at Clinical Practice Meeting
1. 2 mmol/kg/day.4
- Oral replacement is the preferred method.
- Intravenous infusions – usual dose up to 0.2mmol/kg/hour.
- Solution must be diluted to 1mmol/25ml if given via a peripheral
line, or 1mmol/12.5ml via central line.
Acute treatment of symptomatic hypokalaemia
- If renal function is adequate 0.5mmol/kg in an hour. Repeat as necessary.
- Adjust maintenance potassium. Correct hypocalcaemia.
- Prevention and treatment of hypokalaemia
- Bradycardia secondary to hypokalaemia
Contraindications and Precautions
- Caution in babies with severe renal impairment and oliguria and renal disease.
- Caution in babies with severe haemolytic reactions.
- Caution in babies with cardiac disease.
- Caution in babies with systemic acidosis.
- Caution in babies with digoxin intoxication in presence of conduction disturbances.
- Caution in babies receiving potassium sparing diuretic.
Potassium is the major intracellular cation. Hypokalaemia
in critically ill neonates is usually the result of diuretic therapy, inadequate
intake or diarrhoea. Other causes include
congenital adrenal hyperplasia and
renal disorders. However, serum potassium levels are a poor marker of
total body stores of potassium, and a low serum potassium more often reflects
redistribution than true deficit. Alkalosis as well as
insulin infusions will lower serum
potassium concentrations by driving the ion intracellularly. Symptoms of
hypokalaemia include neuromuscular weakness and paralysis, ileus, urine
retention, and ECG changes, ST segment depression, low voltage T wave and
appearance of U wave. Hypokalaemia increases digoxin toxicity. Renal mechanisms
are of primary importance in maintaining both total body potassium and plasma
concentration within narrow limits. Oral potassium preparations are completely
Hyperkalaemia affects cardiac conduction. ECG changes
include tall peaked T waves, heartblock with widening QRS complex, arrhythmia
and cardiac arrest.
Potassium is excreted mainly by the kidneys and is
secreted in the distal tubules where it is involved in the sodium-potassium
exchange process. Some potassium is excreted in the stools and small amounts may
also be excreted in the sweat, saliva, bile and pancreatic juice.
Possible Adverse Effects
- Venous irritation, pain, soft tissue injury at the injection site.
- Gastrointestinal disturbances common (diarrhoea, vomiting, bleeding, abdominal discomfort).
- Altered sensitivity to digoxin.
- Respiratory distress.
- Hyperkalaemia, indicated by weakness, listlessness,
flaccid paralysis, hypotension, cardiac arrhythmias including heart block
and cardiac arrest.
- Administer IV slowly, maximum infusion rate, 0.5mmol/kg/hour.
- Monitor electrolytes.
- Dilute potassium before intravenous administration.
The literature recommends dilution to 40mmol/L, i.e, 1mmol/25ml.4 As this
may cause volume overload, in infants with central line access dilute to 1mmol/12.5ml
1,2 and piggyback with IV
fluids to achieve further dilution.
- If nutritional or fluid
restriction indications dictate, intravenous potassium may be given as a
neat (1 mmol/mL) solution with the attending SMO’s approval. This can only
be done when the solution is piggy-backed with intravenous nutrition / 10%
dextrose solutions. The potassium infusion should be connected at a point
distal to the site of venous access to maximise dilution. Neat potassium
must always be administered via a central line only. The baby shall be on
full cardiac monitoring
- Adequate renal function must be confirmed.
- Management of hyperkalaemia if K+>7mmol/L
unhaemolysed. Refer to