Treatment of low electrolytes - summary

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See guidelines for Hypophosphataemia, Hypomagnesaemia, Hypocalcaemia, Hypokalaemia and Hyponatraemia

Electrolyte

Level

Initial prescribing action

Monitor

Phosphate

 

 

 

Greater than 0·5 to 0·8mmol/L

No supplementation is required if dietary intake adequate.

Check phosphate after 24 hours.

0·3 to 0·5mmol/L

 

Asymptomatic patients may not need to be treated.

Oral: 2 Phosphate Sandoz® tablets daily.

Via enteral feeding tube: dissolve tablet(s) in 50mL water. Stopping feed is not required.

Intravenous: peripheral administration – 10mL Glycophos® diluted in 250mL glucose 5% or sodium chloride 0·9%. Infuse over 12 hours.

Half above doses in patients with eGFR ≤30mL/min.

Check potassium, phosphate and adjusted calcium every 24 hours.

Supplement daily until phosphate more than 0·5mmol/L.

Less than 0·3mmol/L

Intravenous: peripheral administration – 20mL Glycophos® diluted in 500mL glucose 5% or sodium chloride 0·9%. Infuse over 12 hours.

Half above dose in patients with eGFR less than 30mL/min.

Check adjusted calcium, phosphate, sodium, magnesium and potassium every 12 hours.

Magnesium

0·5 to 0·7mmol/L

Oral: 5mL magnesium hydroxide mixture 3 times daily.

Via enteral feeding tube: 1 to 2 magnesium glycerophosphate tablets 3 times daily.   Crush tablets and dissolve in 50mL water.

Half above dose in adults with eGFR less than 30mL/min.

Check magnesium levels daily.

Less than 0·5mmol/L

Intravenous: peripheral administration – 10mL magnesium sulfate 50% injection in 250mL glucose 5% over 3 hours. Give 3 doses at 12 hour intervals.

If eGFR less than 30mL/min – 10mmol (5mL) magnesium sulfate 50% (2mmol/mL) in 250mL glucose 5% over 6 hours. Give 3 doses at 12 hour intervals.

Monitor BP, heart rate, respiratory rate, urine output and for signs of hypermagnesaemia during infusion.

Check magnesium 6 hours after third infusion ends unless eGFR<30mL/min.

eGFR<30mL/min 

Adjusted calcium

2·0 to 2·25mmol/L

 

Oral: Sandocal® 1000, 1 to 2 tablets daily. Prescribe outwith mealtimes.

Via enteral feeding tube: dissolve Sandocal® 1000, 1 to 2 tablets daily in 30 to 50mL water. Consider alfacalcidol if patient has renal failure.

Recheck adjusted calcium after 24 hours.

Less than 2·0mmol/L

 

Intravenous: 50mL (11·25mmol) calcium gluconate 10% injection in 500mL sodium chloride 0·9% or glucose 5%. Infuse over 4 hours.

Check adjusted calcium and magnesium 60 minutes after infusion ends.

 

Hypocalcaemic tetany

Intravenous: 10mL calcium gluconate 10% injection. IV bolus over 5 minutes

THEN

50mL (11·25mmol) calcium gluconate 10% in 500mL sodium chloride 0·9% or glucose 5%. Infuse over 4 hours.

Potassium

3·0 to 3·5mmol/L

Oral: Sando-K® 2 tablets 3 times daily.

 

Monitor potassium after 2 days treatment then twice weekly until stable.

2·5 to 2·9mmol/L and low risk of complications

Oral: Sando-K® 3 tablets 3 times daily.

 

Monitor potassium daily until plasma K+ >2·9mmol/L and then monitor as for 3·0 to 3·5mmol/L.

Editorial Information

Document Id: TAM297