How low of a K would you replace in ED, then Discharge?


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Disinence2

Emergency Medicine
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Hello,

I was wondering what your threshold is for admitting/observing a patient with hypokalemia and no other need for admission. (Tolerating PO, symptoms controlled, no other metabolic problems...all that)

When do you feel safe just giving some PO K, and discharging vs, bringing in for an obs?

Had a discussion with a hospitalist about this the other day, and was curious what the consensus is. He said over 2.5 could be replaced in ED and discharged. I felt that was kinda low.

Thanks!
 

shoal

Oinker!
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In my limited experience. It depends on commodities. Lowest an attending let me discharge was 2.8 in an otherwise healthy 40ish female.. Coming from a 3rd yr resident for what it's worth

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future_dr_house

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If they have no demonstrated cardiac findings and no symptoms why wouldn't you let them orally replete both in the ED and home? If they're reliable without social factors at play I would discharge. Add some magnesium as well.


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dotcb

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As usual, the answer is - it depends…

Do you have an Obs unit? Do you know why it was low? What is patient's ability to follow a plan and obtain follow-up.

My answer: For an isolated K > 3, I'm probably not going to admit. ~2.8 and above I may try to tune up and discharge. I don't always re-check the K value. I would lean toward admission if answers to the questions above are in doubt.
 

Cheese Whiz

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Sep 17, 2014
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If you're treating and discharging, do you usually send out with prescription? How many days are you sending them out with? (in an ideal world, we'd all agree that they'd have follow up for repeat labs but our world's not that ideal)
 

Birdstrike

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Dec 19, 2010
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Hello,

I was wondering what your threshold is for admitting/observing a patient with hypokalemia and no other need for admission. (Tolerating PO, symptoms controlled, no other metabolic problems...all that)

When do you feel safe just giving some PO K, and discharging vs, bringing in for an obs?

Had a discussion with a hospitalist about this the other day, and was curious what the consensus is. He said over 2.5 could be replaced in ED and discharged. I felt that was kinda low.

Thanks!
For a an otherwise perfectly health and asymptomatic patient to have a potassium so low, that you're admitting them on the K+ number alone, you have to really question whether they are really asymptomatic or otherwise healthy to begin with.

It really comes down to their general health (pre-existing heart, GI, renal disease) and ability to hold down and absorb PO potassium. With a "1" anything, that's not going home, but that's not likely to be someone without something else admitable going on. Low 2's, again, usually there's something else going on that got them there. High 2's? You can see that in someone reasonably healthy for whatever reason: crappy diet, diuretic, etc. I think your hospitalist is generally right, in that those patients gradually get that way (low K+) and if you get the number headed in the right direction with PO replacement, that it's unlikely a problem that developed gradually is going to cause some sort of sudden cardiovascular issue/arrhythmia as it improves.

Again, it comes down to a patient that can,

1-Be relied upon to get the K+ in their stomach
2-Reliably keep it in their stomach
3-Reliably absorb it through their GI tract, and
4-Reliably follow up with a PCP in a few days or a week to check the K+
 
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NinerNiner999

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FWIW, potassium <2.8 is considered an inpatient admission criteria per interqual...
 
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