Intravenous (IV) electrolyte repletion is often waste in our system. At UCSF and SFGH, we have a culture of over-checking, and over-repleting electrolytes. IV repletion is specifically bad for three reasons:

1) It is more expensive (but not more effective) than oral (PO) repletion.

2) It tethers patients to their beds and IV towers, increasing falls through the actual tubing and increasing delirium and worsening the care experience through the incessant beeping as each bag finishes or when the tubing kinks.

3) Increases the length of stay. For example, 40 mEq of potassium IV takes at least 4 hours to administer; the equivalent dose of oral potassium could be administered in minutes.

In one review of electrolyte repletion, 74% of patients who received IV potassium repletion were able to take oral medications (Curr Med Res Opin. 2006 Dec;22(12):2449-55.). At SFGH or UCSF, the inpatient pharmacy or floor nurse could be empowered to switch IV repletion to PO if  a)the electrolyte level were not lifethreatening (K>3.2, Mg>1.3) and b) the patient were able to take medications orally.