Rapid potassium repletion in a pericoding patient with severely low K of 1.5 due to mismanaged DKA at outside hospital. How fast would you replete it? What is the fastest you have ever repleted K?

[u/Little_Blackberry588]

I repleted 40 meq via central line in less than an hour, bringing it up to 1.9. The pharmacist is reporting me for dangerously fast repletion. What I can tell you is the patient was able to breath much better shortly after the potassium was given. Pretty sure the potassium was so low he was losing function of his diaphragm. Any thoughts from docs or crit care who have experience with a similar case?

[u/spite-goddess]

I'm an ED Pharmacist and what you did sounds super reasonable. I definitely wouldn't IV push the potassium by any means but there is some evidence for up to 40 mEq/hr or so and it sounds like you had the central line and EKG monitoring set up. Plus, most ED pharmacists are aware we leave the bounds of hard literature/guidelines within reason when patients are that sick; even if I weren't aware of the data for something like this I'd be more inclined to try to help you monitor it rather than be upset about it. Sounds like you did what the patient needed you to do. Not sure why your pharmacist felt the need to report you about it.

Edit: I was obviously not involved, so I don't know what kind of report is being made - sometimes I might document something like this formally/file an "event" for the purposes of bringing up a need for change in current protocols, not in a punitive way. The tone of the post made it sound like it was more of a "gotcha" report but I shouldn't assume.