UCSF Center for Healthcare Value - Caring Wisely 2.0

Crowd-sourcing innovative cost savings ideas from the front lines of care delivery systems

Decrease Electrolyte Labs and Supplementation

When working nightfloat, I am often signed out a PM lytes check with instructions to "replete lytes to K>4, Mg>2". Hypokalemia is rarely clinically significant unless < 3, especially in the patient with no other cardiovascular issues. Where I went to medical school, the 'normal' range for potassium was wider - I believe 3.6-5 - and hence a lot less potassium repletion was seen unless K<3.5.

If we could present the data on clinically signifcant hypokalemia (perhaps in 'Choosing Wisely' posters?) and encourage repletion from K = 3.5-4 only in patients who have a high risk of arrythmia or who have another indication for aggresive K repletion (ie, feeding syndrome and DKA), we may greatly reduce the ordering of BID lytes and the amount of IV and PO potassium and magnesium supplementation.

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