Fluids with + KCl

[lorichka6]

I'm a new peds nurse (just off orientation) and I have been wondering about the frequency that fluids are ordered with K. Most of what is ordered for these kiddos (general peds floor) is D51/2NS + 10 or 20K. Very few ever actually have low K. I even called a surgery MD once because the pt had a K of 4.7 and was ordered D51/2 + 20. You could hear the eye rolling over the phone :)

So what is the logic here? Is that 20K in 1000ml negligible? Are kids more likely to end up losing K than adults (I don't recall seeing this at all in nursing school on adult med surg floors)?

Thanks!

[NotReady4PrimeTime, RN]

Most children have perfectly normal, healthy kidneys. As long as they have urine output, a little bit of KCl in their IV fluid isn't a big deal. A lot of our post-ops will come with orders to the effect that IVF should be D5NS (or D10NS if the kid is under 10 kg) until urine output is present, then to add 20 mmol/L. In our peds cardiac ICU we even run KCl 1mmol/mL via central line to maintain their serum K+ between 3.1 and 5. Keeps their cardiac rhythms normal (since most of them will be on Lasix to maintain a neutral or negative fluid balance while their hearts recover). Our hospital never runs D5 1/2S on children because in our experience, hospitalized children become hyponatremic very quickly and the effects of hyponatremia on children's growing brains are highly undesirable.

[mrsboots87]

I am just a student, but we just learned about the common use of D5 1/2 NS with 20 mEq KCL. I could be wrong so definitely disregard if I am. But my understanding is that this is the most common IV fluid ordered for hospitalized patients (unless contraindicated) because it is giving the glucose for calories, and the 1/2 NS and KCL will usually just be filtered by the kidneys and are given prophylactic because the stress of being in the hospital, or from surgery, or just from illness in general can cause ADH and aldosterone to increase and cause potassium losses. But since that can also cause sodium retention, only 1/2 NS is given. If that helps then cool, if not then my bad.

[jrt4]

I don't typically see it routinely ordered unless the patient was dehydrated on admission or has a risk for dehydration/electrolyte imbalance. You would be surprised at how many patients are at risk for electrolyte imbalance in the hospital.

Other indications for K in fluids can be for critical issues such as KPhos in acidosis...etc... there are multiple indications.

If you are ever unsure, I would just ask the ordering provider!

[ShantheRN, BSN, RN]

We use K fluids all the time - in fact I usually question if the fluids don't have it! My population is hem/onc, though....and they are notorious for electrolyte imbalances, particularly during chemo cycles. However, if a kid came in with a K of 4.7, was eating/drinking fine, and they still wanted K fluids, I would definitely ask. It can't hurt to ask regardless. Let them roll their eyes. It's all fun and games till someone's kidneys or heart goes boom.

[~PedsRN~, BSN, RN]

D5 in 1/2 with 20KCl is our standard fluid order. I work inpatient, acute care. Surgery or trauma is more likely to run LR or NS, but your random kid that needs fluids (dehydration, poor PO, etc) is getting that fluid order.

[KelRN215, BSN, RN]

Most children have perfectly normal, healthy kidneys. As long as they have urine output, a little bit of KCl in their IV fluid isn't a big deal. A lot of our post-ops will come with orders to the effect that IVF should be D5NS (or D10NS if the kid is under 10 kg) until urine output is present, then to add 20 mmol/L. In our peds cardiac ICU we even run KCl 1mmol/mL via central line to maintain their serum K+ between 3.1 and 5. Keeps their cardiac rhythms normal (since most of them will be on Lasix to maintain a neutral or negative fluid balance while their hearts recover). Our hospital never runs D5 1/2S on children because in our experience, hospitalized children become hyponatremic very quickly and the effects of hyponatremia on children's growing brains are highly undesirable.

That's interesting because when I worked in the hospital, they always said we couldn't run D5 NS on infants at all and that they had to get either D5 1/2 NS or D5 1/4 NS. They only got NS if they needed a bolus.

Toddlers/school aged children were usually written for D5 1/2 NS + 10 mEq KCL/500 mL and teenagers D5 NS with 20 mEq KCl/L. The addition of KCl to fluids for all of our patients was pretty standard.

[NotReady4PrimeTime, RN]

I'll pull our reference data for you when I get a minute.