Rapid Correction of Hypokalemia Using Concentrated Intravenous Potassium Chloride Infusions

Rapid Correction of Hypokalemia in a Patient with an Implantable Cardioverter-Defibrillator and Recurrent Ventricular Tachycardia

“…Studies have shown that rapid replacement of potassium via central lines, generally defined as Ն20 mmol or mEq/h, results in only modest acute increases in serum potassium concentration, particularly in patients who have whole body potassium depletion. In these studies, rapid infusion is well tolerated cardiovascularly (23,24,26). Nevertheless, current recommendations are still generally limited to an infusion no greater than 20 mEq KCl/h.…”

“…Furthermore, the patient was under considerable psychological stress from these events. Recommendations over the years have varied and disagreed in regards to the maximum dose and rate of potassium that may be safely given (23,24). Some also have warned against rapid infusion of potassium solutions via central venous catheters out of concern for provoking life-threatening cardiac dysrhythmias.…”

“…Kruse and Carlson retrospectively examined rapid correction of hypokalemia in ICU patients who had received 20 mEq KCl/100 mL normal saline administered over an hour (24). Of these, 18% were admitted with the primary diagnosis of cardiac arrest, 14% with cardiac failure, and 7% with acute myocardial infarction (MI).…”

Disorders of Potassium Metabolism

“…Although significant variations can occur between patients, intravenous administration of 20 mmol KCl typically increases the serum potassium by ~0.25 mmol/l. 34 If more rapid replacement is necessary, 20 mmol/h can be administered through a central venous catheter, but simultaneous continuous ECG monitoring should be used under these circumstances.…”

Enteral potassium supplementation in a pediatric cardiac intensive care unit: Evaluation of a practice change

“…In most intensive care units, intravenous potassium supplementation is the preferred route of administration, despite the known safety risks (3,4). Inappropriate administration of intravenous potassium can lead to various adverse events, including cardiac arrest and death (5).…”