Saturday, October 6, 2012


I don’t know how electrolytes always get so out of whack. Every day you replete them, then the next day, they’re off again. What happens when people are home and don't have daily chem panels?

When I did my ICU rotation as an intern, when you were on overnight, you always had to call the unit before coming over there in the morning to pre-round. Well, you didn't have to, but if you didn't do it, you were screwed. Because the on-call person was responsible for handling all the AM labs, so if you didn't call first to give phone orders, you'd get stuck handwriting a zillion electrolyte replacement orders.

Early in my rotation, I made the big mistake of physically going to the ICU before calling first, so the second I walked in, like five nurses came up to me with morning electrolytes that needed to be repleted on basically every patient in the ICU. Almost all the patients needed several things replaced. I gave all the orders verbally and after I was done, they said to me, "Okay, if you could just write those orders..."

I almost fainted. I wasn’t going to write 50 orders for electrolyte replacement on every patient on the ward, when I had a ton of work to do on my own patients.

Finally, I was like, "Uh, I don't remember anything I just said." Which was true. I think they took pity on me and allowed me to make them verbal orders.


  1. "What happens when people are home and don't have daily chem panels?"

    That. So true. One day, I'm correcting the mind-bogglingly insane electrolytes, and the next day, the patient is discharged? And the only thing that's changed is the fact that they've had a bowel movement and we are now happy with their post-op progress? And yet none comes back three days later with a deadly hyponatremia?

    In light of that, I've come to the conclusion that electrolyte abnormalities are just a figment of my imagination, combined with an evil lab error.

  2. My ICU has electrolyte replacement protocols that are automatic orders for all ICU patients so they nurses can take care of it on their own. We keep an eye on it, but only need to get involved if we would do something different than the protocol. It is a huge time saver.

    I've wondered the same about these darn electrolytes at home! It a wonder we can survive without a daily BMP.