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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

POTASSIUM CHLORIDE

Indication

  • the prevention or treatment of potassium depletion, which may occur with severe vomiting, diarrhea, intestinal drainage or malabsorption, prolonged diuresis, cardiac dysrhythmias (due to digitalis glycosides) or prolonged alkalosis

Pharmacology

  • major cation of intracellular fluid; essential for intracellular function, conduction of nerve impulses, contraction of cardiac, skeletal, and smooth muscles; maintenance of normal renal function and enzyme action
  • the normal potassium requirement for the low birth weight infant is 1-3 mmol/kg/day
  • potassium salts are well absorbed from the GI tract

Side Effects

  • gastrointestinal - vomiting, diarrhea, bleeding, distention and pain (with oral preparations)
  • hyperkalemia (most common and serious hazard) - listlessness, irritability, muscle weakness, hypotension, respiratory distress, cardiac dysrhythmias, heart block, cardiac arrest

Precautions

  • usually administered as a continuous IV infusion; therefore, ensure correct dilution and compatibility with IV solution and infuse at exactly the prescribed rate; fast infusion can elicit side effects of hyperkalemia
  • monitor ECG, serum potassium levels and levels of other electrolytes (chloride, sodium, calcium); peaking of T-waves on the ECG occur with hyperkalemia
  • monitor intake and output
  • liquid potassium supplements for oral use should be diluted with water or feeds before administration
  • extravasation may cause tissue sloughing and necrosis
  • monitor for adequate renal function (potassium is mainly excreted by the kidneys)

Dose

  • highly individualized

    Oral Replacement Therapy
    • 1 to 3 mmol/kg/day
    • divide into frequent doses and give with feeds
     
    Acute Treatment of Symptomatic Hypokalemia
    • begin with 0.5 to 1 mmol/kg/hr for 1 hour, then reassess
    • dilute before administration: do not exceed a concentration of 40 mmol/L
  • ensure dosages are double-checked

Available

  • various KCl solutions are available throughout the hospital. If a certain required solution is not available please call the pharmacy (or the pharmacist on-call)
  • 1.3 mmol/mL oral solution
  • NOTE: 1 mmol K = 1 mEq K

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  3. Ford DC, Leist ER and Phelps SJ: Guidelines for administration of intravenous medications to pediatric patients, American Society of Hospital Pharmacists, Bethesda, MD, 1988.
  4. Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.



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