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Medical Forum / General / Pharmacy / April 2004

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Potassium supplementation guideline

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Jerelyn - 16 Apr 2004 18:57 GMT
My mother-in-law, who weighs 285 lbs., recently had a cardiac
catheterization.  While she was in the day surgery suite, a nurse came
in to the room and told us her potassium level was 2  and she would
have to have supplemental potassium in
the form of IVs and tablets before the procedure could be done.  Two
IVs were given with 9NS w/ 20 mEQs at 150 cc/hr each, plus another 20
mEQ in tablet form.

My questions are: Based on the above IV rate plus the oral tablets,
how many mEQs of potassium choride is required to raise serum
potassium 1 mEQ? Does it require more KCl to raise it from 2 to 3 then
from 3 to 4?  How does potassium carbonate compare with potassium
choride in it's ability to raise the level?

Thanks for your replies.

Jerelyn
Gregory Poon - 16 Apr 2004 20:42 GMT
Ultimately she'll have to be titrated to the target level (presumably normal
range) taking into account also concurrent meds (especially things like
furosemide, ACE inhibitors which can have large effects on K), so it's not
practical to predit a priori.  You have to be careful with a carbonate salt
because you can start messing with pH, which is not a problem with KCl.

Signature

Gregory M. K. Poon, Ph.D., R.Ph., B.Sc.Phm.
Departments of Pharmaceutical Sciences and Chemical Engineering
University of Toronto

> My mother-in-law, who weighs 285 lbs., recently had a cardiac
> catheterization.  While she was in the day surgery suite, a nurse came
[quoted text clipped - 13 lines]
>
> Jerelyn
Jerelyn - 17 Apr 2004 02:34 GMT
Greg, I didn't mean her level ultimately - I just meant how much are
the IVs and tablets "likely" to raise her level over 4.5 hours. The
only drug she takes is Avalide 300/12.5. When a hospital staff member
is presented with a low K patient, they probably apply a guideline
written by their hospital and they start there.

Thanks.

> Ultimately she'll have to be titrated to the target level (presumably normal
> range) taking into account also concurrent meds (especially things like
[quoted text clipped - 19 lines]
> >
> > Jerelyn
Gregory Poon - 17 Apr 2004 04:06 GMT
Sorry I misunderstood your first post.  You're right, for acute hypokalemia
there'd be a sliding scale for the dose of KCl, i.e., determined by the last
measurement of serum [K], with the goal of reaching the normal range (<5
mEq/L). So I'd expect her K level will be raised to the normal range with
the dose she was given.  The Avalide should be fairly K-neutral as it's a
combination of a K-wasting (HCTZ) and K-sparing drug (irbesartan); was she
taken off it for the procedure?

Signature

Gregory M. K. Poon, Ph.D., R.Ph., B.Sc.Phm.
Departments of Pharmaceutical Sciences and Chemical Engineering
University of Toronto

> Greg, I didn't mean her level ultimately - I just meant how much are
> the IVs and tablets "likely" to raise her level over 4.5 hours. The
[quoted text clipped - 27 lines]
> > >
> > > Jerelyn
 
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