Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient
Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient
Electrolyte Repletion Guidelines
(If there is a significant drop in Mag, Phos or K)
When there is concern the patient is entering refeeding syndrome based on low or down-trending potassium, phosphorus or magnesium levels, titrate supplements with the goal to maintain their electrolytes: K > 4.0 mmol/L, Phos > 4.0 mg/dL and Mag > 2.0 mg/dL.
For additional information on multivitamin products, please refer to formulary.
Phosphate
| Supplementation | Dosing | Elemental Phosphorous (mg) | Phosphate (mmol) | Na (meq) | K (mEq) | |
|---|---|---|---|---|---|---|
| PO | K-Phos® Neutral, Phospha® 250 mg Neutral tablet | 2-3 mmol/kg/day in divided doses or 8-16 mmol 4 times/day |
250 | 8 | 13 | 1.1 |
| Phos-Nak® powder 1.5 g packet | 250 | 8 | 7.1 | 7.1 | ||
| Potassium phosphate oral solution per 1 mL (IV form PO) | 93 | 3 | — | 4.4 | ||
| Sodium phosphate oral solution per 1 mL (IV form PO) | 93 | 3 | 4 | — | ||
| IV | Potassium phosphate per 1 mL |
0.08-0.36 mmol/kg Max: 27 mmol phosphate = 40 mEq potassium |
93 | 3 | — | 4.4 |
| Sodium phosphate per 1 mL | 0.08-0.36 mmol/kg | 93 | 3 | 4 | — |
Potassium
- Potassium Chloride (Oral): 2-5 mEq/kg/day in divided doses; not to exceed 1-2 mEq/kg as a single dose (generally 10-40 mEq/dose)
- Potassium Chloride (IV): 0.5-1 mEq/kg/dose (maximum dose = 40 mEq)
- See potassium phosphate options above
Magnesium
- Magnesium Oxide (PO):
- Children: 0.8-1.6 mEq/kg/day in 4 divided doses
- Adults: 20 mEq every 6 hours for 4 doses as needed
- Magnesium Sulfate (IV):
- 25-50 mg/kg/dose every 4-6 hours (maximum single dose: 2000 mg)