• Drayton A Hammond, Jarrod King, Niranjan Kathe, Kristina Erbach, Jelena Stojakovic, Julie Tran, and Oktawia A Clem.
• Drayton A. Hammond is a clinical pharmacy specialist, medical and cardiac intensive care, Department of Pharmacy, Rush University Medical Center, Chicago, Illinois. drayton_hammond@rush.edu.
• Crit Care Nurse. 2019 Feb 1; 39 (1): e13-e18.

BackgroundRules of thumb for potassium replacement are used in intensive care units despite minimal empirical validation.ObjectiveTo evaluate the effectiveness and safety of rule-of-thumb potassium replacement in critically ill patients with mild and moderate hypokalemia.MethodsA retrospective, observational study was done of patients with mild (potassium, 3-3.9 mEq/L) and moderate (potassium, 2-2.9 mEq/L) hypokalemia admitted to a medical intensive care unit who received potassium replacement. Expected and actual frequencies of replacement that achieved target potassium concentrations (≥ 4 mEq/L) were compared by using a χ2 test. Logistic regression analysis was used to assess whether rule-of-thumb administration affected the probability of target attainment within 24 hours of replacement.ResultsSerum potassium concentrations were checked within 24 hours after potassium replacement on 354 of 577 days (61.4%) when replacement was provided. Concentrations were within target range in 82 instances (23.2%). Of 62 episodes of replacement expected to achieve the target according to the rule-of-thumb estimation, 22 did (35%). Rule-of-thumb administration was associated with greater likelihood of target attainment (odds ratio, 2.12; 95% CI, 1.18-3.85; P = .01). This difference in likelihood remained significant after adjustment for covariates (odds ratio, 2.18; 95% CI, 1.04-4.56; P = .04).ConclusionIn critically ill patients given potassium replacement without regard to a formal protocol, the target serum potassium concentration was achieved more often than expected according to the rule-of-thumb estimation but less than one-third of the time.©2019 American Association of Critical-Care Nurses.

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