Potassium Chloride

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Normal Daily Requirement:

• Newborn: 2-6 mmol/kg/day
• Pediatric: 2-3 mmol/kg/day
• Adult: 40-80 mmol/day

Treatment of Hypokalemia:
- Pediatric:

• 2-5 mmol/kg/day IV in divided doses
• 0.5-1 mmol/kg/dose IV intermittent infusion (Maximum: 30 mmol/hr x 2 hr) (PICU/NICU only)

- Adult:

• 40-100 mmol/day IV in divided doses
• 10-20 mmol/dose IV intermittent infusion (Maximum: 40 mmol/dose)

INFUSION VIA PERIPHERAL INTRAVENOUS LINE:

• Usual concentration  20-40 mmol/L (maximum of 60 mmol/L in exceptional circumstances)  .  Dose should normally be less than 0.25 mmol/kg/hour and must not exceed 0.5 mmol/kg/hour.
• Solution must be run on the syringe pump or large volume pump within a drug library.
• Dose calculation is required if the concentration is greater than or equal to 40 mmol/L AND/OR the rate of infusion is greater than or equal to 1.5 times maintenance.   Click here for  potassium dose calculation for 60mmol/L.  Click here for potassium dose calculation for 40mmol/L.
• Serum potassium is checked :
      -every 4 hours at 0.25 mmol/kg/hr   (Exception-oncology patients receiving amphotericin B who are on a cardiac monitor and have stable renal function, who can have serum potassium level monitoring according to the staff oncologist's orders)
      -every 2 hours at  0.5 mmol/kg/hr
      -minimum of twice weekly if patients are on maintenance potassium infusions of less than or equal to 40 mmol/L
• Potassium levels should be measured frequently during aggressive diuresis and correction of acidosis.
• Cardiac monitoring is required for rates exceeding 0.25 mmol/kg/hr.
• When possible, non-standard potassium containing solutions should be changed to standard potassium containing solutions.

INFUSION VIA CENTRAL INTRAVENOUS LINE:

(1) Complex cardiac surgical patients and other very unstable patients in PICU/NICU:

• Usual concentration  0.5 mmol/mL  = 500 mmol/L
• Dose should be 0.5 mmol/kg/hr for 2 hours (maximum of 30 mmol/hr) if serum potassium is less than 3.5 mmol/L  in PICU, and less than 2.5 mmol/L in NICU.  In exceptional circumstances if a dose greater than 0.5 mmol/kg/hr is required, the physician must document in the chart the rationale.
• The infusion will be ordered for 2 hours only and then stopped until serum potassium results are available
• The syringe is  filled with a maximum of 2 hours infusion
• An independent double check is performed each time the infusion is started
• Sample order for a 10 kg child:
  - If serum potassium is less than 3.5 mmol/L, give 5 mmol/hr or 10 mL/hr of 0.5 mmol/mL potassium chloride solution for 2 hours.  Stop infusion and check serum potassium after 2 hours

(2) Medical and surgical patients on other units:

• Usual concentration  20-60 mmol/L
• Solution must be run on the syringe pump or large volume pump within a drug library.
• Dose should normally be less than 0.25 mmol/kg/hr and must not exceed 0.5 mmol/kg/hr to a maximum of 30 mmol/hr
• An independent double check is performed each time the infusion is started or changed if the calculated dose is greater than 0.25 mmol/kg/hour or if the concentration is greater than or equal to 60 mmol/L
• Dose calculation is required if the concentration is greater than or equal to 40 mmol/L AND/OR the rate of infusion is greater than or equal to 1.5 times maintenance. Click here for  potassium dose calculation for 60mmol/L.  Click here for potassium dose calculation for 40mmol/L.
• Serum potassium is checked:
      - every  4 hours at 0.25 mmol/kg/hr 
      - every  2 hours at 0.5 mmol/kg/hr
      - minimum of twice weekly if patients are on maintenance potassium infusions of less than or equal to 40 mmol/L
• Potassium levels should be monitored frequently during aggressive diuresis and correction of acidosis.
• Cardiac monitor is required for rates exceeding 0.25 mmol/kg/hr
• When possible, non-standard potassium containing solutions should be changed to standard potassium containing solutions.

(3) Oncology patients:

• Usual  concentration  20 - 60 mmol/L
• Solution must be run on the syringe pump or large volume pump within a drug library.
• Dose is usually less  than 0.25 mmol/kg/hr and does not exceed 0.5 mmol/kg/hr to a maximum of 30 mmol/hr .  In exceptional circumstances if a dose  greater than 0.5 mmo/kg/hr is required, the physician must document in the chart the rationale.
• The concentration of the solution and the pump settings are independently double-checked  by 2  staff  members each time the infusion is started or changed if the calculated dose is greater than 0.25 mmol/kg/hour or if the concentration is greater than or equal to 60 mmol/L
• Dose calculation is required if the concentration is greater than or equal to 40 mmol/L AND/OR the rate of infusion is greater than or equal to 1.5 times maintenance. Click here for  potassium dose calculation for 60mmol/L.  Click here for potassium dose calculation for 40mmol/L.
• Serum potassium is checked:
      - every  4 hours if equal to or greater than 0.25 mmol/kg/hr  - (Exception-oncology patients receiving amphotericin B who are on a cardiac monitor and have stable renal function, who can have serum potassium level monitoring according to the staff oncologist's orders)
      - every  2 hours at 0.5 mmol/kg/hr   - (Exception - as above)
      - minimum of twice weekly if patients are on maintenance potassium infusions of less than or equal to 40 mmol/L
• Potassium levels should be monitored frequently during aggressive diuresis and correction of acidosis.
• Cardiac monitor is required for rates exceeding 0.25 mmol/kg/hr
• When possible, non-standard potassium containing solutions should be changed to standard potassium containing solutions.