Potassium chloride in sodium chloride intravenous
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusion containing potassium chloride and sodium chloride.
Drugs List
Therapeutic Indications
Uses
Electrolyte imbalance
Hypokalaemia - severe
Dosage
The volume of solution needed to replenish deficits varies with hydration state, age, body weight, complementary treatment and clinical and biochemical status. Dosage and rate of infusion should be determined by ECG and serum electrolyte monitoring.
Adults
Typical doses of potassium for the prevention of hypokalaemia and treatment of mild potassium deficiency is up to 50mmol per day. In the treatment of severe hypokalaemia the recommended dosage is 20mmol over 2 to 3 hours under ECG control.
The rate of infusion should not exceed 10 to 20mmol of potassium per hour.
The recommended maximum dose of potassium is 2 to 3mmol/kg/24 hours. Some manufacturers suggest the total daily dosage of potassium should not exceed 200mmol of potassium.
Elderly
(See Dosage; Adults)
A reduced volume and rate of infusion may be necessary to avoid circulatory overload, particularly in patients with cardiac or renal insufficiency.
Children
The maximum recommended dose of potassium is 2 to 3mmol/kg/day.
Additional Dosage Information
In difficult cases specialist advice should be sought and the patient's 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
Intravenous potassium should be administered in a large peripheral or central vein to diminish the risk of causing sclerosis. If infused through a central vein, to avoid localised hyperkalaemia the catheter must not be in the atrium or ventricle.
Infusion should be given slowly over 2 to 3 hours.
Contraindications
Baseline serum potassium above 5 mmol/L
Recent trauma
Anuria
Cardiac failure
Hyperchloraemia
Hypernatraemia
Oliguria
Recent cerebrovascular accident
Severe renal impairment
Precautions and Warnings
Burns
Cardiopulmonary disorder
Infants
Peripheral oedema
Addison's disease
Adrenal insufficiency
Cardiac disorder
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
Ensure adequate hydration prior to infusion
Monitor acid-base balance
Monitor creatinine, blood urea nitrogen (BUN) and urinary output
Monitor ECG
Monitor fluid and electrolyte status
Monitor for over-hydration in elderly
Monitor patient for infusion-associated reactions (IARs)
Monitor renal function in patients with renal impairment
Monitor serum potassium regularly
Discontinue if renal function deteriorates
A hydrating solution that does not contain potassium should be given before the potassium-containing solution to ensure adequate renal function.
Initial potassium therapy should not involve glucose infusions, because glucose may cause a further increase in the plasma-potassium concentration.
Pregnancy and Lactation
Pregnancy
The use of potassium 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. Caution should also be exercised in the presence of pre-eclampsia.
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 14-17 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 at ( https://www.toxbase.org/ ) or if this is unavailable at the backup site ( https://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
Abdominal cramps
Acid/base balance disturbance
Altered consciousness
Areflexia
Arrhythmias
Behavioural disturbances
Cardiac arrest
Coma
Confusion
Convulsions
Death
Decreased lachrymal secretion
Diarrhoea
Difficulty in swallowing
Dizziness
Electrolyte disturbances
Extravasation necrosis
Fever
Headache
Heart block
Heaviness or weakness of the legs
Hyperchloraemia
Hyperkalaemia
Hypernatraemia
Hypertension
Hypotension
Hypovolaemia
Infusion-related symptoms
Injection site reactions
Irritation (injection site)
Listlessness
Movement disturbances
Muscle paralysis
Nausea
Nerve damage
Over-hydration
Pain / soreness (injection site)
Pallor
Paraesthesia
Peripheral oedema
Phlebitis (injection site)
Pulmonary oedema
Pyrexia
Renal failure
Respiratory arrest
Respiratory insufficiency
Restlessness
Salivation changes
Sweating
Tachycardia
Thirst
Thrombosis (injection site)
Vomiting
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: July 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.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [Accessed on 25 July 2014].
Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications [Accessed on 25 July 2014].
Summary of Product Characteristics: Potassium Chloride 0.15%, Sodium Chloride 0.9% IV Infusion BP, as Steriflex No. 12 and freeflex. Fresenius Kabi Ltd. Revised April 1999.
Summary of Product Characteristics: Potassium Chloride 0.15%, Sodium Chloride 0.9% w/v Solution for Infusion - BP. Baxter Healthcare Ltd. Revised April 2009.
Summary of Product Characteristics: Potassium Chloride 0.15% w/v and Sodium Chloride 0.9% w/v Solution for Infusion. B. Braun Melsungen AG Ltd. Revised April 2017.
Summary of Product Characteristics: Potassium Chloride 0.15% w/v, Sodium Chloride 0.9% w/v Solution for Infusion. Maco Pharma (UK) Ltd. Revised May 2009.
Summary of Product Characteristics: Potassium Chloride 0.2%, Sodium Chloride 0.9% IV Infusion BP, as Steriflex No. 28 and freeflex. Fresenius Kabi Ltd. Revised June 2000.
Summary of Product Characteristics: Potassium Chloride 0.2% w/v Sodium Chloride 0.9% w/v Solution for Infusion. Maco Pharma (UK) Ltd. Revised May 2009.
Summary of Product Characteristics: Potassium Chloride 0.3% w/v & Sodium Chloride 0.9% w/v Solution for Infusion - BP. Baxter Healthcare Ltd. Revised April 2003.
Summary of Product Characteristics: Potassium Chloride 0.3% w/v & Sodium Chloride 0.9% w/v Solution for Infusion. B. Braun Melsungen AG. Revised April 2017.
Summary of Product Characteristics: Potassium Chloride 0.3%, Sodium Chloride 0.9% IV Infusion BP, as Steriflex No. 15 or freeflex. Fresenius Kabi Ltd. Revised June 2000.
Summary of Product Characteristics: Potassium Chloride 0.3% w/v Sodium Chloride 0.9% w/v Solution for Infusion. Maco Pharma (UK) Ltd. Revised November 2006.
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
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