experience –
Electrolyte ReplacementRating: (votes: 0) I am afraid it is not as simple as one before another. Clearly, one must consider the patient from a clinical perspective. If I have somebody with hypokalaemia and hyponatraemia, I may be inclined to consider replacing sodium if said patient is seizing from the hyponatraemia. In addition, who says you cannot consider replacing multiple electrolytes? Comment:
I never knew you had to replete mag before potassium. Why is that? We often replete multiple electrolytes at the same time.
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From what I was taught in school and confirmed by a physician when discussing this was another nurse at the nurses station is that a patient with a low magnesium can not absorb the potassium, therefore magnesium must be normal before potassium is infused.
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Thanks for the info!
Comment:
It's not really electrolyte replacement, but sodium bicarb can cause electrolyte shifts that can result in hypokalemia so it's always a good idea to check and replace potassium prior to giving sodium bicarb, particularly if the patient is prone to ventricular rhythms. The only time I have seen an intracardiac injection of potassium was to a patient in sustained torsades. The patient's initial potassium was around 4 but then dropped to around 2.5 following IV sodium bicarb. That, combined with a QTc of around 500 msec probably put them into torsades.
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