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9.2 Fluids and electrolytes

9.2.1.1 Oral Potassium

Potassium Effervescent tablets ("Sando K") (12mmol Potassium)
Potassium chloride syrup 1 mmol Potassium/ml

Note:

1. Routine potassium supplementation is not recommended when low doses of thiazides are used to treat uncomplicated essential hypertension, or when treating mild heart failure with loop diuretics.

2. Slow release potassium tablets should be swallowed whole with fluid during meals, while sitting or standing.

Potassium Removal
Calcium Resonium powder, enema
Resonium A powder (management of Hyperkalaemia in the prescence of Hypercalcaemia)

Note:

1. For hypokalaemia associated with diuretic use, a potassium-sparing diuretic (section 2.2.3.) is generally a more effective and convenient alternative to potassium chloride supplements.

2. For guidelines on the management of Hypokalaemia click here and for Hyperkalaemia see the Coronary Care Guidelines, appendix 4.

 

9.2.1.2 Oral sodium and water

Sodium chloride MR tablets *
Oral rehydration salt.
"Dioralyte" sachets.
St Marks Electrolyte Mix powder - to be extemporaneously prepared by ward staff or patient according to instructions; for specialist initiation by a gastroenterologist only for patients with short-bowel syndrome. See link for further information.

* Should be swallowed whole with fluid during meals, while sitting or standing.

 

9.2.1.3 Oral bicarbonate

Sodium bicarbonate capsules, tablets

Notes:

1. Tablets are to be prefered as they are considerably cheaper.

2. Sodium bicarbonate is given by mouth for chronic acidotic states. It may increase blood pressure or cause fluid retention and pulmonary oedema in those at high risk; hypokalaemia may be exacerbated.

 

9.2.2 Parenteral preparations for fluid and electrolyte balance

NICE CG174: Intravenous fluid therapy in adults in hospital – click here
Trust Guideline for Intravenous Fluid Administration in Adults – click here

 

9.2.2.2 Plasma and plasma substitutes

Albumin solution 4.5%, 20% (salt-poor)
Dextran 40, 70 infusion
Gelofusine infusion (Preferred in theatres because of longer duration of action.)
Haemaccel infusion (Preferred in Accident and Emergency because of shorter duration of action)

Note:

Hydroxyethyl starch was withdrawn in June 2013 following an MHRA recall and suspension of the marketing authorisation - see Drug Safety Update June 2013

  

For link to BNF section: 9.2 Fluids and electrolytes