Approved Hospital Formulary
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Approved Hospital Formulary
06/22/20 mc HOSP Adult Hyperkalemia Orders/HOSP Adult Stabilization Orders for Acute Hyperkalemia
June 22, 2020
From: "Monroe Crawley" <monroe.crawley@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, June 15, 2020 9:45:17 AM
Subject: HOSP Adult Acute Hyperkalemia Orders/HOSP Adult Stabilization Orders for Acute Hyperkalemia
Pharmacists,
We want to remind you that the new hyperkalemia power plans go live TODAY, June 15, 2020. Please reference the information below when verifying these orders. For any questions not answered by this information, please do not hesitate to ask. Thank you all.
The approved PowerPlan will consist of two modalities for hyperkalemia treatment:
- HOSP Adult Acute Hyperkalemia Orders
- Main PowerPlan which consists of treatment for MILD hyperkalemia (K+ 5.3 - 5.6 mEq/mL) and MODERATE to SEVERE hyperkalemia (5.6 - 6.4 mEq/mL)
- Options for treatment include sodium polystyrene sulfonate, furosemide, regular insulin, and albuterol
- If any patient develops EKG changes consistent with hyperkalemia or has a potassium level > 6 mEq/mL, they should receive stabilization orders included in the subphase below
- HOSP Adult Stabilization Orders for Acute Hyperkalemia
- For patients with EKG changes or K > 6 mEq/mL
- Includes calcium gluconate for cardiac stabilization
- When the PowerPlan is initiated, it will generate an AUTOMATIC CONSULT for pharmacists to review the patient's medication profile. This can be accomplished in two steps:
- The profile should be reviewed for potassium-containing replacement therapies and potassium-containing fluids
- Pharmacy has approval to automatically DISCONTINUE potassium replacement therapies through this consult.
- However, for IV fluids containing potassium, provider approval is needed prior to discontinuation
- The profile should be reviewed for medications that can increase potassium.
- Some of the most common medications that increase potassium are:
- ACE-inhibitors: captopril, trandolapril, lisinopril, enalapril (PO and IV), ramipril
- Lisinopril is the workhorse agent
- Also, amlodipine-benazepril is formulary unrestricted (even though benazepril itself is restricted) - ARBs: losartan, valsartan
- Both are workhorse agents
- Also, Losartan-Hydrochlorothiazide is unrestricted - K-sparing Diuretics: Sprironolactone, Trimethoprim, Triamterene
- Trimethoprim alone is technically unrestricted
- Sulfamethoxazole-trimethoprim as Bactrim, Septra, Bactrim DS, and Septra DS
- Triamterene is also formulary unrestricted and has a BBW for hyperkalemia. Likely used most often as triamterene-HCTZ - A comprehensive list can be found on Micromedex.
- Provider approval is needed prior to discontinuation.
- Patients with ESRD or acute renal insufficiency should receive 5 units of regular insulin (instead of 10 units)
- Studies have indicated these patients are able to achieve adequate potassium lowering with lower risks for hypoglycemia
- Patients should receive a dextrose bolus if their BG level is < 250 mg/dL when receiving insulin.
- Furosemide is NOT an effective treatment for hyperkalemia in patients with ESRD.