Potassium, parenteral administration

            Large doses/sudden infusions of parenteral potassium can cause cardiac arrest.  Therefore, potassium infusions should be closely monitored by physicians, nurses, and the pharmacy.

            To prevent inadvertent administration of dangerous amounts of concentrated potassium, all parenteral potassium preparations dispensed by the pharmacy will be diluted.  KCl to be administered via central line or added to a buretrol will be diluted to a concentration of 1 mEq/5mL (0.2 mEq/mL.)  KCL to be administered via peripheral iv will be diluted to a concentration of 1 mEq/12.5mL (0.08 mEq/mL.)

In the NICU, hypokalemia can usually be slowly corrected by adjusting the amount of K+ in the maintenance IV fluids or TPN running continuously over 24 hours. In cardiac babies, particularly babies on digoxin, serum potassium concentrations must be closely monitored and hypokalemia promptly corrected due to the risk of arrhythmias.

Potential ways to increase potassium intake in the hypokalemic patient

1. For mild hypokalemia, the potassium concentration (in mEq/kg) in the patient’s daily TPN or IVF should be increased.  Alternatively, in the patient receiving full enteral nutrition, diluted oral potassium supplements may be added to feeds.
2. For patients with more severe hypokalemia whose electrolyte intake needs to be increased before new TPN could be ordered, small amounts of additional potassium may be added to the buretrol.  WizOrder allows for either 1 or 2 mEq of additional KCl to be added to 100mL in the buretrol (thereby increasing the amount of potassium in the fluid by either 10 or 20 mEq/L.)  When ordering, the physician should specify the diluent in which the pharmacy should send the KCl (D5W, D10W, D20W, or NS.)  The dose will arrive in 5 – 10 ml of volume respectively and should be added by the nurse to 95 or 90 ml in the buretrol to achieve the appropriate concentration.  The buretrol should then be carefully labeled with the new amount of potassium infusing.
3. Rarely, for life-threatening hypokalemia, a potassium bolus infusion (“K-run”) may be considered.  The dose is 0.5 mEq/kg (maximum dose of 10 mEq) running no faster than 0.5 mEq/kg/hr (minimum infusion time over 1 – 2 hours).  Again, the pharmacy will dispense the dose diluted to either 1 mEq/5mL for a central infusion or 1 mEq/12.5mL for a peripheral infusion.  Due to the potential for serious complications with K-runs, correction of hypokalemia by adding potassium to the buretrol is preferred.  Attending approval is required before ordering a K-run.

            MAXIMUM CONCENTRATIONS OF POTASSIUM IN INFUSIONS

Resolved at the Collaborative Pathways meeting 4/21/03.