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Potassium chloride Intravenous INFUSION for Adults
Who can administer
Commercially available bags containing not more than 40mmol per 500ml
- May be administered by registered competent doctor or nurse/midwife.
Infusions prepared at ward level using ampoules
- May be administered by registered competent doctor or nurse/midwife, PROVIDED the guidelines below (in Methods of Administration) have been adhered to
Higher concentrations: Administration RESTRICTED - see Appendix 1
Important information
- Potassium chloride solutions can be FATAL if given inappropriately - administration must be by slow intravenous infusion through a pump
- Any form of Potassium which contains a concentration greater than 40mmol per litre, is a controlled drug within Galway University Hospitals.
- Pain at the site of injection and phlebitis may occur during intravenous administration of solutions containing 40mmol or more potassium per litre (ref 1)
- For Y-site compatibility see below
- For addition of potassium concentrate to infusion bags - see under Methods of Administration below
Available preparations
| Fluid | Potassium content | Volume | Order code | Comments |
|---|---|---|---|---|
| Sodium chloride 0.9% | 10mmol | 500ml | B1763 | All generally available - many as stock on wards - available to order if not stock |
| Sodium chloride 0.9% | 20mmol | 500ml |
B1983 |
|
| Sodium chloride 0.9% | 20mmol | 1000ml | B1764 | |
| Sodium chloride 0.9% | 40mmol | 1000ml | B1984 | |
| Sodium chloride 0.9%, Glucose 5% | 20mmol | 500ml | B2486 | Paediatric DKA policy |
| Sodium chloride 0.18%, Glucose 4% | 20mmol | 500mL | FE1723J | Perioperative management of some diabetics - see insulin prescription chart |
| Glucose 5% | 40mmol | 1000ml | B1264 | All generally available - many as stock on wards - available to order if not stock |
| Glucose 5% | 20mmol | 1000ml | B1134 | |
| Glucose 5% | 20mmol | 500ml | B1263 | |
| Sodium chloride 0.9% (controlled drug) (Unlicensed) | 40mmol | 500ml | Fresenius Kabi 794764 |
Unlicensed Controlled drug in GUH |
| Sodium chloride 0.9% (controlled drug) | 20mmol | 100ml | G5028 | Critical care areas only |
| Sodium chloride 0.9% (controlled drug) | 40mmol | 100ml | G5020 | Critical care areas only |
|
Potassium chloride 15% CONCENTRATE (for dilution and infusion) Controlled drug |
20mmol | 10ml | Critical or complex care areas, ED, paediatrics, neonatal unit only. |
Reconstitution
Already in solution
Infusion fluids
Ready made infusion bags as listed above
Sodium Chloride 0.9% with potassium 20mmol per 500ml (B1983) may be used if potassium concentrate is being added to an infusion bag
Use Sodium Chloride 0.9% as fluid of choice for initial replacement (unless contraindicated) as Glucose may cause a further decrease in plasma potassium levels (ref 1)
Methods of intravenous administration
Intravenous infusion (using an electronically controlled infusion device - i.e. pump)
NB: Pumps must never be removed while a potassium infusion is hanging - this includes when patients are being moved between units/wards
| PERIPHERAL LINE | |
|---|---|
| Available as |
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Administration |
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CENTRAL LINE |
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| Available as |
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| Administration |
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Addition of potassium concentrate to infusion bags
- GUH hospital policy requires that pre-mixed bags be used in preference
- If essential to prepare at ward level
- Preparation must be done jointly by a doctor and a nurse in the clinic room.
- Both the Controlled Drug register, and the Additive label must be signed by the SAME doctor and nurse
- UNUSED ampoules must immediately be returned to the CD press and signed back into the CD register by the SAME doctor and nurse
- It is recommended that potassium concentrate be added to an existing lower concentrate potassium infusion bag
- i.e add 20mmol to a bag containing 20mmol in 500mL Sodium chloride 0.9% (B1983) to produce an infusion of 40mmol in 500mL
- clearly over-label the infusion bag to reflect the TOTAL amount of mmol of potassium
- After adding potassium concentrate to an infusion bag, squeeze and invert bag a MINIMUM of ten times to avoid inadvertent administration of a toxic bolus (ref 1)
- Cannot exceed 40mmol per 500mL concentration
Dose in adults
- Always prescribe in mmol and specify the final volume of infusion to avoid confusion (ref 1)
- Oral potassium supplements can be prescribed in conjunction with intravenous potassium (ref 1)
- Patients at risk of hypokalaemia should receive oral supplementation or maintenance potassium infusions as a means of restricting the necessity for 'rescue' high strength infusions.
- Doses can be highly variable (monitoring is essential)
The following options for administering potassium IV are listed in order of preference (four options)
Option 1 (preferred)
- Using the premixed infusions available - up to 40mmoL per litre
- Give at a usual rate of 10mmol per hour (up to 20mmoL per hour with cardiac monitoring, do not exceed 20mmoL/hour) (ref 1,4)
Option 2: (if fluid volume is an issue)
- Use pre-mixed 40mmol in 500ml sodium chloride 0.9%
- Administer via a large peripheral vein
- Give at a rate of 10mmoL per hour (up to 20 mmoL per hour with cardiac monitoring)(ref 1,4)
Option 3: (Critical care areas ONLY)
- If fluid volume is an issue, using the pre-mixed bag of 20mmol or 40mmol per 100mL(unlicensed)
- Administer via central line only
- Give at a rate of 10mmoL per hour (up to 20 mmol per hour with cardiac monitoring) (ref 1,4)
- Initial rates (with cardiac monitoring) of up to 40mmol per hour have been used for life-threatening hypokalaemia (ref 3)
Option 4 (Where no premixed bag is suitable)
- The addition of potassium concentrate to an existing lower concentrate potassium infusion bag may be considered (with over-labelling to reflect the TOTAL amount of mmol of potassium in the bag)
- Take careful note of maximum allowable concentrations for peripheral or central line use (see under Methods of administration)
- Thorough mixing of the bag after adding the potassium concentrate is essential (squeeze and invert bag at least ten times (ref 1))
- See guidelines above under table for central/peripheral lines for guidance on how to add to bags
Monitoring
Continuous Cardiac Monitoring requirements (ref 1)
- Advised if the rate of infusion is greater than 10mmol potassium/hour, and must be used if the rate of infusion is 20mmol potassium/hour or greater
- Required if the potassium concentration being administered exceeds 80mmol per litre
- Required if the patient's serum potassium is less than or equal to 2.5mmol/L
- Peaking of the T wave or other ECG changes associated with hyperkalemia indicate that the rate of potassium infusion is excessive and should be reduced
Site of infusion
- Monitor patient for pain or phlebitis which may occur at the site of infusion during peripheral administration of solutions containing potassium
- If pain occurs, either the infusion rate, or preferably, the concentration should be reduced (ref 2)
Storage
- Controlled drug press for any parenteral potassium with a concentration which exceeds 40mmol/litre of potassium
- Store below 250C
References
1. Best practice guidelines for the safe use of intravenous potassium in Irish Hospitals, October 2020 Irish Medication Safety Network
2. Uptodate- accessed online 25/01/2023
3: BNF accessed online via MedicinesComplete 25/01/2023
4: Injectable medicines guide. Medusa, downloaded 25/01/2023
5: GUH policy- potassium concentrate, supply and storage in GUH hospitalsCLN-PHAR/UCH-023
6. Injectable Drugs Guide Accessed via MedicinesComplete 25/01/2023
7. Clinical Pharmacy Team. "MEDICINE DISCONTINUATION: FKB1666: Sodium chloride 0.9% & Potassium Chloride 0.6% (40mmol) in 500ml". Email communication to GUH Mailing List. 25 August 2023.
Therapeutic classification
Electrolyte