›Critical patient workflow
›Cardiac monitor
›IV access
›ECG if severe symptoms or potassium under 3.0 mmol/L
›Point of care glucose if altered mental status
›Escalate to resuscitation bay if unstable rhythm
Potassium replacement strategy
›Replacement decision points
›Oral preferred if mild to moderate and able to tolerate
›IV preferred if severe under 2.5 mmol/L
›IV preferred if ECG changes
›IV preferred if paralysis
›Oral potassium chloride examples
›Potassium chloride 40 mmol once
›Potassium chloride 20 mmol every 2 to 4 hours
›Typical daily total 60 to 120 mmol divided doses
›IV potassium chloride examples
›Peripheral infusion 10 mmol per hour
›Central infusion 20 mmol per hour with continuous ECG monitoring
›Concentration and rate per local protocol dependent
›Repletion safety
›Avoid dextrose containing fluids during active repletion when shift suspected
›Use infusion pump
›Frequent site checks for peripheral infusions
Magnesium and cofactor management
›Magnesium repletion
›Magnesium sulfate 2 g IV once
›Repeat dosing guided by magnesium level and symptoms
›Oral magnesium options if stable and tolerating
Stop losses and treat cause
›Loss control and etiology treatment
›Antiemetic therapy if vomiting driving losses
›Diarrhea management with etiology directed therapy
›Hold or reduce diuretics when clinically safe
›Mineralocorticoid excess evaluation if hypertension and alkalosis
Monitoring and reassessment loop
›Reassessment loop
›Repeat potassium 2 to 4 hours after IV replacement in severe cases
›Repeat potassium 4 to 6 hours after oral replacement in moderate cases
›Repeat magnesium with repeat potassium if refractory
›Repeat ECG if symptoms persist or ectopy occurs
Special populations and adjustments
›Pediatrics
›Oral potassium 1 to 2 mmol per kg per day divided doses
›IV potassium 0.5 to 1 mmol per kg over 1 hour with monitoring
›Pregnancy
›Oral replacement preferred when feasible
›Etiology screen for hyperemesis and GI losses
›Chronic kidney disease
›Lower total dose per replacement interval
›Closer lab interval monitoring
›Digoxin exposure
›Maintain potassium above 4.0 mmol/L target individualized
›Continuous telemetry if symptomatic