King Khalid University Hospital Pharmacy Department Adult Electrolytes Replacement Guide Clinical Pharmacy Services

Sodium (Na)
1mmol = 1 mEq= 23mg

Potassium (K) 1mmol = 1 mEq= 39mg 3.5-5mmol/L

Magnesium (Mg) 1mmol = 2 mEq = 24 mg

Phosphate (PO4) 1 mmol = 31 mg

1mmol KPO41.4mEq K 1mmol NaPO4 1.3mEq Na 1 mmol PO43 mEq PO4

Calcium (Ca)
1mmol = 2 mEq= 40mg

Normal Value Normal daily requirements

Oral Dosing

135-145 mmol/L 70-120mmol/day 70-150 mmol/day

50-80mmol/day 600 mg (8mmol)/tablet BID or TID/day

0.7-1.2 mmol/L 10mmol/day 1-2 gm po q8hr * Oral replacement might be limited by diarrhea * Replace over 3-5 days

0.8-1.7 mmol/L 10mmol/day

Asymptomatic, Mild (Serum level: 0.7 - 0.8 mMol/L ): Phosphate Sandoz 500 mg (16.1 mMol) PO TID

2.25-2.75 mmol/L 1.2gm/day Mild, asymptomatic (Serum level: 2-2.1 mmol/dL) 1-3 gm of E.Ca in divided doses q4-6h mg elemental Ca Moderate
(Serum level: 1.87

Oral Dose ordered as IV Dosing

Mmol or mEq of Sodium Calculate: Na deficit (mEq)= 0.6 x wt(kg) x [desired Na Pt Na] * 3% NaCl is desired for replacement only when sodium levels <120 mmol/L or <130mmol/L with CNS symptoms or seizure history.

mg or Mmol of potassium chloride Central line: K>2.5 mmol/L 20mmol/100ml/hr K<2.5 mmol/L 40 mmol/100ml/hr

mg of Mg salt IV: 2 g over 2-4hr, q8-12 hrs for 3-4 times Recommended rate: 2 gm/hr * Re check level, repeat if needed q6-8 hrs up to 3-4 times. *max. single dose : 2g magnesium sulfate

* Administer with food to reduce risk of diarrhea mg or Mmol of phosphorus (Consider K or Na content)
Asymptomatic, Mild (Serum level: 0.7 - 0.8 mMol/L): 15 mMol IV of NaPO4 or KPO4 Asymptomatic, Moderate (Serum level: 0.32-0.7 mMol/L): 30 mMol IV of NaPO4 or KPO4 Symptomatic, Severe (Serum level: < 0.32 mMol/L): 45 mMol IV over 6hrs of NaPO4 or KPO4

Peripheral line: K>2.5 mmol/L 10mmol/100ml/hr K<2.5 mmol/L 20 mmol/100ml/hr

IV Dose ordered as

mmol of Sodium & % NaCl solution desired

Mmol of potassium

mg of magnesium sulfate salt

Mmol of phosphorus Consider K or Na content

mmol/dL) Oral replacement as above OR Calcium Gluconate: 1g IV in 50 ml D5W over 30 min. (10ml of 10% of calcium gluconate) Sever (Serum level: < 1.87 mmol/d Calcium Gluconate 2g IV in 50 ml D5W over 30 min. OR Ca. Chloride 10%: 0.5-1gm slow infusion 1ml/min * Re check level, repeat q4-6hrs mg of salt

Adult IV Electrolytes Replacement Guide

Drug Diluents D5W, NS Standard Concentration 2gm/50ml Maximum Concentration 100 mg/ml (in case of cardiopulmonary resuscitation) Average Starting Dose (Dose Range) Hypocalcemia: 0.5-1gm slow infusion 1ml/min (5-10ml of a 10% of CaCL) Given slowly at a rate not exceeding 1 ml/min. Cardiopulmonary resuscitation: 8-16 mg/kg of a 10% solution (5-10 ml) IV; may repeat at 10-minute intervals as needed 1-2g IV in 50 ml D5W over 30 min. (1gm =10ml of 10% Ca.Glu Hypomagnesaemia: 2gm/50ml over 20 min ( 2-4 gm /day for 3 days) In sever hypomagnesaemia 6gm/ day over 6hrs for 3 days D5W, D10W, D20W, NS, D5NS Peripheral Line: 20 mmol/L 40 mmol/L Central Line: 80 mmol/L PL: 80 mEq/1L CL: 200 mEq/1L (max. 200 mEq/L) Emergency: 2gm/10ml over 5 min 20mEq/dose Over 1 hr Comments
-Incompatible with

Calcium Chloride (10%, 100mg/ml)

bicarbonate or phosphate solutions - Central line is preferred, (high risk of extravasation & necrosis).

Calcium Gluconate

D5W, D10W, D20W, NS, D5NS D5W, NS

50mg/ml

100m/ml (in CRP)

(10%, 100mg/ml)

-In case of cardiac arrest may administer dose over 10-20 sec. For medical emergencies (seizure, status asthmaticus, torsades de pointe): Infuse over 20-30 min

Magnesium Sulfate (50%, 500mg/ml)

2-4gm/50-100 ml 6gm/250ml

200 mg/ml

Potassium Chloride

Potassium Phosphate (3mmol/ml, 15ml) Sodium Phosphate (3mmol/ml, 15ml)

D5W, NS

15 mmol/250 ml

PL: 15 mmol/250ml CL: 30 mmol/100ml

D5W, NS

15 mmol/250 ml

PL: 5 mmol/100ml CL: 30 mmol/100ml

requires continuous cardiac monitoring Dont use KCL central line Recheck level, repeat doses as for peripheral line. needed PL IV administration of concentration K solution is associated with thrombophlebitis and pain at the injection site. Intermediate infuse: 15 mmol = 22 mEq/K 15-30 mmol/ over 4 - 6 hrs 30 mmol =44 mEq/K Max dose 45 mmol/ dose over 6hrs 45 mmol = 66 mEq/K - Do not infuse with calcium * Maximum rate: 7.5 mmol/hr containing IV fluids Intermediate infuse: 1mmol NaPO4 1.3 mmol 15-30 mmol/ over 4 - 6 hrs Na Max dose 45 mmol/ dose over 6hrs - Do not infuse with calcium * Maximum rate: 7.5 mmol/hr containing IV fluids

Electrolytes Products
Concentrations Calcium (Ca) Chloride 1 g/10 ml (10%): (270mg Ca/1g salt);1 ml = 27 mg Ca = 1.36 mEq Ca Gluconate 1 g/10 ml (10%):(90 mg Ca/1g salt); 1 ml = 9 mg Ca = 0.46 mEq Ca Administration Tips Gluconate salt is less irritating, yet contains less Ca per ml than chloride salt. * Ca chloride needs central line

Calcium carbonate: (400mg ca/1g salt) Calcium glubionate: (62mg Ca/1g salt)
Magnesium (Mg) Phosphate (PO4) Potassium (K) Sodium (Na) Sulfate 1 g/2 ml (50%) 1 g = 98.6 mg elemental Mg = 8 mEq Mg KPO4: K 1 ml = 3 mM PO4 = 4.4 mEq K (1mmol KPO4 =1.4 mEq K) NaPO4: Na 1 ml = 3 mM PO4 = 4.0 mEq Na (1mmol NaPO4 =1.3 mEq Na) KCl 1 ml = 2 mEq K = 149 mg KCl

Administration guidelines differ when used in obstetrical patients for tocolysis Should be diluted before administration Should be diluted before administration

1ml NS =0.154 mEq Na. 1ml 3% NaCl = 0.513 mEq Na Randa Jaroudi, PharmD (SICU Clinical Pharmacist) Pager: 0744. Date: 12/2010

Prepared by References
1. 2. 3. 4. 5. 6.

Sodorff M, Galt K, Galt M, et cl. Recommended maximum concentrations of common acute care parenteral admixtures. Hops Pharm 1999;34(8):937-42 Hutchinson TA, Shahan DR & Anderson ML (Eds): DRUGDEX System. MICROMEDEX, Inc., Grernwood Village, Colorado (Edition expires {3/2008}) Lawrence A. Trissel. Trissel's Handbook on Injection Drugs. 13 th edition Betty L. Gahart, Nazareno R. 2004 intravenous medications handbook, 28 th edition McEyoy G.k. AHFS Drug Information. Bethesda, MD: ASHP, Inc 2006 edition Package inserts.