Dilution Potassium Chloride - KCL

Potassium chloride (KCL)

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Usual Diluents

NS, D5W

Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]

(Floors: 10 meq/hr )
[10 meq] [100 ml] or
[20 meq] [250 ml] or
[40 meq] [500 ml]ICU's:
[20 meq] [100 ml] [1-2 hours]

Primary admixture - 'Ready-to-use' KCL 20 meq/100ml - Floors and ICU:
Ready-to-use, solution of Potassium Chloride, USP in Water for Injection, USP for electrolyte replenishment in a single dose container for intravenous administration.20 mEq/100 mL: Osmolarity: 400 mOsmol/L
[Peripheral line may be used - Monitor for pain during the infusion and adjust rate if needed.]
[Normal physiologic osmolarity range is approximately 280 to 310 mOsmol/L.]

DOSAGE AND ADMINISTRATION
The dose and rate of administration are dependent upon the specific condition of each patient.

Administer intravenously only with a calibrated infusion device at a slow, controlled rate. Because pain associated with peripheral infusion of Potassium Chloride solution has been reported, whenever possible, administration via a central route is recommended for thorough dilution by the blood stream and avoidance of extravasation. Highest concentrations (300 and 400 mEq/L) should be exclusively administered via central route. Administration of substantially hypertonic solutions (>/=600 mOsmol/L) may cause vein damage.

Recommended administration rates should not usually exceed 10 mEq/hour or 200 mEq for a 24 hour period if the serum potassium level is greater than 2.5 mEq/liter.

In urgent cases where the serum potassium level is less than 2.0 mEq/liter or where severe hypokalemia is a threat, (serum potassium level less than 2.0 mEq/liter and electrocardiographic changes and/or muscle paralysis) rates up to 40 mEq/hour or 400 mEq over a 24 hour period can be administered very carefully when guided by continuous monitoring of the EKG and frequent serum K+ determinations to avoid hyperkalemia and cardiac arrest. Baxter Healthcare Corporation

HOW SUPPLIED
Potassium Chloride Injection in Viaflex® Plus plastic containers is available as follows:
2B0826 10 mEq/100 mL NDC 0338-0709-48 [ Osmolarity: 200 mOsmol/L ]
2B0821 10 mEq/50 mL NDC 0338-0705-41 [ Osmolarity:: 400 mOsmol/L ]
2B0827 20 mEq/100 mL NDC 0338-0705-48 [ Osmolarity: 400 mOsmol/L ]
2B0823 30 mEq/100 mL NDC 0338-0707-48 [ Osmolarity: 601 mOsmol/L ]
2B0822 20 mEq/50 mL NDC 0338-0703-41 [Osmolarity: 799 mOsmol/L ]
2B0824 40 mEq/100 mL NDC 0338-0703-48 [ Osmolarity: 799 mOsmol/L ]

Source:
Deerfield, IL 60015 USA
Printed in USA
©Copyright 1988, 1989, 1990, 1991, 1994, Baxter Healthcare Corporation.
All rights reserved.
07-19-73-138
Rev. April 2014

Stability / Miscellaneous

For intravenous use only. Must be diluted prior to injection.

EXP: 1 DAY (RT)
[Normal range: 3.5 to 5 meq/L]

DESCRIPTION
Potassium Chloride for Injection Concentrate, USP is a sterile, nonpyrogenic, hypertonic, concentrated solution of Potassium Chloride, USP in Water for Injection, USP to be administered by intravenous infusion only after dilution in a larger volume of fluid.

Each mL of Potassium Chloride for Injection Concentrate, USP contains 2 mEq (150 mg) of Potassium Chloride, USP. Osmolarity: 4024 mOsmol/L (calc). pH: 6.0 (4.0 to 8.0). It does not contain an antimicrobial agent.

Potassium Chloride for Injection Concentrate, USP (appropriately diluted) is a parenteral fluid and electrolyte replenisher.

CLINICAL PHARMACOLOGY
Potassium is the chief cation of body cells (160 mEq/liter of intracellular water) and is concerned with the maintenance of body fluid composition and electrolyte balance. Potassium participates in carbohydrate utilization and protein synthesis, and is critical in the regulation of nerve conduction and muscle contraction, particularly in the heart. Chloride, the major extracellular anion, closely follows the metabolism of sodium, and changes in the acid-base of the body are reflected by changes in the chloride concentration.

Normally about 80 to 90% of the potassium intake is excreted in the urine, the remainder in the stools and to a small extent, in the perspiration. The kidney does not conserve potassium well so that during fasting, or in patients on a potassium free diet, potassium loss from the body continues resulting in potassium depletion. A deficiency of either potassium or chloride will lead to a deficit of the other.

INDICATIONS AND USAGE
Potassium Chloride for Injection Concentrate, USP is indicated in the treatment of potassium deficiency states when oral replacement therapy is not feasible.

CONTRAINDICATIONS
Potassium Chloride for Injection Concentrate, USP is contraindicated in disease where high potassium levels may be encountered, and in patients with hyperkalemia, renal failure and in conditions in which potassium retention is present.

WARNINGS
This injection is for preparation of intravenous admixtures only, not for direct infusion.

To avoid potassium intoxication, do not infuse these solutions rapidly. In patients with renal insufficiency, administration of potassium chloride may cause potassium intoxication and life-threatening hyperkalemia.

The administration of intravenous solutions can cause fluid and/or solute overload resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentration. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentration.

WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 µg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

ADVERSE REACTIONS
Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, hypervolemia, and hyperkalemia.

Too rapid infusion of hypertonic solutions may cause local pain and, rarely, vein irritation. Rate of administration should be adjusted according to tolerance.

Reactions reported with the use of potassium-containing solutions include nausea, vomiting, abdominal pain and diarrhea. The signs and symptoms of potassium intoxication include paresthesias of the extremities, areflexia, muscular or respiratory paralysis, mental confusion, weakness, hypotension, cardiac arrhythmias, heart block, electrocardiographic abnormalities and cardiac arrest. Potassium deficits result in disruption of neuromuscular function, and intestinal ileus and dilatation.

If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.

OVERDOSAGE
In the event of fluid overload during parenteral therapy, reevaluate the patient’s condition, and institute appropriate corrective treatment.

In the event of overdosage with potassium-containing solutions, discontinue the infusion immediately and institute corrective therapy to reduce serum potassium levels.

Treatment of hyperkalemia includes the following:

Dextrose Injection, USP, 10% or 25%, containing 10 units of crystalline insulin per 20 grams of dextrose administered intravenously, 300 to 500 mL per hour.
Absorption and exchange of potassium using sodium or ammonium cycle cation exchange resin, orally and as retention enema.
Hemodialysis and peritoneal dialysis. The use of potassium-containing foods or medications must be eliminated. However, in cases of digitalization, too rapid lowering of plasma potassium concentration can cause digitalis toxicity.

DOSAGE AND ADMINISTRATION
Potassium Chloride for Injection Concentrate, USP must be diluted before administration. Care must be taken to ensure there is complete mixing of the potassium chloride with the large volume fluid, particularly if soft or bag type containers are used.

The dose and rate of administration are dependent upon the specific condition of each patient.

If the serum potassium level is greater than 2.5 mEq/liter, potassium can be given at a rate not to exceed 10 mEq/hour in a concentration of up to 40 mEq/liter. The 24 hour total dose should not exceed 200 mEq.

If urgent treatment is indicated (serum potassium level less than 2.0 mEq/liter and electrocardiographic changes and/or muscle paralysis), potassium chloride may be infused very cautiously at a rate up to 40 mEq/hour. In such cases, continuous cardiac monitoring is essential. As much as 400 mEq may be administered in a 24 hour period. In critical conditions, potassium chloride may be administered in saline (unless contraindicated), rather than in dextrose containing fluids, as dextrose may lower serum potassium levels.

Source: [package insert]