be adjusted according to patient tolerance.		
	☐	potassium chloride 10 mEq in 100 mL sterile water IVPB	Once	S	1 treatment	
		10 mEq, intravenous, at 100 mL/hr, Administer over: 60 Minutes, every 1 hour, Starting when released, for 2 doses
	Http://www.tmh.tmc.edu/dept/pharmacy/physorders/rx230.pdf. 
	FOR PERIPHERAL LINE ONLY (IF PATIENT CAN NOT SWALLOW ORAL TABLETS OR LIQUID)
	Rate of administration should be adjusted according to patient tolerance.		

Magnesium Replacement Protocol 	

	
	Interval	Defer Until	Duration	
	☐	magnesium sulfate IVPB 2 g	Once	S	1 treatment	
		2 g, intravenous, Administer over: 2 Hours, once, Starting when released		
	☐	magnesium sulfate IVPB 1 g	Once	S	1 treatment	
		1 g, intravenous, Administer over: 1 Hours, once, Starting when released		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued