D5.2NS with 20 mEq KCL @ 75 ml/hr

Esme12, ASN, BSN, RN · Apr 13, 2012

Of course it is. It's sugar, salt and water with potassium. All things your body has and needs. what made you think it wasn't safe?

Celt42 · Apr 13, 2012

Actually, I finally found the answer. The med itself is safe, but you run the risk of fluid overload and electrolyte imbalance with the dosage. 1000 ml is an adult dose, a four year old should have 250 ml at 51 ml/hr instead of 75 ml/hr

Esme12, ASN, BSN, RN · Apr 14, 2012

Well done!

Double-Helix, BSN, RN · Apr 14, 2012

Actually, I finally found the answer. The med itself is safe, but you run the risk of fluid overload and electrolyte imbalance with the dosage. 1000 ml is an adult dose, a four year old should have 250 ml at 51 ml/hr instead of 75 ml/hr

Well, not exactly.

Saying that 1000mL is an adult dose doesn't make any sense. You aren't giving a bolus of fluid, you are giving a continuous infusion for maintenance hydration. If you give 1000mL of fluid over 20 hours, is that still an adult dose?

Also, this is a pediatric patient. Pediatric dosages are calculated by weight. Here is a simple way to calculate the fluid requirement for a pediatric patient:

Fluid Requirements for Children

So going by this chart, if your patient weighs 30kilograms, their daily fluid requirement would be 1500 mL + 20ml/kg for each kilogram over 20. Since they weigh 30kg, their requirement is 1500 + 20 x 10 = 1700 mL of fluid per day. (Keep in mind that your post-op patient is not drinking anything by mouth, so their entire fluid requirements must come from the IV fluid.)

Divide that by 24 hours per day and you get a rate of approximately 71 mL of fluid per hour in order to meet the daily fluid requirement.

The hourly fluid rate may also need to be increased in certain situations, such as the patient is dehydrated or has a fever (fever = higher metabolic rate = greater insensible fluid loss)

What you need to think about here is the amount of potassium the patient is receiving. What is the safe dose for IV potassium chloride?

I'm guessing that you looked it up and found that the minimum dilution of KCl is 20mEq in 250mL. That's where you came up with the statement that 250 mL is the pediatric dose.

However, what that means is that you may not give more than 20mEq of KCl in less that 250mL of another fluid because it will be too concentrated and could cause damage to the veins. Also, this dose cannot be given over less than an hour. This is for both pediatric and adult patients.

What you really need to know is that the maximum rate of a continuous infusion of potassium is 10mEq/hour. How much potassium is your patient getting? You may not know that the type of fluid you have should be correctly written as: D5 0.2% NS with 20mEq KCl/L. Meaning that one liter of the fluid contains 20 mEq.

Since your patient is getting 75 ml/h, that means it will take about 13 hours for the patient to get one liter, or 20 Meq of potassium chloride. 20 mEq divided by 13 hours is about 1.5 mEq of potassium per hour, which is well within the safe dosage range.

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Saying that a 4 year old should get 250mL at 51 mL per hour only gives them 5 hours of fluid. It's not a correct response because their fluid needs are based on their weight and clinical presentation, not their age.

So redo your calculations based on the weight of your patient and considering any factors that might increase the need for more fluid. Depending on your patient's weight, you may come to a different conclusion about whether this is a safe dose or not.

Esme12, ASN, BSN, RN · Apr 14, 2012

Ashley's right.....I was just being simplistic for the answer to the question that you deducted what was wrong with the statement in the question of the IVF being unsafe. What Ashley says about overall fluid administration is accurate and well said.

KelRN215, BSN, RN · Apr 14, 2012

Actually, I finally found the answer. The med itself is safe, but you run the risk of fluid overload and electrolyte imbalance with the dosage. 1000 ml is an adult dose, a four year old should have 250 ml at 51 ml/hr instead of 75 ml/hr

1000 mL is the size of the bag, not the dose. Whether you have a 1000 mL bag or a 250 mL bag, the child's rate for fluid maintenance is going to be the same, the only difference is how often you'd have to change the bag. Without knowing the child's weight, it is impossible for us to tell you if that is the correct rate, as fluid maintenance in pediatrics is based on weight, not age. Fluid maintenance in pediatrics is 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg and 1 mL/kg/hr thereafter.

Assuming that 51 mL/hr is the child's maintenance rate though, that doesn't necessarily mean that 75 mL/hr is wrong. There are some situations which warrant maintenance and a half IV fluid.

turnforthenurse, MSN, NP · Apr 14, 2012

I had an adult patient on D5 1/4NS with 10mEq KCl going at 30cc/hr. 1000cc bag.

I would think for a child it would be less...

KelRN215, BSN, RN · Apr 14, 2012

Perhaps your adult patient was on some kind of fluid restriction. 30 mL/hr is fluid maintenance for a 7.5 kg child... which would be the typical size of a 6 month old baby.