Below is a detailed list of foods that contain potassium. Potassium phosphates injection is only for administration to a patient with a serum potassium concentration less than 4 meqdl see warnings and precautions 5. Potassium is a silverywhite metal that is soft enough to be cut with a knife with little force. Crystalloid solutionsiv fluids containing varying concentrations of electrolytes.
St georgesutherland hospitals and health services stg renal. Addition of concentrated potassium chloride to iv infusion fluid bags has some serious. Intravenous fluid therapy childrens hospital colorado. Thus, under ordinary conditions where a patient has a normal cardiovascular status, and normal renal function, adequate electrolytes will be provided using an intravenous fluid containing. Learn the purpose of this procedure and what to expect. Research article outcomesofaclinicalpathwaytostandardizeuse. These fluids have been associated with morbiditymortality secondary to hyponatraemia. Safe use of potassium chloride kcl oral and intravenous prompt doc no. Recommend an appropriate intravenous fluid regimen based on a patients clinical characteristics. Its the fluid of choice for resuscitation efforts as well. Intravenous solutions with potassium chloride rx only. If the potassium concentration is 4 meqdl or more, use an alternative source of phosphate. Potassium chloride is widely used and administered intravenously in diluted solutions to treat low potassium levels hypokalaemia in more seriously ill patients.
Ensure hypomagnesaemia is also corrected as this will assist. Oralngtube fluids are safer because they are much less likely to cause salt fluid overload, electrolyte abnormalities and do not require a cannula infection risk. To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with. Identify common intravenous fluid regimens and describe appropriate dosages and concentrations for electrolyte additives. The nurse realizes that the reason the pt is receiving this replacement. To be removed after 1stpp on target not all iv fluids are the same. Pharmacist objectives discuss the distribution of total body fluid, and apply this concept towards the management of a patients fluid replacement. When calculating fluid rates, care must be taken that a safe rate of iv potassium administration is adhered to. Potassium should not be added to intravenous fluid bags as this is dangerous. Intravenous fluids hourly maintenance intravenous fluid requirements resuscitation bolus normal saline. Demonstrate the procedure for iv insertion, conversion to a saline lock, administration of iv fluids, discontinuation of the iv identify possible complications of intravenous therapy and nursing interventions to treat each. O is responsible for ensuring appropriate pathology request forms are completed and results checked. Only in critical care areas give up to 40mmol in 100ml bags via a central line at 2550mlhr.
Furthermore, ecw at birth and insensible water loss decrease as birth weight and gestational age increase. These are plasma substitutes and contain large molecular substances which will not escape through the vessel walls and tend to prevent the circulating fluid from leaking into the tissues. Your dietitian will explain its importance and how many serves from each food. Maintenance intravenous fluids ivfs are used to provide critical supportive care for children. The australian council for safety and quality in health care has issued a highrisk medication alert for intravenous potassium chloride see box for recommendations. Moritz, md, faap,o subcommittee on fluid and electrolyte therapy maintenance intravenous fluids ivfs are used to provide critical supportive care for children who are acutely ill. Administration of iv potassium chloride is a potentially dangerous procedure, where errors in calculation, preparation of potassium containing iv solutions or too rapid rate of administration can result in death. Before administering this solution to the patient, it is essential that the nurse. Iv fluids when administering iv fluids, the type and amount of fluid may influence patient outcomes. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 meq or more of the total body stores of potassium. The hollidaysegar equation remains the standard method for calculating maintenance fluid requirements. Algorithms for iv fluid therapy in adults weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24hour period. Extracellular spacespace outside the cells consisting of the intravascular and interstitial spaces. Weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a.
Safe prescribing of intravenous potassium and other electrolytes. Intravenous fluid guidelines paediatric and neonatal. Monitoring of serum potassium levels monitor daily serum potassium levels on all patients requiring intravenous potassium. Caution in patients with renal failure lr contains some potassium. Fluid type does not matter as long as, over 24 hours, it approximately matches the normal requirements for their weight in terms of water, sodium and potassium. Prior to entering vial, remove the metal seal and cleanse the rubber closure with a suitable antiseptic agent. Shsct policy for the use of potassium chloride concentrate intravenous solution and other strong potassium solutions page 3 of 1. One of the most common iv fluids, it is administered for most hydration needs. Patients with low potassium levels may require intravenous potassium very quickly, within minutes. Drugs that increase the vasopressin effect reduce renal electrolyte free water excretion and may also increase the risk of hyponatremia following treatment with intravenous fluids. Pdf best practices for safe handling of products containing.
Potassium phosphates injection, usp 3 mmolml, is indicated as a source of phosphate, for addition to large volume intravenous fluids to prevent or correct hypophosphatemia in patients with restricted or no oral intake. Potassium chloride in sodium chloride injection, usp in patients receiving products, such as diuretics, and certain antiepileptic and psychotropic medications. Potassium chloride in sodium chloride injection, usp in. Intravenous fluid management is a common medical task, and safe unambiguous fluid prescribing is a required training outcome for junior doctors. Never give injectable potassium chloride undiluted. Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Pathway implementation was supported by the creation of an electronic order set powerplan and hospitalwide education. In an effort to reduce the risks associated with the use of intravenous potassium chloride, the australian council for safety and quality in health care has issued a highrisk medication alert for. Check maintenance fluids infusion rate according to weight. Potassium chloride in 5% dextrose injection, usp in plastic fda. Highlights of prescribing information phosphorus 150 mmol50. Lothian guidance for intravenous fluid and electrolyte. Potassium chloride in sodium chloride injection fda. Potassium containing fluids must be given via a pump.
Traditionally hospitals bought a small range of fluids combining saline. Parenteral drug products should be inspected visually for particulate matter and discoloration, whenever solution and container permit. Do not infuse with calciumcontaining intravenous fluids see warnings and. The solution is administered after dilution by the intravenous. Intravenous fluids would not be the initial intervention. Optimum hydration performance decreases with water loss of 2% or more of body weight prehydration prior to exercise helps avoid excessive losses during exercise goal to be euvolemic measuring body weight prior to and after exercise can estimate sweat rates electrolytes also need to. Solutions which contain potassium ions should be used with great care, if at all, in patients with hyperkalemia, severe renal failure and in conditions in which potassium. Colloid solutionsiv fluids containing large proteins and molecules that tend to stay within the vascular space blood vessels. Apr 28, 2007 pokalaemia if their intravenous replacement fluids do not contain potassium. Besides the use of hypotonic fluids, many hospitalized children are felt to have nonosmotic stimuli for antidiuretic secretion e.
If oral supplementation is not possible, use potassium containing maintenance fluids ready mixed e. All paediatric patients on intravenous fluids will have minimum daily electrolyte monitoring. In order to reduce microbiological hazards it is recommended that further dilution be effected immediately prior. Mandatory standard for intravenous potassium wa health. Hypokalemia is treated with oral or intravenous potassium. Parenteral must be diluted prior to administration. If the potassium concentration is 4 meqdl or more, use an alternative source of phosphorus. Adding potassium to bags of fluid on the ward is a safety risk. Potassium chloride concentrate solution can be fatal if given inappropriately. Maintenance intravenous fluids in children american academy of.
A client has been receiving intravenous iv fluids that contain potassium. The product and its admixtures contain no antimicrobial agent. Intravenous fluid therapy in adult inpatients the bmj. At birth, there is an excess of extracellular water ecw, and this decreases over the first few days after birth. Hypotonic fluid containing a sodium concentration less than plasma is no longer recommended in children. Develop an effective electrolyte replacement plan based on a patients clinical status and electrolyte abnormalities. Different fluid types were considered in detail in part one of this article. Inadvertent infusion of kcl via an epidural catheter kcl mistaken for ns to dilute anaesthetic 7.
Potassium phosphates injection is indicated as a source of phosphorus in intravenous fluids to correct hypophosphatemia in adults and pediatric patients 12 years of age and older when oral or enteral replacement is not possible, insufficient or contraindicated. Bicarbonate would be contraindicated as the ph is already high. To ensure you are reading the current version, check the policy and procedure site on the alfred health intranet. Potassium is a chemical element with the symbol k from neolatin kalium and atomic number 19. Not enough information is given to determine the need for intravenous fluids.
In a patient with metabolic acidosis, potassium chloride can be added to the buffer containing intravenous fluids, whereas potassium chloride is added preferentially to normal saline solution for the patient with metabolic alkalosis. The requirements for fluids and electrolytes of the newborn infant are unique. All patients receiving iv diuretics who had a serum potassium level less than 4. The iv site is red and there is a red streak along the vein that is painful to the client. Hypotonic a hypotonic solution shifts fluid out of the intravascular compartment, hydrating the cells and the interstitial compartments. Do not infuse with calcium containing intravenous fluids see warnings and precautions 5. This protocol has been developed based upon the need for providing safe and effective guidelines for the infusion of intravenous potassium salts and to reduce the occurrence or potential occurrence of medication errors or adverse effects. Potassium is the chief cation of body cells 160 meqliter of intracellular water. November 20 page 1 of 7 the hard copy of this document may be out of date. Potassium chloride concentrate is compatible with most commonly used intravenous infusion fluids. In an accompanying editorial, waikar and winkelmayer discuss the effects of chloride on renal function. National patient safety agency patient safety alert.
Delineate the differences between colloid and crystalloid fluids, and recall appropriate instances for their use. Solutions containing potassium chloride are contraindicated in diseases where high potassium levels may be encountered. Potassium chloride potassium chloride injection, solution. Hypertonic a hypertonic solution draws fluid into the intravascular compartment from the cells and the interstitial compartments. Pressurizing intravenous solutions contained in flexible plastic containers to. Potassium phosphates fda prescribing information, side. Sep 15, 2015 because use of intravenous potassium increases the risk of hyperkalemia and can cause pain and phlebitis, intravenous potassium should be reserved for patients with severe hypokalemia, hypokalemic. Potassiumcontaining fluids must be given via a pump. Use of intravenous fluid with a sodium concentration of 140mmoll has a lower risk of hyponatraemia than fluids containing less than 140mmoll sodium.
We created an evidencebased clinical pathway to guide providers on the indications for ivf, its preferred composition, and appropriate clinical monitoring. Intravenous fluid regulation is the control of the amount of fluids you receive in a vein through an iv. Medication distribution intravenous potassium administration. Crystalloids crystalloid solutions contain small molecules that flow easily across semipermeable membranes, from the bloodstream into the cells and body tissues. Patients have died in hospitals both in australia and overseas after being mistakenly injected with potassium chloride instead of normal saline. Policy for the use of potassium chloride concentrate. Intravenous fluid therapy in adults in hospital ncbi bookshelf. To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Potassium metal reacts rapidly with atmospheric oxygen to form flaky white potassium peroxide in only seconds of exposure. Education practice competent novice intravenous fluid therapy. Potassium administration of oral and intravenous infusion. Potassium phosphates injection is only for administration to a patient with a serum potassium concentration less than 4 meqdlsee warnings and precautions 5. Yunos and coauthors report on the association between a chlorideliberal vs chloriderestrictive intravenous fluid administration strategy and kidney injury in critically ill adults.
Iv fluid should be given via volumetric pump if a patient is on fluids for over 6 hours or if the fluid contains potassium. When administering iv fluids, the type and amount of fluid may influence. The usual adult dietary intake is 50 to 100 meq potassium per day. It is also useful as an additive for preparing specific intravenous. Dose and rate of administration are dependent on patient condition. The significance of potassium the pharmaceutical journal. A normal potassium level does not mean that there is no total body potassium deficit. Potassium phosphates injection, usp 3 mm pml millimolesml is a sterile, nonpyrogenic, concentrated solution containing a mixture of mono and dibasic potassium phosphate in water for injection. Potassium phosphates injection, usp is indicated as a source of phosphate, for addition to large volume intravenous fluids to prevent or correct hypophosphatemia in patients with restricted or no oral intake. Serum sodium at 24 hours postinitiation for patients continuing to receive 75% of their maintenance need via iv fluid subsequent serum sodium daily until iv fluid constitutes. It is found in low concentration in plasma and extracellular fluids 3. Individualize dose based on serum potassium levels.
Improper use of maintenance intravenous fluids ivfs may cause serious hospitalacquired harm. Potassium gluconate an overview sciencedirect topics. Potassium chloride and sodium chloride infusion solutions do not contain an. This often led to ivf bags being wasted when potassiumcontaining ivf were subsequently ordered after admission. Medication distribution intravenous potassium administration n 1107a intent. The form of the potassium does not affect its absorption and about 90 per cent of ingested potassium is absorbed, irrespective of the amount consumed. Absorption and elimination potassium is derived from the diet and the reference nutrient intake is 90mmol per day. Safe prescribing of intravenous potassium and other. Optimizing fluid and electrolyte status is the cornerstone of short bowel syndrome sbs management. Make sure to understand the differences between fluid products and their effects. Careful attention to fluid and electrolyte status is essential to not only avoid lifethreatening complications but also to minimize clinical interventions, to maximize the chance of success in weaning off intravenous fluids or parenteral nutrition, and above all to improve a patients. Weightbased potassium prescriptions should be rounded to the nearest common fluids available for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24hour period. Fluids and electrolytes ucsf benioff childrens hospital.
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