High risk medicine.
The use of pre-mixed potassium chloride solutions are preferred where possible.
The addition of potassium chloride to the maintenance fluids is preferred over the use of a side line to minimise the risk. Additional potassium chloride must not be added to premixed potassium chloride intravenous solutions.
Recommended to store only 10 mmol/10 mL potassium chloride concentrated ampoules to avoid errors. At Canberra Hospital, a premixed solution of 10mmol/100mL is available and stored in NICU.
Concentrated potassium ampoules MUST BE DILUTED prior to intravenous infusion.
When correcting severe or symptomatic hypokalaemia – Avoid diluting with glucose solution as serum potassium level may further decrease.
Osmolality of 1 mmol/1 mL of potassium chloride = 2000 mOsm/L.(1)
Intravenous (IV) fluids with regular pre-mixed 2 mmol/100 mL (20 mmol/L) potassium chloride provides a daily maintenance dose of 2.4 to3.0 mmol/kg/day of potassium at 120 to150 mL/kg/day.
Standard Australian consensus amino-acid formulations and paediatric IV fluids have 2 mmol/100 mL potassium chloride.
Central IV administration: maximum concentration is 80 mmol potassium chloride/L (0.08mmol/mL).(2)
Peripheral IV administration: maximum concentration is 40 mmol potassium chloride/L (0.04mmol/mL).(2)
A maximum concentration of 200mmol/L for central line and 80 mmol/L through peripheral IV has also been suggested. Given the availability of 10mmol/100mL solution at Canberra hospital, the preferred option is to use this preparation undiluted through a central line.(12)
Consider all sources of potassium including parenteral nutrition when calculating total daily dose.
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