Accuracy of Potassium Supplementation of Fluids Administered Intravenously

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Potassium (K<sup>+</sup>) 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<sup>+</sup> 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<sup>+</sup> concentration ([K<sup>+</sup>]) was compared to the intended [K<sup>+</sup>] of the bag. In a second experiment, 60 stock fluid bags were supplemented to achieve a concentration of 20 mmol/L K<sup>+</sup>, mixed well and [K<sup>+</sup>] was measured. In another 12 bags of 0.9% NaCl, K<sup>+</sup> was added without mixing the bag, and [K<sup>+</sup>] of the delivered fluid was measured at regular time points during constant rate infusion. Results: The measured [K<sup>+</sup>] was significantly higher than intended [K<sup>+</sup>] (mean difference 9.0 mmol/L, range 6.5 to >280 mmol/L, P < .0001). In 28% of clinical samples measured [K<sup>+</sup>] was ≥5 mmol/L different than intended [K<sup>+</sup>]. With adequate mixing, K<sup>+</sup> supplementation of fluids can be accurate with the mean difference between measured and intended [K<sup>+</sup>] of 0.7 (95% CI -0.32 to 1.7) mmol/L. When not mixed, K<sup>+</sup> supplementation of 20 mmol/L can lead to very high [K<sup>+</sup>] of delivered fluid (up to 1410 mmol/L). Conclusions and Clinical Importance: Inadequate mixing following K<sup>+</sup> supplementation of fluid bags can lead to potentially life threatening IV infused [K<sup>+</sup>]. Standard protocols for K<sup>+</sup> supplementation should be established to ensure adequate mixing.

Original languageEnglish (US)
Pages (from-to)834-839
Number of pages6
JournalJournal of Veterinary Internal Medicine
Volume29
Issue number3
DOIs
StatePublished - May 1 2015

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Potassium
potassium
bags
Veterinary Medicine
Fluid Therapy
Observational Studies
Cats
Dogs
fluid therapy
crystalloid solutions
fluids
observational studies
veterinary medicine
cats
dogs
animals

Keywords

  • Additives
  • Crystalloid fluids
  • Electrolytes
  • Hyperkalemia
  • Mixing

ASJC Scopus subject areas

  • veterinary(all)

Cite this

Accuracy of Potassium Supplementation of Fluids Administered Intravenously. / Hoehne, S. N.; Hopper, Katrina; Epstein, Steven E.

In: Journal of Veterinary Internal Medicine, Vol. 29, No. 3, 01.05.2015, p. 834-839.

Research output: Contribution to journalArticle

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abstract = "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.",
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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.

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