Potassium IV solutions

Hi everyone,

I need some help with something that happened on the medical unit today, my pt was admitted for liver failure and had a history of alcoholism. Upon receiving the patient I went to look at the morning labs and collect my usual information. I noticed however that the potassium level was at 2.6!... extremely low. Anyways so i went hunting around for information trying to figure out if the LPN had called the doctor or if anyone was aware. After I called the doctor he told me to start the pt on NS with 40 KCl.... However at 0800 I had already administered 1200 mg of potassium supplements. I didnt even THINK of this as I set the IV pump and went on with my day.

As soon as went to give the 1000 meds I noticed that I had given the 1200 mg of potassium and that the pt was also on KCl IV as well.

Long story short the pt was ok, but i was wondering what you would have done, since i had no orders to stop the potassium supplements, i know i should have informed the doctor that i had given them.

Close call.. NEVER doing that again.
What do you mean by 1200mg of potassium supplements?

I'm also curious - what Potassium supplements come in milligrams rather than mEq? At first I thought you just mis-typed Mg rather than mEq, but the dose of 1200 made me think that it's a dietary supplement rather than pure potassium.Depending on the answer to that question, I think you're OK. Sure, it would have been best to remind the MD of the supplements, but hanging a maintenance fluid with KCl on a pump likely would not be affected by the supplements, since they don't appear to be on a par with actual mEq's of Potassium.

It was definetly 1200 MG... And you know.. now that I think of it... I am not sure.. they were big round slow release potassium supplements... I have never seen the other kind before.Later on today I got called in to file an incident report...??? This is why I am kind of trying to figure out if giving those potassium pills would have caused harm along with the NS 40 KCl..

I'm not familiar with 1200mg potassium supplements either. I've only seen potassium in any form measured in meqs. A potassium level of 2.6 could probably require more than 40meqs of repletion to get above 4.0 anyway. What exactly did they want you to fill an incident report out for?

I take big round slow release potassium supplements - - 4 of them. They are 20 mEq each. I can't imagine how many more anyone would take!

40 mg equal 1 meq. So, essentially you gave 30 meq. I am sure the patient definitely needed it. Now, you have to wonder why was the patient taking this much potassium daily. I am sure they needed it in addition to the iv. Whenever I've had a pt with that low of a k level I've given po + iv. How, do they know you didn't tell the doctor? Anyways, unless there is some renal issues I'm sure you didn't give that patient enough with that daily dose plus the extra that was ordered.

I'm not sure why you had to fill out an incident report. A K of 2.6 is really low. The IV fluid with 40 mEq total is in the entire bag, which probably will run over many hours. You needed to give quite a bit of KCl, probably 60 to 80 mEq PO . . . I don't know what the 1200 mg supplement is, but I don't think you even gave enough. I would do some research into those supplements and find out how much you actually gave, then decide whether to dispute the incident report.

If what the above poster is true (with you giving 30 mEq of KCL PO = 1200mg), For a K+ of 2.6, getting 30 mEq PO + 40 mEq of IV KCL isn't all that much, especially with normal renal function. It's also not uncommon to administer by both routes at the same time. What I am not seeing is how fast you administered the 1L bag of fluids with the 40mEq KCL in it. Did you put it on a pump as IVF at a certain rate? That should have been fine. You didn't rapidly infuse a bag of IVF in with 40 mEq of KCL in it, did you? That is the only mistake I can come up with in this scenario.

The amount of supplements and IV would not be harmful unless the patient has poor renal clearance. Supplemental potassium depends on the body for absorption and it seems as if your patient either does not absorb, or is wasting potassium. I personally don't think you did anything wrong. The lab should have been reported as a critical value by the nurse that received the report.

Perhaps she had to fill out an incident report to explain that the nurse before her didn't call the K+ value to the dr to get it taken care of?...

It's not unusual for alcoholics to have chronically low electrolytes, and at 2.6 you would have a hard time overloading him with potassium, particularly since the patient was only receiving part of the potassium in IV form. Aside from limitations based on the type of IV, potassium shouldn't be given at a rate faster than 40meq per hour when given IV because of the potentially harmful extreme intracellular/extracellular electrolyte shifts that occur at rates faster than that, but it doesn't sound like you were anywhere near exceeding that limit.The one potential issue is that with a peripheral IV, you should not exceed 250ml hour when using a 40meq/liter bag. (Our policy is that 10meq Kcl/hr is the max for a peripheral IV).

It takes a bag with 20 mEq KCl to basically stay normal. If you're givimg IVF that has less potassium (perhaps 10 mEq), you're likely going to slowly drop your level, if you give above 20 mEq KCl in your IVF, you'll SLOWLY raise it.Nothing you did sounds off to me. Before calling a physician to report a critical K value, I'd make sure I had their other electrolyte values in front of me, along with their medications (especially supplements and diuretics.)But like I said, it doesn't sound like you did anything abnormal giving oral potassium supplements along with what is just a tiny bit extra IV potassium in the fluids.