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Potassium chloride in glucose and sodium chloride intravenous

Presentation

Infusion containing potassium chloride, glucose and sodium chloride.

Drugs List

  • potassium chloride 0.15% (10mmol potassium) in glucose 4% and sodium chloride 0.18% 500ml infusion
  • potassium chloride 0.15% (10mmol potassium) in glucose 5% and sodium chloride 0.45% 500ml infusion
  • potassium chloride 0.15% (20mmol potassium) in glucose 4% and sodium chloride 0.18% 1000ml infusion
  • potassium chloride 0.2% (13.5mmol potassium) in glucose 4% and sodium chloride 0.18% 500ml infusion
  • potassium chloride 0.2% (27mmol potassium) in glucose 4% and sodium chloride 0.18% 1000ml infusion
  • potassium chloride 0.3% (20mmol potassium) in glucose 4% and sodium chloride 0.18% 500ml infusion
  • potassium chloride 0.3% (40mmol potassium) in glucose 4% and sodium chloride 0.18% 1000ml infusion
  • 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

    For the prophylaxis of hypokalaemia a typical dose is up to 50mmol of potassium daily. Similar doses may be adequate in mild potassium deficiency.

    The maximum recommended dose of potassium is 2mmol/kg/day to 3mmol/kg/day. The administered amount of glucose should not exceed 3g/kg/day to 4g/kg/day.

    The maximum rate of infusion should not exceed 10mmol potassium/hour when serum potassium levels are above 2.5mmol/l and 40mmol/hour if serum potassium levels are below 2mmol/l.

    Children

    Children aged 1 month to 18 years
    The volume and rate of infusion will be depend on the requirements of the individual.

    Alternative sources suggest 1mmol/kg to 2mmol/kg of potassium daily. The maximum recommended dose of potassium is 2mmol/kg/day to 3mmol/kg/day.
    Potassium infusions should be given slowly over at least 2 to 3 hours and at a rate not exceeding 0.2mmol/kg/hour.

    Neonates

    The volume and rate of infusion will be depend on the requirements of the individual.

    Alternative sources suggest 1mmol/kg to 2mmol/kg of potassium daily. The maximum recommended dose of potassium is 2mmol/kg/day to 3mmol/kg/day.
    Potassium infusions should be given slowly over at least 2 to 3 hours and at a rate not exceeding 0.2mmol/kg/hour.

    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.

    Additional Dosage Information

    In difficult cases specialist advice should be sought and the patients ECG monitored.
    Faster infusion rates may be given in very severe potassium depletion but require specialist advice as rapid infusion may result in cardiac reactions.

    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.

    Infusion should be given slowly over 2 to 3 hours.

    Contraindications

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

    Precautions and Warnings

    Burns
    Cardiopulmonary disorder
    Peripheral oedema
    Addison's disease
    Adrenal insufficiency
    Cardiac disorder
    Diabetes mellitus
    Hepatic impairment
    Hypertension
    Pre-eclampsia
    Pulmonary oedema
    Renal impairment
    Severe dehydration
    Severe haemolysis
    Sickle cell disease

    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 creatinine, blood urea nitrogen (BUN) and urinary output
    Monitor ECG
    Monitor fluid and electrolyte status
    Monitor renal function in patients with renal impairment
    Monitor serum potassium regularly
    Discontinue if renal function deteriorates

    Monitor fluid and electrolyte status. Initial potassium therapy should not involve glucose infusions, because glucose may cause a further increase in the plasma potassium concentration.

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

    Pregnancy and Lactation

    Pregnancy

    The use of potassium, sodium and glucose containing products during pregnancy is not considered to pose a hazard.

    Because high or low potassium levels are detrimental to maternal and foetal cardiac function, serum potassium levels should be closely monitored.

    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 2011).

    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

    Areflexia
    Arrhythmias
    Cardiac arrest
    Chills
    Confusion
    ECG changes
    Extravasation
    Febrile reactions
    Heart block
    Heaviness or weakness of the legs
    Hyperglycaemia
    Hyperkalaemia
    Hypertension
    Hypervolaemia
    Hypotension
    Listlessness
    Local infection at injection site
    Muscle paralysis
    Oedema
    Over-hydration
    Paraesthesia
    Peripheral coldness
    Phlebitis (injection site)
    Respiratory insufficiency
    Shivering
    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: August 2014

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Potassium Chloride 0.15% w/v, Sodium Chloride 0.18% w/v, and Glucose 4%w/v Intravenous Infusion BP. B. Braun Melsungen AG. Revised December 2020.

    Summary of Product Characteristics: Potassium Chloride 0.15% w/v, Sodium Chloride 0.18% w/v and Glucose 4% w/v, Solution for Infusion. Fresenius Kabi Limited. Revised April 1999.

    Summary of Product Characteristics: Potassium Chloride 0.15% w/v, Sodium Chloride 0.18% w/v and Glucose 4% w/v, Solution for Infusion. Maco Pharma UK Ltd. Revised May 2009.

    Summary of Product Characteristics: Potassium Chloride 0.2%, Sodium Chloride 0.18%, Glucose 4% Intravenous Infusion BP, as Steriflex No. 30 or freeflex. Fresenius Kabi Ltd. Revised June 2000.

    Summary of Product Characteristics: Potassium Chloride 0.3% w/v, Sodium Chloride 0.18% w/v and Glucose 4% w/v Intravenous Infusion BP. B. Braun Ltd. Revised July 2010.

    Summary of Product Characteristics: Sodium Chloride 0.45% w/v, Potassium Chloride 0.15% w/v and Glucose 5% Intravenous Infusion. Terumo BCT Ltd. Revised April 2012.

    NICE Evidence Services Available at: www.nice.org.uk Last accessed: 7 September 2017

    The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.

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