How fast do you run potassium?

[Dred Pirate]

oh my gosh, an actual pharmacy question - lol
How fast does your insitution allow KCL to be run?
In the CC forum I had a doc tell me they allowed up to 50 or 60 meq an hour based on access. I told them 20 meq is our max - and I believe it is the common max at most places (but I have only worked as a rph at two hospitals so my experience with others is limited). Also, it doesn't matter access as far as rate and cardiac safety (access only allows a higher concentration/less burning).

thanks

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[StockPharmD2020]

20 pet dose

 

[Dred Pirate]

20 pet dose

you mean 20 meq per hour?

 

[StockPharmD2020]

Yea 20 per dose per hour sorry. Can give 40 by ordering 2 20 doses, in icu only with k less than 2.5 and attending discretion- not NP

 

[Dred Pirate]

Yea 20 per dose per hour sorry. Can give 40 by ordering 2 20 doses, in icu only with k less than 2.5 and attending discretion- not NP

you limit ordering 40 meq to ICU pt's only? Don't you have electrolyte replacement protocol for all pt's? We do 80 meq for pt's that are lower tan ~2.5 (I think that is the level) but it is given for 4-8 hours depending on telemetry, etc.

 

[StockPharmD2020]

you limit ordering 40 meq to ICU pt's only? Don't you have electrolyte replacement protocol for all pt's? We do 80 meq for pt's that are lower tan ~2.5 (I think that is the level) but it is given for 4-8 hours depending on telemetry, etc.

At once, yes

 

[TheBlaah]

We generally limit it to 10meq per hour for peripheral, 20meq per hour for central.

I've only been in 1 or 2 situations where we did 30-40meq an hour, and that was only because the patient was basically coding on and off due to low potassium and were being monitored very closely.

 

[mustang sally]

We generally always just do 10mEq/hr. Will do 20 an hour with central line and tele. No ICU where I work.

 

[PharmDBro2017]

10meq/hour as a safety precaution.

 

[Rockinacoustic]

I have also trained to the classic 10mEq/hr peripheral, 20mEq/hr central with tele monitoring, but as with anything it depends on the patient.

I've run two 10mEq bags via two seperate peripherals concurrently for hypokalemia. One of my colleagues has also pushed undiluted potaasium chloride in a patient arresting with a potassium in the low 2s.

 

[Dred Pirate]

At once, yes

So if a pt is on the tele-floor with a k of 2.3 - you only allow 20meq x 1 - then what? Do you need a repeat lab (which would take ~1 hour) before they can order more? That sounds like a code waiting to happen.

 

[confettiflyer]

So if a pt is on the tele-floor with a k of 2.3 - you only allow 20meq x 1 - then what? Do you need a repeat lab (which would take ~1 hour) before they can order more? That sounds like a code waiting to happen.

Our policy is K level after the 40th mEq of IV.

If I had a K = 2.3 pt on the floor and looking to aggressively replace, I’d give 40-60 mEq PO/NG/etc… + 40 mEq IV over 4hrs (2hrs if they qualify with a central line + tele.

If I get an order for 60 mEq over 6hrs I’ll dispense the 40 and hold the remaining two for labs after chatting with the doc.


(our policy is 10 mEq/hr peripheral, 20 mEq/hr central + tele, and only these two preparations available as piggybacks)

 

[njac]

oh my gosh, an actual pharmacy question - lol
How fast does your insitution allow KCL to be run?
In the CC forum I had a doc tell me they allowed up to 50 or 60 meq an hour based on access. I told them 20 meq is our max - and I believe it is the common max at most places (but I have only worked as a rph at two hospitals so my experience with others is limited). Also, it doesn't matter access as far as rate and cardiac safety (access only allows a higher concentration/less burning).

thanks

10 meq/hr peripheral, 20 meq/hr central. 40meq/hr if dire.

However. In extenuating circumstances and on tele I will double up from multiple sites - run KPhos in one PIV, KCL in another.

 

[njac]

I have also trained to the classic 10mEq/hr peripheral, 20mEq/hr central with tele monitoring, but as with anything it depends on the patient.

I've run two 10mEq bags via two seperate peripherals concurrently for hypokalemia. One of my colleagues has also pushed undiluted potaasium chloride in a patient arresting with a potassium in the low 2s.

Have also squeezed in the 20meq/100ml piggybacks in an arrest. Like to think the concentration would be less cardio toxic than straight KCL from a vial.

 

[PharmDBro2017]

No mention of repleting Mag first ITT? C'mon man.

On a srs note, good thread. Enjoy seeing real pharmacy discussion from time to time.

 

[Dred Pirate]

Are mag and kcl usually go hand in hand on our replacement protocol for inpatients. But ya. For an Ed pt definitely need the mag.

 

[storyhill2]

Yeah, I've worked in 3 hospitals and they've all been as others have posted. 20 meq/hr via central line and 10 meq /hr if peripheral. My current hospital schedules each 10 meq bag over an hour q90 minutes just to decrease the calls from nurses about being late for a dose when they were scheduled q1hr. I've also had some hospitals that add lidocaine and some that don't.

This is a good reminder to add this to my code cheat sheet. I was in a code once in CT room and asked if we had potassium and I wasn't aware you could give it over a few minutes in those situations until after when I looked into it further. I told the doc at the time that it wasn't in our code cart and I would need a few minutes to get it from a machine on another unit. He didn't want me gone and just moved on.