Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance
Hypokalaemia - severe

Administration

Sterile and non-pyrogenic equipment should be used.

Intravenous potassium should be administered via a large peripheral or central vein to reduce the risk of causing sclerosis. If infused through a central vein, ensure that the catheter is not in the atrium of ventricle in order to avoid localised hyperkalaemia.

Solutions containing potassium should be administered slowly. Infusion rates greater than 500ml over three hours should be controlled by infusion pump.

In order to avoid potentially fatal over infusion of intravenous fluids to the neonate, special attention needs to be paid to the method of administration. When using a syringe pump to administer intravenous fluids or medicines to neonates, a bag of fluid should not be left connected to the syringe. When using an infusion pump all clamps on the intravenous administration set must be closed before removing the administration set from the pump, or switching the pump off. This is required regardless of whether the administration set has an anti free flow device.

The intravenous infusion device and administration equipment must be frequently monitored.

Contraindications

Baseline serum potassium above 5 mmol/L
Diabetic hyperosmolar coma
Impaired glucose tolerance
Recent head trauma
Addison's disease
Anuria
Cardiac failure
Hyperchloraemia
Hyperglycaemia
Hyperlactataemia
Oliguria
Recent cerebrovascular accident
Severe renal impairment
Uncontrolled diabetes mellitus

Precautions and Warnings

Burns
Cardiopulmonary disorder
Adrenal insufficiency
Cardiac disorder
Diabetes mellitus
Pulmonary oedema
Raised intracranial pressure
Renal impairment
Severe dehydration

Reduce dose in patients with renal impairment
Initial IV potassium therapy should be in sodium chloride infusions only
Avoid rapid infusion rates
Do not give blood products in same intravenous line
Diabetic control may need adjustment
Ensure adequate hydration prior to infusion
Monitor acid-base balance
Monitor blood / urinary glucose concentrations in diabetic patients
Monitor children closely for signs and symptoms of hyponatraemia
Monitor creatinine, blood urea nitrogen (BUN) and urinary output
Monitor ECG
Monitor fluid and electrolyte status
Monitor glucose closely during intracranial hypertension episodes
Monitor renal function in patients with renal impairment
Monitor serum glucose in newborns
Monitor serum potassium regularly
Discontinue if hypersensitivity reactions occur
Discontinue if renal function deteriorates

Infusion of solutions containing glucose could be contraindicated in the first 24 hours following head trauma.

If hyperglycaemia occurs during therapy, reduce the rate of infusion or administer insulin.

During long term therapy, a convenient nutritive treatment supply must be given to the patient.

Stop treatment immediately if signs or symptoms of suspected hypersensitivity reaction develop. Appropriate counter measures should be initiated. Solutions containing dextrose should be used with caution in patients with known allergy to corn or corn products.

Premature babies and those with low birth weight are at increased risk of developing hypoglycaemia or hyperglycaemia and therefore need close monitoring during treatment with intravenous glucose solutions to ensure adequate glycaemic control in order to avoid potential long term effects.

Pregnancy and Lactation

Pregnancy

There are no concerns regarding the administration of glucose and potassium infusion during pregnancy provided maternal electrolyte serum levels are kept within the physiological range.

Hyperkalaemic and hypokalaemic states lead to impaired cardiac function of the maternal and foetal hearts. Maternal electrolyte levels must therefore be controlled regularly.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

The use of potassium containing products during breastfeeding is not considered to pose a hazard.

Breast milk is naturally high in potassium with levels that are 3 to 4 times those in plasma. Because potassium passes freely in and out of milk, the use of potassium chloride by a lactating woman with normal plasma potassium levels would have no adverse effect on a nursing infant (Briggs 2015).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Arrhythmias
Cardiac arrest
Chills
Confusion
Extravasation
Fever
Heart block
Heaviness or weakness of the legs
Hyperglycaemia
Hyperkalaemia
Hypersensitivity reactions
Hypertension
Hypervolaemia
Hypotension
Irritation (injection site)
Listlessness
Local infection at injection site
Muscle paralysis
Over-hydration
Pain / soreness (injection site)
Pallor
Paraesthesia
Paraesthesia in extremities
Peripheral coldness
Phlebitis (injection site)
Respiratory insufficiency
Shivering
Sweating
Thrombophlebitis
Thrombosis (injection site)
Weakness

Presentation

Infusion containing potassium chloride and glucose.

Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance
Hypokalaemia - severe

Dosage

Dosage depends on the age, weight, clinical and biological (acid-base balance) condition of the patient, concurrent therapies and the hydration state of the patient.

High volume infusion should be accompanied by specific monitoring in patients with cardiac or pulmonary failure.

Dosage and rate of infusion should be determined by ECG and serum electrolyte monitoring.

Adults

Children

Administration

Sterile and non-pyrogenic equipment should be used.

Intravenous potassium should be administered via a large peripheral or central vein to reduce the risk of causing sclerosis. If infused through a central vein, ensure that the catheter is not in the atrium of ventricle in order to avoid localised hyperkalaemia.

Solutions containing potassium should be administered slowly. Infusion rates greater than 500ml over three hours should be controlled by infusion pump.

In order to avoid potentially fatal over infusion of intravenous fluids to the neonate, special attention needs to be paid to the method of administration. When using a syringe pump to administer intravenous fluids or medicines to neonates, a bag of fluid should not be left connected to the syringe. When using an infusion pump all clamps on the intravenous administration set must be closed before removing the administration set from the pump, or switching the pump off. This is required regardless of whether the administration set has an anti free flow device.

The intravenous infusion device and administration equipment must be frequently monitored.

Contraindications

Baseline serum potassium above 5 mmol/L
Diabetic hyperosmolar coma
Impaired glucose tolerance
Recent head trauma
Addison's disease
Anuria
Cardiac failure
Hyperchloraemia
Hyperglycaemia
Hyperlactataemia
Oliguria
Recent cerebrovascular accident
Severe renal impairment
Uncontrolled diabetes mellitus

Precautions and Warnings

Burns
Cardiopulmonary disorder
Adrenal insufficiency
Cardiac disorder
Diabetes mellitus
Pulmonary oedema
Raised intracranial pressure
Renal impairment
Severe dehydration

Reduce dose in patients with renal impairment
Initial IV potassium therapy should be in sodium chloride infusions only
Avoid rapid infusion rates
Do not give blood products in same intravenous line
Diabetic control may need adjustment
Ensure adequate hydration prior to infusion
Monitor acid-base balance
Monitor blood / urinary glucose concentrations in diabetic patients
Monitor children closely for signs and symptoms of hyponatraemia
Monitor creatinine, blood urea nitrogen (BUN) and urinary output
Monitor ECG
Monitor fluid and electrolyte status
Monitor glucose closely during intracranial hypertension episodes
Monitor renal function in patients with renal impairment
Monitor serum glucose in newborns
Monitor serum potassium regularly
Discontinue if hypersensitivity reactions occur
Discontinue if renal function deteriorates

Infusion of solutions containing glucose could be contraindicated in the first 24 hours following head trauma.

If hyperglycaemia occurs during therapy, reduce the rate of infusion or administer insulin.

During long term therapy, a convenient nutritive treatment supply must be given to the patient.

Stop treatment immediately if signs or symptoms of suspected hypersensitivity reaction develop. Appropriate counter measures should be initiated. Solutions containing dextrose should be used with caution in patients with known allergy to corn or corn products.

Premature babies and those with low birth weight are at increased risk of developing hypoglycaemia or hyperglycaemia and therefore need close monitoring during treatment with intravenous glucose solutions to ensure adequate glycaemic control in order to avoid potential long term effects.

Pregnancy and Lactation

Pregnancy

There are no concerns regarding the administration of glucose and potassium infusion during pregnancy provided maternal electrolyte serum levels are kept within the physiological range.

Hyperkalaemic and hypokalaemic states lead to impaired cardiac function of the maternal and foetal hearts. Maternal electrolyte levels must therefore be controlled regularly.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

The use of potassium containing products during breastfeeding is not considered to pose a hazard.

Breast milk is naturally high in potassium with levels that are 3 to 4 times those in plasma. Because potassium passes freely in and out of milk, the use of potassium chloride by a lactating woman with normal plasma potassium levels would have no adverse effect on a nursing infant (Briggs 2015).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Arrhythmias
Cardiac arrest
Chills
Confusion
Extravasation
Fever
Heart block
Heaviness or weakness of the legs
Hyperglycaemia
Hyperkalaemia
Hypersensitivity reactions
Hypertension
Hypervolaemia
Hypotension
Irritation (injection site)
Listlessness
Local infection at injection site
Muscle paralysis
Over-hydration
Pain / soreness (injection site)
Pallor
Paraesthesia
Paraesthesia in extremities
Peripheral coldness
Phlebitis (injection site)
Respiratory insufficiency
Shivering
Sweating
Thrombophlebitis
Thrombosis (injection site)
Weakness

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 2018

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Foetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Potassium chloride 0.15% w/v and glucose 5% w/v solution for infusion. Baxter Healthcare Ltd. Revised June 2015.

Summary of Product Characteristics: Potassium chloride 0.15% and glucose 5% Intravenous Infusion BP. Fresenius Kabi Ltd. Revised May 2015.

Summary of Product Characteristics: Potassium chloride 0.15% w/v and glucose 5% w/v solution for infusion. Maco Pharma (UK) Ltd. Revised May 2009

Summary of Product Characteristics: Potassium chloride 0.2% w/v and glucose 5% w/v IV Infusion BP, as Steriflex No.29 and freeflex. Fresenius Kabi Limited. Revised May 2005

Summary of Product Characteristics: Potassium chloride 3mg/ml (0.3% w/v) and Glucose 50mg/ml (5% w/v) Solution for Infusion. B. Braun Melsungen AG. Revised July 2018.

Summary of Product Characteristics: Potassium chloride 0.3% w/v and glucose 5% w/v Intravenous Infusion BP, as Steriflex No.16 or freeflex. Fresenius Kabi Limited. Revised June 2015

Summary of Product Characteristics: Potassium chloride 0.3% w/v and glucose 5% w/v Solution for Infusion. Macopharma (UK) Ltd. Revised June 2015.