Treatment of Electrolyte Deficiency

NHS Borders clinical guidelines
NHS Borders

Guidance for Treatment of Electrolyte Deficiency


• If patient is at risk of refeeding syndrome dietetic advice on monitoring may be needed
• This advice does not apply to ITU patients
• Seek advice from GI, renal, ITU, dietetic team when appropriate

Potassium

  • Consider cause (including medications) and history of hypokalaemia (acute or chronic?)
  • Measure as part of a bundle - calcium, magnesium, potassium and phosphate.
  • Consider ECG if patient on cardioactive medication or presenting with palpitations.
  • ECG necessary in K+ < 3.0 (acute hypokalaemia)
  • Complex hypokalaemic patients need senior discussion - if considering replacing with potassium above 40mmol/L contact consultant on call/HAN team or Dr O’Donnell (daytime).

**NaCl 0.9% or Dextrose 5% with 40mmol KCl in each litre bag are also available

Phosphate

  • Normal range is 0.74 -1.52mmol/L
  • Not to be prescribed without senior discussion
  • Measure as part of a bundle - calcium, magnesium, potassium and phosphate.
  • Replacement of phosphates in hypophosphataemia is generally via the IV route

Magnesium

  • Normal range (0.75-1.0mmol/L)
  • Measure as part of a bundle - calcium, magnesium, potassium and phosphate.
  • If hypomagnesaemia occurs with hypocalcaemia and hypokalaemia, magnesium replacement should be via IV route.

* 10mls of Magnesium Sulphate 50% contains 20mmol Magnesium.

IV Calcium Gluconate

  • Rarely necessary and only in symptomatic patients (except in arrhythmia and hyperkalaemia) where  Calcium (corrected) < 1.8
  • Consider cause of hypocalcaemia
  • Measure as part of a bundle - calcium, magnesium, potassium and phosphate.
  • Use corrected calcium value (normal range is 2.12-2.62mmol/L)
  • Monitoring of ECG & plasma calcium required
Slow IV injection of 10-20ml calcium gluconate 10% (2.25-4.5mmol calcium)
  • Can be repeated if required.
  • Alternatively follow initial IV injection with an infusion of 100ml calcium gluconate 10% in 1 litre of  either sodium chloride 0.9% or glucose 5% given at initial rate of 50ml/hour. Adjust according to response.

Editorial Information

Last reviewed: 31/10/2023

Next review date: 31/10/2026

Author(s): Harvey K.

Version: V5.0

Author email(s): BOR.Prescribing@borders.scot.nhs.uk.

Approved By: Area Drugs & Therapeutic Committee

Reviewer name(s): BGH Clinical Teams including Gastroenterology and Pharmacy.