Accuracy of Potassium Supplementation of Fluids Administered Intravenously

TY - JOUR

T1 - Accuracy of Potassium Supplementation of Fluids Administered Intravenously

AU - Hoehne, S. N.

AU - Hopper, Katrina

AU - Epstein, Steven E

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: Potassium (K+) supplementation of isotonic crystalloid fluids in daily fluid therapy is commonly performed, yet its accuracy in veterinary medicine is undetermined. Objective: To investigate the accuracy of K+ supplementation in isotonic crystalloid fluids. Animals: None. Methods: Observational study. 210 bags of fluid supplemented with KCl being administered to hospitalized dogs and cats intravenously (IV) were sampled over a 3-month period. Measured K+ concentration ([K+]) was compared to the intended [K+] of the bag. In a second experiment, 60 stock fluid bags were supplemented to achieve a concentration of 20 mmol/L K+, mixed well and [K+] was measured. In another 12 bags of 0.9% NaCl, K+ was added without mixing the bag, and [K+] of the delivered fluid was measured at regular time points during constant rate infusion. Results: The measured [K+] was significantly higher than intended [K+] (mean difference 9.0 mmol/L, range 6.5 to >280 mmol/L, P < .0001). In 28% of clinical samples measured [K+] was ≥5 mmol/L different than intended [K+]. With adequate mixing, K+ supplementation of fluids can be accurate with the mean difference between measured and intended [K+] of 0.7 (95% CI -0.32 to 1.7) mmol/L. When not mixed, K+ supplementation of 20 mmol/L can lead to very high [K+] of delivered fluid (up to 1410 mmol/L). Conclusions and Clinical Importance: Inadequate mixing following K+ supplementation of fluid bags can lead to potentially life threatening IV infused [K+]. Standard protocols for K+ supplementation should be established to ensure adequate mixing.

AB - Background: Potassium (K+) supplementation of isotonic crystalloid fluids in daily fluid therapy is commonly performed, yet its accuracy in veterinary medicine is undetermined. Objective: To investigate the accuracy of K+ supplementation in isotonic crystalloid fluids. Animals: None. Methods: Observational study. 210 bags of fluid supplemented with KCl being administered to hospitalized dogs and cats intravenously (IV) were sampled over a 3-month period. Measured K+ concentration ([K+]) was compared to the intended [K+] of the bag. In a second experiment, 60 stock fluid bags were supplemented to achieve a concentration of 20 mmol/L K+, mixed well and [K+] was measured. In another 12 bags of 0.9% NaCl, K+ was added without mixing the bag, and [K+] of the delivered fluid was measured at regular time points during constant rate infusion. Results: The measured [K+] was significantly higher than intended [K+] (mean difference 9.0 mmol/L, range 6.5 to >280 mmol/L, P < .0001). In 28% of clinical samples measured [K+] was ≥5 mmol/L different than intended [K+]. With adequate mixing, K+ supplementation of fluids can be accurate with the mean difference between measured and intended [K+] of 0.7 (95% CI -0.32 to 1.7) mmol/L. When not mixed, K+ supplementation of 20 mmol/L can lead to very high [K+] of delivered fluid (up to 1410 mmol/L). Conclusions and Clinical Importance: Inadequate mixing following K+ supplementation of fluid bags can lead to potentially life threatening IV infused [K+]. Standard protocols for K+ supplementation should be established to ensure adequate mixing.

KW - Additives

KW - Crystalloid fluids

KW - Electrolytes

KW - Hyperkalemia

KW - Mixing

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U2 - 10.1111/jvim.12588

DO - 10.1111/jvim.12588

M3 - Article

VL - 29

SP - 834

EP - 839

JO - Journal of Veterinary Internal Medicine

JF - Journal of Veterinary Internal Medicine

SN - 0891-6640

IS - 3

ER -