Parenteral Manual

Potassium Chloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
KCl
Classification: 
Electrolyte
Original Date: 
August 2005
Revised Date: 
June 2014
Indications: 
  • Potassium replacement therapy

 

Reconstitution and Stability: 
  • Available as 2 mmol/mL injection solution -store at room temp  -Pharmacy Use Only
  • Available as 0.5 mmoL/mL solution (in 20 mL & 50 mL syringes) -refrigerate  -prepared by Pharmacy
  • Stable 24 hours at room temperature or 30 days in the fridge when diluted in NS or D5W
  • Mix IV infusion solution thoroughly after adding potassium chloride
Compatibility: 

- Solutions Compatible: all commonly used IV solutions

- Compatible: many drugs- please check the individual drugs

- Incompatible: amphotericin B, azithromycin, diazepam, phenytoin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

June

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

YES, Critical Care Areas (PICU/NICU)
Central line:
Usual dilution: 0.5 mmol/mL in D5W  = 500 mmoL/L
Infusion rate:  0.5 mmol/kg/hr x 2 hrs (max 30 mmol/hr)

IV Continuous Infusion

YES
Peripheral line:
-Usual dilution: 20-40 mmol/L (maximum 60 mmol/L)
Infusion rates: 
     - normally less than 0.25 mmoL/kg/hr & do not exceed     0.5 mmol/kg/hr

 Central line:
-Usual dilution: 20-60 mmol/L (Max: 160 mmol/L)
Infusion rates:
   - normally less than 0.25 mmoL/kg &  do not exceed  0.5 mmoL/kg/hr  (max: 30 mmoL/hr)

Dosage: 

(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.

 

Potential hazards of parenteral administration: 
  • Hyperkalemia, cardiac arrest (especially in renal impairment or if administered too rapidly)
  • Extravasation may cause pain and tissue necrosis. If extravasation occurs, click HERE for treatment guidelines.   
  • May cause pain if administered in high concentrations into small veins
  • Nausea and vomiting
Notes: 
  • DO NOT FLUSH LINES CONTAINING HIGH CONCENTRATIONS OF POTASSIUM INTO THE PATIENT
  • When using fluids containing potassium chloride to administer medication, ensure that the infusion rate for medicaton administration does not exceed potassium chloride infusion rate guidelines.
  • If infusion via peripheral IV lines, check IV site frequently for signs of extravasation
  • 1 mEq KCl = 1 mmol KCl

Antidote for hyperkalemia:

  • 0.5-1 g/kg of dextrose combined with regular insulin 1 unit for every 4-5 g of dextrose given; infuse over 2 hours (infusions as short as 30 minutes have been recommended)
  • 60-100 mg of calcium gluconate/kg/dose Q10 minutes (maximum 3 g/dose)

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