potassium replacement protocol

Nurses General Nursing

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Hello! I work in a med/surg floor. They recently change our K protocol from 20meq po q4 into 20-40 meq po q2 depending on the k of course... My question is, is it safe to give 40 meq of kcl liquid q2 hours all at once? Or would it be better to give it 20 then wait 30 minutes to give the next 20? Some say that it can cause gastric irritation if you give the whole 40.... What do you guys think? Thanks!

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If gastric irritation is the only concern and pt is not NPO, just give something else to drink or eat with the potassium.

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My main concern is how it's going to affect the cardiac status off the patient...

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My main concern is how it's going to affect the cardiac status off the patient...

I'm not aware of any adverse effect on cardiac status. Did you check the drug book on this? If it's not out of the range of usual dosing then I wouldn't worry about it.

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Hello! I work in a med/surg floor. They recently change our K protocol from 20meq po q4 into 20-40 meq po q2 depending on the k of course... My question is, is it safe to give 40 meq of kcl liquid q2 hours all at once? Or would it be better to give it 20 then wait 30 minutes to give the next 20? Some say that it can cause gastric irritation if you give the whole 40.... What do you guys think? Thanks!

As part of our protocol we routinely give 40meq of K-lor at one time. I usually mix it with juice because it tastes awful, but I have never had a patient complain of gastric irritation (unless they were already nauseated and/or vomiting, in which case I would just order the potassium IVPB anyway).

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Specializes in Oncology/Haemetology/HIV.

We give 40 meq PO KCl frequently. As PO KCl breaks down slower in the system than IV, there are should be no issues. Have you spoken to your pharmacist regarding your concerns?

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[h=2]per davis drug guide:

"potassium chloride (oral)[/h]route/dosage

• expressed as meq of potassium. potassium acetate contains 10.2 meq/g; potassium bicarbonate contains 10 meq potassium/g; potassium chloride contains 13.4 meq potassium/g; potassium gluconate contains 4.3 meq/g

[color=#330098]normal daily requirements• [color=#44447e]po[color=#44447e] (adults): 40–80 meq/day.

• [color=#44447e]po[color=#44447e] (children): 2–3 meq/kg/day.

• [color=#44447e]po[color=#44447e] (neonates): 2–6 meq/kg/day.

[color=#330098]prevention of hypokalemia during diuretic therapy• [color=#44447e]po[color=#44447e] (adults): 20–40 meq/day in 1–2 divided doses; single dose should not exceed 20 meq.

• [color=#44447e]po[color=#44447e] (neonates , infants and children): 1–2 meq/kg/day in 1–2 divided doses.

[color=#330098]treatment of hypokalemia• [color=#44447e]po[color=#44447e] (adults): 40–100 meq/day in divided doses.

• [color=#44447e]po[color=#44447e] (neonates , infants and children): 2–5 meq/kg/day in divided doses"

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yes, he said to give it 30 minutes apart because it's hard on the stomach...

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Specializes in ER, progressive care.

Potassium can cause nausea, therefore mixing a liquid prep in some juice and giving some crackers or something to snack on helps. I have never had a patient complain of nausea this way.

I have given 40mEq PO frequently. The patient doesn't have to down the juice in seconds. Our protocol doses KCl based on the patient's K level, and we have both PO and IV protocols. To use the protocol, the creatinine needs to be 3.

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Specializes in cardiology/oncology/MICU.

The 40 Meq PO doses here say specifically to dilute before admin. It is alcohol based so it will burn otherwise. Also I think it would take quite a lot of PO K+ to cause any cardiac issues unless the patient is in ARF/CRF. I like the comment above about insuring creat is adequate. It does not hurt to check mag as well.

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Specializes in ER, progressive care.
It does not hurt to check mag as well.

Absolutely. If the patient isn't benefiting from potassium replacement (the K isn't really going back up), check the mag. Generally mag should be replaced first if low.

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Specializes in Pedi.

PO potassium supplements should not affect the cardiac status of the patient the same way an IV dose potentially could.

I was on PO KCl for nearly a year due to chronic hypokalemia r/t (at the time undiagnosed) renal tubular acidosis. I was taking 60 mEq/day but because it was slow release, the maximum recommended dose was 20 mEq/dose so I was taking 20 mEq TID. There were times I'd take two doses pretty close together though and I was never concerned with my cardiac status. In fact, they never once did an EKG on me during that whole time. As long as the patient has normal kidney function, they should be able to excrete any excess potassium.

Inpatient, I have given PO doses of 40 mEq before without any issues. Of course, getting a child to actually take it is fairly difficult because both the liquid formulation and the packet that needs to be mixed with juice taste horrible. And the pills are HUGE!

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