Accuracy of Potassium Supplementation of Fluids Administered Intravenously. (9th April 2015)

• Record Type: Journal Article
• Authors: Hoehne, S. N.; Hopper, K.; Epstein, S. E.
• Is Part Of: Journal of veterinary internal medicine. Volume 29:Number 3(2015:May/Jun.)
• Page Start: 834
• Page End: 839
• Publication Date: 2015-04-09
• Subjects: Veterinary medicine -- Periodicals; 636.0896
• DOI: 10.1111/jvim.12588
• Languages: English
• ISSNs: 0891-6640

Abstract

<abstract abstract-type="main" id="jvim12588-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jvim12588-sec-0001" sec-type="section"> <title>Background</title> <p>Potassium (K<sup>+</sup>) supplementation of isotonic crystalloid fluids in daily fluid therapy is commonly performed, yet its accuracy in veterinary medicine is undetermined.</p> </sec> <sec id="jvim12588-sec-0002" sec-type="section"> <title>Objective</title> <p>To investigate the accuracy of K<sup>+</sup> supplementation in isotonic crystalloid fluids.</p> </sec> <sec id="jvim12588-sec-0003" sec-type="section"> <title>Animals</title> <p>None.</p> </sec> <sec id="jvim12588-sec-0004" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="jvim12588-sec-0005" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> < .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).</p> </sec> <sec id="jvim12588-sec-0006" sec-type="section"> <title>Conclusions and Clinical Importance</title> <p>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.</p> </sec> </abstract>