Rational and Key Points
|1. Obtain documented laboratory value prior
to drug administration
||A normal serum potassium level is 3.5 to 5.5 mEq/L. Maintenance
intravenous solutions are designed to maintain a normal range of serum
potassium. Intermittent dose infusions (bolus) of potassium (KCl)
are ordered in hypokalemic states where the serum potassium is less than
|2. Obtained order from physician.
Order must include: dosage in mEq/kg; rate of infusion; type of solution
or diluent; and total volume to administer.
||Potassium orders should not be accepted if not properly written.
Potassium dosage 2 to 5 mEq/kg/day.
|3. KCl concentrations according to type of IV access. Concentrations
up to a maximum of:
||80 mEq/L -= 0.08 mEq/cc
||1000 mEq/L = 1 mEq/cc in PICU only
||200 mEq/L = 0.2 mEq/cc on general pediatric ward
||1000 mEq/L = 1 mEq/cc in PICU only.
||KCl is stocked in a concentration of 2 mEq/cc. Never administer
potassium by IV push or undiluted.
*For an umbilical line to be considered central, the tip of
the catheter must be above the diaphragm, otherwise treat line as a peripheral
line (confirm by x-ray).
|Example: If a patient is ordered to receive 10 mEq of KCl via
peripheral access, KCl must be further diluted in a total of 125 cc of
|4. All pediatric patients require a cardiac monitor if the infusion
of KCl is given over less than 4 hours regardless of the rate, dose or
||Rarely is there a need to administer potassium over less than 4 hours,
but on occasion in a critically ill, fluid restricted, hypokalemic patient,
KCl may be delivered over 1 hour.
Cardiac monitor: 0.1 to 1 mEq/kg/hour
No monitor: 0.5 to 1 mEq/kg over 4 hours.
|5. The usual potassium bolus dose for critically ill, fluid restricted,
hypokalemic PICU patients is 0.5 to 1 mEq/kg/dose administered over 1 hour.
On the general pediatric ward, 0.5 to 1 mEq/kg over 4 hours. If the
patient is more than 40 kg, the maximum amount of potassium that may be
given is 40 mEq per dose (This is the maximum adult dose regardless of
A 10 kg patient with a central line in the PICU is ordered for 10 mEq
KCl. 10 mEq is 5 cc, therefore the KCl is further diluted with 5
cc of diluent for a total volume of 10 cc to be delivered over 1 hour.
Dose equals 1 mEq/kg/dose. The maximum amount of KCl that this patient
can receive in one dose is 10 mEq.
|6. All bolus doses of KCl should be administered via a syringe
pump. If volume is greater than 60 cc, infusion should be via a 570
IVAC pump. After KCl dose is properly diluted, pruse fluid through
tubing so infusion can begin immediately. Tubing should be properly
labeled during infusion. After potassium infusion is complete, flush
with standard IV solution over appropriate amount of time.
||By purging the fluid through the tubing, the infusion can begin immediately.
Tubing should be labeled appropriately, to avoid accidental bolus of medication.
Remember, potassium remains in the tubing post bolus, therefore standard
IV solution should be infused at an appropriate rate to clear the tubing
|7. Patient in cardiac monitors should be closely monitored for:
EKG changes (i.e., peaked T waves, tachycardia progressing to bradycardia,
arrythmias-- V-tachycardia or V-fibrillation; hypotension, heart block,
or cardiac arrest.
Musculoskeletal: muscle weakness or flaccid paralysis.
CNS: Hyperreflexia progressing to weakness and mental confusion.
|With hyperkalemia, EKG changes are common. It is imperative that
the nurse observe for these changes and notify M.D. immediately.
|8. Monitor intake and output closely. If urine output starts
to decrease, notify M.D. immediately. A serum potassium level may
||Remeber to account for volume of fluid administered to a patient on
flowsheet. Potasssium is excreted via the kidneys, therefore a decrease
in urine output could increase serum potassium.
|9. Document on appropriate medication record
Amount of drug
Time and Date
|When administering potassium, make sure concentration and dilution
does not exceed stated parameters.
|10. Document any adverse effects in the patients condition on
the flow sheet, including who was notified, intervention(s) taken, and
outcome after intervention.
|11. If KCl is administered via a peripheral intravenous line,
assess IV site for: redness, swelling, and tenderness prior to and
during infusion q 30 minutes. If any of these signs are present prior
to infusion, do not infuse. If sign(s) are noted during infusion,
stop infusion immediately and obtain another site for access. Attempt
to aspirate catheter. If unable to aspirate, do not flush, remove
catheter. If infiltration occurs administer wydase (see policy).
||KCl extravasation can be very severe. Pain at catheter site or
phlebitis may be your only sign of an impending infiltrate. If IV
is questionable, do not infuse KCl bolus or stop infusion if already begun.
|12. If line needs to be interrupted during infusion, aspirate
at least 2 cc of blood and discard to prevent rapid infusion of KCl
||A bolus of KCl can cause cardiovascular collapse.
|13. If patient can tolerate enteral feedings, oral potassium
should be considered. For administration of oral potassium, the
physician should include the same information as IV administration in the
||Oral potassium absorbs well from the GI tract. Further dilution
of oral potassium is required prior to administration. Adverse
reactions: nausea, vomiting, diarrhea, or abdominal cramping.
|14. A verbal order for the admnistration of KCl should not be
taken (*see individual hospital policies).
|15. After admnistration of any potassium (KCl) bolus, a serum
potassium must be obtained within 30 to 60 minutes. Do not repeat
a bolus dose until the result is obtained form the lab, and the physician
||A serum potassium may be obtained before 30 minutes, but may be falsely
low. Blood obtained by peripheral stick or ABG (if patient has an
arterial line) is the preferable method. A serum potassium obtained
by heel stick may be falsely elevated, and a peripheral stick warranted
Children's National Medical Center (1995-1996). Choy, F & Carnegie,
L (Eds.). Pediatric Drug Therapy and Formulary Handbook 634:476-479.
Hamill, RJ, Robinson, LM, Wexler, HR, Moote, C. 1991. Efficacy
and safety of potassium infusion therapy in hypokalemic critically ill
patients. Critical Care Medicine 19(5):694-699.
Khilnani, P. 1992. Electrolyte abnormalities in critically
ill children. Critical Care Medicine 20(2):241-250.
Takemoto, CK, Hodding, JH, Kraus, DM (1996-1997). Pediatric
Dosage Handbook, 3rd. Ed, 562-564.