IV intermittent infusions

≤10 mEq/hr; repeat as needed based on lab values done frequently; central line
infusion and continuous ECG monitoring recommended for infusions >10 mEq/hr

10 mEq of potassium chloride increases serum potassium levels by approximately 0.1

mEq/.L

Dosing based on serum potassium

2.5-3.5 mEq/L: 10 mEq/hr maximum infusion rate; 40 mEq/L mazimum concentration; not
to exceed 200 mEq dose/24hr
<2.5 mEq/L or symptomatic hypokalemia (excluding emergency treatment of cardiac
arrest): 40 mEq/hr maximum infusion rate (central line only) in presence of
continuous ECG monitoring and
frequent lab monitoring; patients may require up to 400 mEq/24hr.

-If treatment is urgent (serum potassium less than 2 mEq/L and electrocardiographic
changes and/or muscle paralysis), infuse cautiously at up to 40 mEq/hour with
continuous cardiac
monitoring Maximum daily dose: 400 mEq
-In critical situations, may administer in saline rather than dextrose (dextrose
may lower serum potassium)

Comments:
-Never give injectable potassium chloride undiluted.
-The usual adult dietary intake is 50 to 100 mEq potassium per day.
-Potassium depletion sufficient to cause hypokalemia usually requires the loss of
200 mEq or more of the total body stores of potassium.

Parenteral (must be diluted prior to administration):

Dose and rate of administration are dependent on patient condition
-If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and
manufacturers recommend that concentration not exceed 40 mEq/L
Maximum daily dose: 200 mEq

This medication is a mineral supplement used to treat or prevent low amounts of

potassium in the blood. A normal level of potassium in the blood is important.
Potassium helps your cells,
kidneys, heart, muscles, and nerves work properly. Most people get enough potassium
by eating a well-balanced diet. Some conditions that can lower your body's
potassium level include
severe prolonged diarrhea and vomiting, hormone problems such as
hyperaldosteronism, or treatment with "water pills"/diuretics.

pediatric
Dose and rate of administration are dependent on patient condition

-If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and
manufacturers recommend that concentration not exceed 40 mEq/L
Maximum daily dose: 200 mEq
-If treatment is urgent (serum potassium less than 2 mEq/L and electrocardiographic
changes and/or muscle paralysis), infuse cautiously at up to 40 mEq/hour with
continuous cardiac
monitoring Maximum daily dose: 400 mEq
-In critical situations, may administer in saline rather than dextrose (dextrose
may lower serum potassium).

adult
---2.5-3.5 mEq/L: 10 mEq/hr maximum infusion rate; 40 mEq/L mazimum concentration;
not to exceed 200 mEq dose/24hr
-If treatment is urgent (serum potassium less than 2 mEq/L and electrocardiographic
changes and/or muscle paralysis), infuse cautiously at up to 40 mEq/hour with
continuous cardiac
monitoring Maximum daily dose: 400 mEq
-In critical situations, may administer in saline rather than dextrose (dextrose
may lower serum potassium)

Indications
– Treatment of severe hypokalaemia (arrhythmia, marked muscular weakness,
rhabdomyolysis or serum potassium level ≤ 2.5 mmol/litre)

Forms and strengths, route of administration

– Ampoule containing 10% potassium chloride hypertonic solution (100 mg/ml, 10 ml),
i.e. 1 g of potassium chloride (KCl) per 10 ml ampoule
– Ionic composition:
• potassium (K+): 13.4 mmol per 10 ml ampoule (13.4 mEq)
• chloride (Cl–): 13.4 mmol per 10 ml ampoule (13.4 mEq)
– Check concentration before use: potassium chloride also comes in ampoules
containing 7.5%, 11.2%, 15% and 20% solutions.
– NEVER USE BY IV OR IM OR SC INJECTION. Potassium chloride must always be
administered by slow IV infusion, diluted in 0.9% sodium chloride.
– For dilution:
• The potassium concentration in the infusion fluid should not exceed 40
mmol/litre.
• Mix thoroughly the potassium and the 0.9% sodium chloride solution by inverting
at least 5 times the infusion bottle or bag.

Dosage and duration

Dosage depends on the severity of hypokalaemia and the patient’s underlying
condition. For information:

– Child over 1 month: 0.2 mmol/kg/hour for 3 hours

Each mmol of potassium is diluted in 25 ml of 0.9% sodium chloride.
Examples:

10 kg

0.2 (mmol) x 10 (kg) = 2 mmol/hour x 3 hours = 6 mmol

6 mmol (= 4.5 ml of 10% KCl solution) diluted in 150 ml of NaCl 0.9% and
administered over 3 hours

15 kg
0.2 (mmol) x 15 (kg) = 3 mmol/hour x 3 hours = 9 mmol
9 mmol (= 6.5 ml of 10% KCl solution) diluted in 225 ml of NaCl 0.9% and
administered over 3 hours

– Adult: 40 mmol (= 3 ampoules of 10 ml of 10% KCl) in one litre of 0.9% sodium

chloride, to be administered over 4 hours. Do not exceed 10 mmol/hour.

The infusion may be repeated if severe symptoms persist or if the serum potassium
level remains < 3 mmol/litre.

Contra-indications, adverse effects, precautions

– Administer with caution to elderly patients.
– Administer with caution and reduce the dose in patients with renal impairment
(increased risk of hyperkalaemia).
– May cause:
• in the event of rapid or excessive administration: hyperkalaemia, cardiac
conduction and rhythm disorders, potentially fatal;
• in the event of extravasation: necrosis.
– Infusion must be constantly monitored.

Remarks
– A 7.5% potassium solution contains 1 mmol of K+/ml; a 11.2% solution contains 1.5
mmol of K+/ml; a 15% solution contains 2 mmol of K+/ml; a 20% solution contains
2.68 mmol of K+/ml.
– Moderate hypokalaemia is defined as a potassium level < 3.5 mmol/litre; severe
hypo kalaemia as a potassium level ≤ 2.5 mmol/litre.
– Storage: below 25 °C

kcl dosage and duration.

NEVER USE BY IV OR IM OR SC INJECTION. Potassium chloride must always be

administered by slow IV infusion, diluted in 0.9% sodium chloride.
– For dilution:
• The potassium concentration in the infusion fluid should not exceed 40
mmol/litre.
• Mix thoroughly the potassium and the 0.9% sodium chloride solution by inverting
at least 5 times the infusion bottle or bag.

10 kg

0.2 (mmol) x 10 (kg) = 2 mmol/hour x 3 hours = 6 mmol

6 mmol (= 4.5 ml of 10% KCl solution) diluted in 150 ml of NaCl 0.9% and
administered over 3 hours

15 kg

0.2 (mmol) x 15 (kg) = 3 mmol/hour x 3 hours = 9 mmol

9 mmol (= 6.5 ml of 10% KCl solution) diluted in 225 ml of NaCl 0.9% and
administered over 3 hours
– Adult: 40 mmol (= 3 ampoules of 10 ml of 10% KCl) in one litre of 0.9% sodium
chloride, to be administered over 4 hours. Do not exceed 10 mmol/hour.

Maintenance or Prophylaxis,
Typical dose is 20 mEq per day.

V. Management: Oral Potassium Replacement

Dietary Sources: Fruits and Vegetables
See Foods with High Potassium Content
May supply 40-60 meq/day
However 40 meq is equivalent to 4 bananas which may be difficult to sustain
Dietary Potassium (Potassium phosphate) is less effective replacement than KCl
Most Hypokalemia is associated with concurrent chloride depletion
Oral KCl 20-40 meq immediate release powder in water or juice or KCl extended
release tablets
Powder has unpleasant taste (patients may prefer Swallowing tablets)
Serum Potassium < 3.0 mEq/L (total body deficit 200-300 meq)
Give KCl 20 meq orally every 2 hours for 4 doses, then recheck level OR
Give KCl 40 meq orally every 2 hours for 2 doses, then recheck level
Typically continue Potassium Replacement at 20 meq twice daily for 4-5 days
Serum Potassium: 3.0 to 3.5 mEq/L (total body deficit 100-200 meq)
Give KCl 20 mEq orally every 2 hours for 2 doses OR KCl 40 mEq once, then recheck
level
Typically continue Potassium Replacement at 20 meq twice daily for 2-3 days
Maintenance dosing
KCl 20 mEq orally daily when on Loop Diuretics or for Hyperaldosteronism
VI. Management: IV Potassium Replacement
IV Preparations
Potassium Chloride (KCl) 10 meq IV "K bump"
Potassium Chloride (KCl) 20 meq use is limited to delivery via Central IV Access
IV Replacement Algorithm
Use 10 meq KCl IV in 50ml solution over 30 minutes minimum
Dextrose containing IV solution not recommended
Risk of Insulin induced exacerbation of Hypokalemia
In select situations, may give up to 40 meq in 1 hr
Example indication for faster delivery: DKA
Cardiac monitoring if replacing >10 mEq per hour
Recheck Serum Potassium after 30 mEq given
Serum Potassium < 3.0 mEq/L (total body deficit 200-300 meq)
Give KCl 10 meq IV slowly every hour for 5 doses, then recheck level
Serum Potassium: 3.0 to 3.5 mEq/L (total body deficit 100-200 meq)
Give KCl 10 meq IV slowly every hour for 3 doses, then recheck level