-Rule of thumb in patients with normal renal function: every 10 mEq KCL given will raise the serum potassium level by 0.1 mmol/dL.
-PO is the best way to replace potassium if the patient can take PO.
-10mEq/hr is the recommended rate for giving KCL peripherally.
-If you want to give it faster than 10mEq/hr, use a central line because the peripheral line will burn.
-Check and replace Magnesium.
“Under normal circumstances, dietary deficiency of potassium does not occur. The most important cause of potassium deficiency is excessive losses, usually through the alimentary tract or the kidneys. Large alimentary potassium losses may occur through prolonged vomiting, chronic diarrhea, or laxative abuse. The most common cause of excessive renal loss is the use of diuretic agents, especially for the treatment of hypertension. Some forms of chronic renal disease and metabolic disturbances (e.g., diabetic acidosis) can also lead to severe potassium loss. Deficiency symptoms include weakness, anorexia, nausea, listlessness, apprehension, drowsiness, and irrational behavior. Severe hypokalemia may result in cardiac dysrhythmias that can be fatal.” https://www.ncbi.nlm.nih.gov/books/NBK234935/
This UTD article shows you how to give potassium peripherally and centrally. Scroll to the Recommended approach section: https://www.uptodate.com/contents/clinical-manifestations-and-treatment-of-hypokalemia-in-adults
“For patients with severe hypokalemia due to gastrointestinal or renal losses, the recommended maximum rate of potassium administration is 10 to 20 meq/hour in most patients. However, initial rates as high as 40 meq/hour have been used for life-threatening hypokalemia. Rates above 20 meq/hour are highly irritating to peripheral veins. Such high rates should be infused into a large central vein or into multiple peripheral veins.
Potassium can be given intravenously via a peripheral or a large central vein. To decrease the risk of inadvertent administration of a large absolute amount of potassium, we suggest the following maximum amounts of potassium that should be added to each particular sized infusion container:
- In any 1000 mL-sized container of appropriate non-dextrose fluid, we suggest a maximum of 60 meq of potassium
- In a small-volume mini-bag of 100 to 200 mL of water that is to be infused into a peripheral vein, we suggest 10 meq of potassium
- In a small-volume mini-bag of 100 mL of water that is to be infused into a large central vein, we suggest a maximum of 40 meq of potassium
Intravenous potassium is most often infused in a peripheral vein at concentrations of 20 to 60 meq/L in a non-dextrose-containing saline solution. Use of an infusion pump is preferred to prevent overly rapid potassium administration in any intravenous container with more than 40 meq of potassium or if the desired rate of potassium administration is more than 10 meq/hour. For patients with severe hypokalemia, administration in a large central vein is preferred if this access is available.” UTD
**When you are giving potassium to someone who needs replacement, don’t give it with dextrose because dextrose will drive potassium into cells. Give it with just normal saline.
If the patient can take PO, give PO.
I spoke with a pharmacist and my wife who is a med-surge nurse at our hospital and they both agree that 10Meq/hr of K-rider is often given at the hospital and it’s safe. Many doctors use it. The pharmacist recommends that if I were to want to give 60mEq of potassium in a patient who couldn’t take PO, I would put that in a 500mL bag and run it at 10mEq/hr. If I needed to give more potassium, like 80mEq in a patient who couldn’t take PO, I would order two it in two 500mEq bags and give them at a rate of 100cc/hr over 8hrs to get in the 80mEq I want.
Questions:
What is a K-rider?
What is potassium piggyback?