Fluid & Electrolyte Q 30

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The physician has ordered IV replacement of potassium for a patient with severe hypokalemia. The nurse would administer this:

  

    A. By rapid bolus

    B. Diluted in 100 cc over 1 hour

    C. Diluted in 10 cc over 10 minutes

    D. IV push

    

    

Correct Answer: B. Diluted in 100 cc over 1 hour

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Potassium must be well diluted and given slowly because rapid administration will cause cardiac arrest. Intravenous KCl may be used as an alternative in these cases if the patient cannot tolerate oral KCl. Severe (less than 2.5 mEq/L) or symptomatic hypokalemia necessitates intravenous administration of KCl.

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Option A: Injectable KCl formulations have the potential to cause injection site complications (e.g., phlebitis, erythema, thrombosis, etc.). Also, rapid injection of KCl can precipitate mild hyperkalemia. If the necessary infusion rate for such cases is greater than 10 mEq/hour, the KCl should be administered through a central line and with cardiac monitoring.

Option C: Patients treated with intravenous KCl may require more frequent checking, especially if the serum potassium level addressed is below 2.5 mEq/L. The use of continuous cardiac monitoring can aid in correlating symptoms with telling electrocardiogram (ECG) changes (e.g., peaked T waves in hyperkalemia, flattened T waves in hypokalemia, etc.).

Option D: KCl toxicity is primarily a discussion of hyperkalemia. Like hypokalemia, the potentially fatal complication of hyperkalemia is cardiac arrhythmia. The risk for cardiac arrhythmia is significant at serum potassium levels greater than 6.0 to 6.5 mEq/L.

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