BOWRAL AND DISTRICT HOSPITAL MEDICATION MANAGEMENT

BDH_PD2012_D01.54
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Policy Directive

Potassium Chloride Intravenous Guidelines for Adult Patients

Document No: BDH_PD2012_D01.54

Functional Sub-Group: Medication / Management

Summary: To provide staff with guidelines for the safe use of

intravenous potassium chloride (adult patients)

Approved by: Drug Advisory Committee, Director of Clinical &

Support Services

Publication (Issue) Date: December 2012

Next Review Date: December 2014

Replaces Existing Policy: BDH_PD2010_D01.54

Previous Review Dates: 12/03, 08/05, 08/08, 12/10

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South Western Sydney Local Health District Policy No: BDH_PD2012_D01.54
Date Issued: December 2012

Potassium Chloride Intravenous Guidelines for Adult Patients

1. Introduction
The risks addressed by this policy:
Clinical risk. SAC 2.
The aims / expected outcome of this policy
Safe prescribing and administration of intravenous potassium chloride in adult
patients.

2. Policy Statement
Potassium chloride must always be administered by an intravenous infusion and
never as a bolus injection. Intravenous potassium is potentially fatal if
administered inappropriately or incorrectly.
The administration and prescribing of potassium chloride in adult patients at the
Bowral & District Hospital will comply with the Sydney South West Area Health
Service Guidelines and the NSW Health Department Policy Directive for
intravenous potassium chloride.

3. Principles / Guidelines
Prescribing
 Intravenous potassium chloride will only be prescribed when the oral route
is unavailable or clinically inappropriate.
 Intravenous potassium chloride must be prescribed in millimoles (mmol) of
potassium and must specify the dose, route, dilution and volume. The rate
of administration should also be prescribed and expressed as millilitres per
hour (mL/h). Prescriptions will be considered incomplete if any one of these
elements is omitted. Incomplete prescriptions must be corrected before
administration.
 Potassium salts MUST NEVER be prescribed or given intramuscularly
or as an intravenous push (bolus).
 Standard premixed potassium concentrations are to be prescribed
whenever possible in all areas of the hospital.
 The treating specialist is able to approve the prescription of non-standard
potassium chloride solutions.

Storage and Supply of Potassium Chloride Products

 Potassium chloride 10mmol in 10mL (0.75g) ampoules are only stocked
and supplied at Bowral Hospital. Potassium chloride ampoules are only
stored In the High Dependency Unit, Emergency Department, Operating
Rooms and Pharmacy Department and are not stored in the general wards.
 Potassium chloride ampoules are stored separately from Water for Injection
ampoules, sodium chloride ampoules or other ampoules of similar
appearance. The ampoule boxes are clearly labelled – Concentrated
Potassium Chloride must be diluted before use.
 Potassium chloride ampoules should not be stored on resuscitation trolleys.
 The premixed potassium chloride bags are distinguished from other
intravenous fluids as they are packaged in a pink outer bag with red print
labelling.

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South Western Sydney Local Health District Policy No: BDH_PD2012_D01.54
Date Issued: December 2012

 The premixed Intravenous potassium chloride products stocked at Bowral

Hospital include:
Potassium chloride 30mmol in 1 litre 0.9% sodium chloride.
Potassium chloride 30mmol in 1 litre 4% glucose & 0.18% sodium
chloride.
Potassium chloride 30mmol in 1 litre 5% glucose.
Potassium chloride 10mmol in 500mL 0.45% sodium chloride & 2.5%
glucose.

Solution Preparation
Preparation of infusions using potassium chloride ampoules:
 Potassium chloride ampoules are concentrated and must be diluted
before use.
 Flasks must only be loaded by registered nurses and in accordance with
the intravenous administration therapy and intravenous medication policies.
Loaded flasks and administration lines must be labelled.
 Potassium chloride ampoules must never be added to a hanging bag.
 The solution must be inverted ten times to ensure potassium chloride is
thoroughly mixed throughout the solution as unshaken bags are prone to
layering of added concentrate and are extremely dangerous.
 Additional potassium chloride ampoules must not be added to pre-
mixed potassium chloride intravenous solutions.

Administration
Peripheral Intravenous Administration
 The treating specialist must approve administration of intravenous
potassium chloride regimens, which differ from these guidelines. Reason
and signed approval for the differing regimens must be documented in the
patient’s progress notes.
 All potassium infusions must be administered via a volumetric infusion
pump with an in-line burette to prevent unintentional bolus doses of
potassium chloride being administered.
 Additives of any description are not permitted to any intravenous
infusion bags containing potassium chloride.
 The maximum rate of potassium chloride prescribed and administered via a
peripheral line is 10mmol per hour on general wards. Higher infusion rates
require continuous cardiac monitoring. The maximum potassium
concentration that can be loaded for peripheral administration in 40mmol/L.
Note: peripheral veins may be damaged by a potassium concentration
greater than 40mmol/L.

Central Line Administration

Where higher and faster rates of potassium chloride administration are required
these should be infused using a rate limiting device and continuous cardiac
monitoring. Maximum dose should not exceed 40mmol per hour.

Guidelines for Potassium Replacement

CAUTION: These guidelines may not be appropriate for patients with complex
alterations in electrolyte balance, acid base status, renal function or disturbance of
other components of plasma will require individualised care.

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South Western Sydney Local Health District Policy No: BDH_PD2012_D01.54
Date Issued: December 2012

Magnitude of Potassium Deficit

The serum potassium is used as a guide to estimate the magnitude of the total
body deficit (assuming the pH is normal). You will also need to consider ongoing
losses:
Serum Potassium (K+) mmol/L Estimated Potassium (K+) Deficit mmol
3 200
2.5 300
2 400
1.5 400+

Critical potassium depletion

Serum Potassium (K+) less than 2.0mmol/L
Critical emergency – admit to ICU/HDU/ED. Use IV and oral replacement (if oral
route possible).
IV: 40mmol potassium (K+) over one hour via a central line (in an emergency a
large cubital fossa vein may be used until a central line is established).
Oral: 28 – 42 mmol potassium (K+) every two to four hours if tolerated.
Span K, Slow K (8mmol per tablet).
Chlorvescent (14mmol per tablet – must be dissolved in 100 – 200 mL water).
Continue to measure serum potassium every one to two hours and replace until
serum potassium is greater than 2.8mmol/L.

Severe potassium depletion

Serum Potassium (K+) 2.0 – 2.5mmol/L
Admit to ICU/HDU/ED. Use IV and oral replacement (if oral route possible).
IV: 20 – 30 mmol potassium (K+) over one hour via central line (in an emergency
a large cubital fossa vein may be used until a central line is established).
Oral: 28 – 42 mmol potassium every two and four hours if tolerated.
Span K, Slow K (8mmol per tablet).
Chlorvescent (14mmol per tablet – must be dissolved in 100 – 200 mL water).
Continue to measure serum potassium every one to two hours and replace until
serum potassium is greater than 2.8mmol/L.

Moderate potassium depletion

Serum Potassium (K+) 2.5 – 3.0mmol/L
Oral (preferred) and IV replacement.
Oral: 24 – 48 mmol potassium three times a day.
Span K, Slow K (8mmol per tablet).
Chlorvescent (14mmol per tablet – must be dissolved in 100 – 200 mL water).
Until serum potassium is greater than 2.8mmol/L.
IV: reserve IV administration for patients who are nil by mouth.
10mmol potassium chloride added to compatible intravenous fluid or 30mmol
potassium chloride premixed bag at a rate of 5-10mmol per hour.
Continue to measure serum potassium until it is greater than 3.2mmol/L.

Mild potassium depletion

Serum Potassium (K+) 3.0 – 3.5mmol/L
Oral: 24 – 48 mmol potassium three times a day.
Span K, Slow K (8mmol per tablet).

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South Western Sydney Local Health District Policy No: BDH_PD2012_D01.54
Date Issued: December 2012

Chlorvescent (14mmol per tablet – must be dissolved in 100 – 200 mL water).

4. Performance Measures
Medication incidents and/or adverse events reported on IIMS data base.

5. Definitions
Nil.

6. References and links

Labelling of Injectable Medicines, Fluids and Lines. Bowral & District Hospital.
BDH_PD2012_D01.17.
http://intranet.sswahs.nsw.gov.au/SSWPolicies/pdf/Bowral/BDH_PD2012_D01.17.
pdf
Potassium Intravenous (IV) Administration. Liverpool Hospital.
LH_PD2010_C03.53.
http://intranet.sswahs.nsw.gov.au/SSWpolicies/pdf/liverpool/LH_PD2010_C03.53.
pdf
Australian Injectable Drugs Handbook. Fifth Edition. The Society of Hospital
Pharmacists of Australia. 2011.
Sydney South West Area Health Service. Guidelines: Safe Use of Intravenous
Potassium Chloride (Adult Patients). December 2005.
Safe Handling of Intravenous Potassium Chloride in Health Care Facilities –
Policy. PD2005_342.
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_342.pdf

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