Why does IV potassium burn?

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Cocogirl

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I've been asked this question on rotation and I've run some pubmed searches and haven't been able to find anything! It's driving me crazy. Is it tonicity?

Does anyone know the answer or at least know where to direct me to find it?

Thanks!
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Cocogirl said:
I've been asked this question on rotation and I've run some pubmed searches and haven't been able to find anything! It's driving me crazy. Is it tonicity?

Does anyone know the answer or at least know where to direct me to find it?

Thanks!
Click to expand...

Who would ask that type of question? Does it even have clinical relevancy? It is so vague. What do u mean by burn exactly? Like burn on skin? lol
 
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No, potassium chloride burns when it is run in a peripheral IV line. Typically the cut off for a peripheral line is 10mEq/hr KCl and 20mEq/hr for a central line. In general, it's just more concentrated when given in a smaller peripheral line.
 
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I can attest to the fact that it DOES burn! I was in the hospital, had a line, they gave me potassium, and I started yelling for the nurse. It is very painful!
 
Don't know the specifics but I guess it irrites the vein; That's why they add lidocaine for KCl-series infusion IVPB.
 
Anyone know why it is irritating? Does it extravasate?
 
KCL is very hypertonic therefore irritating to the veins and tissues hence care must be taken to prevent perivascular infiltration and extravasation which could lead to tissue necrosis.

Of course that is not the only adverse effect of potassium administration. We do use it in lethal injection.
 
Thanks Zpacksux!
 
ZpackSux said:
KCL is very hypertonic therefore irritating to the veins and tissues hence care must be taken to prevent perivascular infiltration and extravasation which could lead to tissue necrosis.

Of course that is not the only adverse effect of potassium administration. We do use it in lethal injection.
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I'd have to respectfully offer a different suggestion. If you look at the osmolality of the bags of 10-30mEq K/L D5...the oslmolality ranges from 272-312 mOsm. Normal blood mOsm is 280-310.

However, the pH of these solutions is very low - 4.5 - where normal blood pH is 7.35-7.45.

We don't normally have an issued running up to 40mEQ/L in a vein, as long as the veing is large & the IV is running fairly rapidly - its not staying in contact with the venous walls too long.

Any greater content, or slower flow, we try to use a central line, which allows very rapid dilution therefore rapid pH equilibration.

Just my thoughts on the subject.
 
sdn1977 said:
I'd have to respectfully offer a different suggestion. If you look at the osmolality of the bags of 10-30mEq K/L D5...the oslmolality ranges from 272-312 mOsm. Normal blood mOsm is 280-310.

However, the pH of these solutions is very low - 4.5 - where normal blood pH is 7.35-7.45.

We don't normally have an issued running up to 40mEQ/L in a vein, as long as the veing is large & the IV is running fairly rapidly - its not staying in contact with the venous walls too long.

Any greater content, or slower flow, we try to use a central line, which allows very rapid dilution therefore rapid pH equilibration.

Just my thoughts on the subject.
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cmon... :smuggrin:

The KCL you're referring to are in a liter bag.. very very diluted. Of course it will have MOsmol/L which will be fairly isotonic. But if you look at 40meq KCL/100ml, it's very hypertonic.. 799 mOsmol/L and 20meq KCL/100ml = 400 mOsmol/L.

And we bolus KCL in 100 - 200ml....
 
ZpackSux said:
cmon... :smuggrin:

The KCL you're referring to are in a liter bag.. very very diluted. Of course it will have MOsmol/L which will be fairly isotonic. But if you look at 40meq KCL/100ml, it's very hypertonic.. 799 mOsmol/L and 20meq KCL/100ml = 400 mOsmol/L.

And we bolus KCL in 100 - 200ml....
Click to expand...

Is that what the op was talking about????

hmmm....you still (well...as long as you're there...) give 40/100? - our max in the ICU is 20/100 - those nurses caused too much cardiotoxicity & it was always run thru a central line so I'm not sure burning was an issue. How would hypertonicity be a pain issue centrally?

But....still - a D5 w/ K40 still will burn - especially a small lady in L&D & especially when it extravasates because she has held her SO's hand too tight & poked the catheter thru the other side of the vein wall.

Obviously....not enough info to go on...but for the op - you have a couple of mechanisms which will apply depending on your specific situation.
 
sdn1977 said:
Is that what the op was talking about????

hmmm....you still (well...as long as you're there...) give 40/100? - our max in the ICU is 20/100 - those nurses caused too much cardiotoxicity & it was always run thru a central line so I'm not sure burning was an issue. How would hypertonicity be a pain issue centrally?

But....still - a D5 w/ K40 still will burn - especially a small lady in L&D & especially when it extravasates because she has held her SO's hand too tight & poked the catheter thru the other side of the vein wall.

Obviously....not enough info to go on...but for the op - you have a couple of mechanisms which will apply depending on your specific situation.
Click to expand...

40meq/100ml is for central line only and is piggy bagged into primary IV fluid. We rarely do 40meq/100ml. 10meq/100 for perfipheral line and 20meq/100 for central.
 
ZpackSux said:
40meq/100ml is for central line only and is piggy bagged into primary IV fluid. We rarely do 40meq/100ml. 10meq/100 for perfipheral line and 20meq/100 for central.
Click to expand...

i mentioned it before, but the hospital I work at has tele/post-cath order sets with a replacement protocol of 40meq/150 D5w with 200 mg lido. Trying to get that changed, but it's been that way for years.
ICU can give 40meq in 100 if through a central line with fluids.
I would prefer the way Zpacks hospital does it.
 
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pharmboy30 said:
i mentioned it before, but the hospital I work at has tele/post-cath order sets with a replacement protocol of 40meq/150 D5w with 200 mg lido. Trying to get that changed, but it's been that way for years.
ICU can give 40meq in 100 if through a central line with fluids.
I would prefer the way Zpacks hospital does it.
Click to expand...

hmmmm.....thats really going away from current "good" practice.

You might want to do an ....."outcome" study - how many peripheral lines are lost & see if you can correlate that with how many times that line is used to administer K replacement.

There are lots of potential harms here - the first being if that K replacement ran in too quickly, you not only have 40mEq of K on the heart, you have a bolus of 200mg of lidocaine:eek: !

The lidocaine shouldn't be more than 2% I'd think for infiltration, but you seem to have a full therapeutic bolus in that K replacement.

I think JCAHO has some guidelines, but perhaps Zpak can get his hands on them faster since he's packing stuff up.
 
We had patients complain of discomfort even for 10 mEq KCl/100 cc dilution;
adding 10 mg lidocaine per 10 mEq KCl seems to resolve the issue.
 
sdn1977 is right to suggest studies for anyone still using anything more than 20mEq in 100 mL. I think AACN published a couple years ago, but I can't recall the issue.
 
per protocol said:
We had patients complain of discomfort even for 10 mEq KCl/100 cc dilution;
adding 10 mg lidocaine per 10 mEq KCl seems to resolve the issue.
Click to expand...

I would avoid adding lidocaine if at all possible as I had a nurse do that with out running it by the docs (crazy azz) and that pt brady'ed down to a point that we had to start dopamine.
 
From what I understand its the concentration that burns, not necessarily the rate.

We use 10-20meq/100ml bags for central lines, 40meq/500ml for peripheral.

The rate is max: 20meq/hr with EKG, 40meq/hr in emergency situations.
 
Not that anyone cares about this topic anymore, but intracellular potassium >> extracellular potassium so high potassium activates pain receptors because it typically is indicative of tissue damage/cell lysis.
 
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slycaper said:
I would avoid adding lidocaine if at all possible as I had a nurse do that with out running it by the docs (crazy azz) and that pt brady'ed down to a point that we had to start dopamine.
Click to expand...

Oh boy. I think the nurse might have forgotten or never learned that lidocaine is an antiarrhythmic in addition to being an anesthestic.

Good thread though.
 
I don't think the OP question was answered. Why does KCl burn ?
 
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samven582 said:
I don't think the OP question was answered. Why does KCl burn ?
Click to expand...

Yeah. Nobody answered..If you ignore these three answers:

ZpackSux said:
KCL is very hypertonic therefore irritating to the veins and tissues hence care must be taken to prevent perivascular infiltration and extravasation which could lead to tissue necrosis.

Of course that is not the only adverse effect of potassium administration. We do use it in lethal injection.
Click to expand...
sdn1977 said:
I'd have to respectfully offer a different suggestion. If you look at the osmolality of the bags of 10-30mEq K/L D5...the oslmolality ranges from 272-312 mOsm. Normal blood mOsm is 280-310.

However, the pH of these solutions is very low - 4.5 - where normal blood pH is 7.35-7.45.

We don't normally have an issued running up to 40mEQ/L in a vein, as long as the veing is large & the IV is running fairly rapidly - its not staying in contact with the venous walls too long.

Any greater content, or slower flow, we try to use a central line, which allows very rapid dilution therefore rapid pH equilibration.

Just my thoughts on the subject.
Click to expand...
zelman said:
Not that anyone cares about this topic anymore, but intracellular potassium >> extracellular potassium so high potassium activates pain receptors because it typically is indicative of tissue damage/cell lysis.
Click to expand...
 
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It draws water out your vascular cells until they can't take anymore and sort of implode into themselves. Turns out that **** hurts.
 
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This thread made me nostalgic for when we used to talk about drugs vs the crappy job market.
 
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spacecowgirl said:
This thread made me nostalgic for when we used to talk about drugs vs the crappy job market.
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Okay. Can do.

What drugs do you recommend to cope with the crappy job market?
 
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zelman said:
Okay. Can do.

What drugs do you recommend to cope with the crappy job market?
Click to expand...


Adderall XR
Propranolol bid

When you start to get a little spun out - add bupropion
 
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Bupropion makes me edgy AF. I think some nice big Xannie bars are more to my "this world sucks" liking.
 
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back in 08 I was pregnant, extremely sick the whole pregnancy. In and out of the hospital to receive fluids up until delivery and lost 15 pounds while pregnant. They gave me this through a iv one time and it was awful. I told them i could feel it burning throughout my body and they did nothing so I pulled my iv out and told them to **** off.
 
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