central max per facility policy · 10 mEq ↑ K ~0.1 mEq/L
Mg2+ MAGNESIUM1.7–2.2 mg/dL
Repletion
1–2 g IV over 30–60 min
TORSADES
2 g IV over 1–2 min
PO₄ PHOSPHORUS2.5–4.5 mg/dL
Mild–mod
0.08–0.16 mmol/kg IV
Severe <1.5
0.16–0.32 mmol/kg IV
Infuse over 4–6 h · K-phos if K low, else Na-phos
Ca2+ CALCIUMiCa 1.1–1.3 mmol/L
Gluconate
1–2 g IV · peripheral OK
Chloride
1 g = 3× elemental · CENTRAL
NEVER
K+ IV push — ever
CaCl periph — necrosis
Rapid Mg unless torsades
Ca + phos same line — precipitates
CO-REPLACEMENT
Mg first — K won't hold
K-phos counts toward K
Recheck before re-dose
PO route preferred if able
Mg BEFORE K
hypomagnesemia makes K repletion refractory — replete Mg first
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
FRONT
ECG BY DERANGEMENT
Δ
FINDINGS
↑K+
peaked T→ PR↑ · flat P → wide QRS →sine wave
↓K+
U waves · ST↓ · flat T · ectopy
↓Mg2+
↑QT · torsades risk · worse with ↓K
↑Mg2+
↓DTRs → PR↑ · wide QRS → block / arrest
↓Ca2+
long QT · tetany · Chvostek / Trousseau
↑Ca2+
short QT · bradycardia · lethargy
⚠ HYPERKALEMIA — EMERGENT · ECG Δ OR K ≥6.5
1 STABILIZE Ca gluconate 1 g IV over 2–3 min →2 SHIFT insulin 10 U reg IV + D50 25 g · albuterol 10–20 mg neb / 10 min →3 ELIMINATE dialysis · K binders · loop diuretic
Calcium protects the myocardium only — serum K unchanged. Track glucose after insulin.
EXPECT IT situation → derangement
Massive transfusion
↓iCa (citrate) — give Ca
DKA on insulin
K · Phos crash — replete early
Refeeding
↓Phos · ↓K · ↓Mg
Crush · rhabdo · burns
↑K — anticipate, monitor
Diuretics · NG losses
↓K · ↓Mg
CKD · oliguria
↑K risk — replete cautiously
RECHECK after dose
K+
1–2 h after IV dose
Mg2+
6–12 h after dose
PO₄ Phos
6 h after infusion
iCa
6 h after repletion
CORRECTIONS
Corr Ca = Ca + 0.8 × (4 − alb)
iCa preferred when available
Total Ca misleads in hypoalbuminemia — trust ionized.
TREAT THE ECG, NOT THE NUMBER
ECG changes at any K — calcium first, then shift, then eliminate
VERIFY AGAINST LOCAL PROTOCOL
BACK
REAL CARD ARTWORK · VECTOR TEXT — ZOOM ALL YOU WANT
CC-LYT-01 · ACUTE CARE 08
Electrolyte Replacement Reference Badge
Severity-tiered IV repletion for K, Mg, phos, and calcium with the critical rate limits in amber.
$14First run — ships July 25
Free US shipping
Rigid PVC · water-resistant
2.25 × 3.5 in · badge-reel slot
SKU
CC-LYT-01
Series
ACUTE CARE 08
Size
2.25 × 3.5 in (CR80)
Material
Rigid PVC, water-resistant
Finish
Dark ink on field-kit tan
For
ICU, ED, and med-surg nurses; anyone titrating riders at 0300.
Electrolyte repletion, off the top of the stack. Normal ranges, severity-tiered IV doses, and the critical rate limits for potassium, magnesium, phosphorus, and calcium — the numbers you second-guess at 0300, on one dense field-kit card behind your badge. Built for ICU, ED, and med-surg nurses, paramedics, and anyone titrating drips who is tired of re-Googling whether that K rider needs a monitor.
Front
the full REPLACEMENT DOSING table — potassium tiers with the peripheral rate limit in amber, magnesium repletion plus the torsades dose, phosphorus by severity, and calcium gluconate vs chloride with the 3×-elemental / central-line rule; an amber NEVER panel (no K IV push, no peripheral CaCl, no rapid Mg outside torsades, never Ca and phos in the same line) paired with a CO-REPLACEMENT panel; and the boxed rule: Mg BEFORE K.
Back
an ECG BY DERANGEMENT table — the hyperkalemia progression to sine wave, plus the findings for low K, low and high Mg, and low and high Ca; an amber HYPERKALEMIA — EMERGENT strip with the stabilize → shift → eliminate sequence and doses; an EXPECT IT table mapping situations (massive transfusion, DKA on insulin, refeeding, crush/rhabdo, diuretics, CKD) to the derangement they cause; RECHECK timing per electrolyte beside the corrected-calcium formula; and the boxed rule: TREAT THE ECG, NOT THE NUMBER. Rigid PVC, water-resistant, standard CR80 badge size in the tan field-kit colorway with dark olive-and-amber print. Punched badge-reel slot at the top — rides in your badge stack, survives the shift. Clinician-reviewed against standard references. Field reference only, not a protocol — ranges and protocols vary by facility; always verify locally.