POTASSIUM CHLORIDE 0.22% IN DEXTROSE 3.3% AND SODIUM CHLORIDE 0.3% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Potassium chloride replaces potassium ions, essential for maintaining intracellular fluid balance, nerve impulse transmission, and muscle contraction. Dextrose provides a source of calories and may help prevent ketosis. Sodium chloride replaces sodium and chloride ions, maintaining osmotic pressure and acid-base balance.
| Metabolism | Potassium is primarily excreted unchanged by the kidneys; dextrose is metabolized to carbon dioxide and water, providing energy; sodium and chloride are excreted primarily by the kidneys and are not significantly metabolized. |
| Excretion | Potassium is primarily excreted by the kidneys (90%), with small amounts lost in feces (10%). Minor losses occur through sweat. Renal excretion involves glomerular filtration and tubular secretion, with aldosterone-regulated reabsorption. Biliary excretion is negligible. |
| Half-life | Potassium has a biological half-life of approximately 8 hours in healthy adults, but this is highly variable based on renal function and total body stores. The terminal elimination half-life is not classically defined as it follows multicompartment kinetics; the redistribution half-life is about 1 hour. Clinical context: half-life is prolonged in renal impairment and with high potassium intake. |
| Protein binding | Potassium is not significantly bound to plasma proteins; protein binding is less than 10% and not clinically relevant. It exists primarily as free ions in plasma. |
| Volume of Distribution | The apparent volume of distribution for potassium is 0.06-0.1 L/kg (total body water distribution). Potassium is predominantly intracellular, so the Vd reflects the extracellular compartment. Clinical meaning: a small Vd indicates that the drug remains largely in plasma and interstitial fluid; changes in Vd can occur in acid-base disorders or with shifts between intra- and extracellular spaces. |
| Bioavailability | Oral potassium chloride: bioavailability is 90-100% as it is efficiently absorbed in the gastrointestinal tract. Intravenous: 100% bioavailable. Rectal: variable and not clinically used for systemic effect. |
| Onset of Action | Intravenous infusion: onset within seconds to minutes, as plasma potassium levels rise immediately. Oral administration: onset of gastrointestinal absorption occurs within 1-2 hours, with peak serum levels at 2-4 hours post-dose. |
| Duration of Action | Intravenous: effect persists for about 8-12 hours after infusion, depending on distribution and elimination. Oral: duration of action is approximately 6-8 hours for serum potassium elevation, but sustained-release formulations can extend up to 12 hours. Clinical note: Duration is highly dependent on renal function and concurrent medications (e.g., diuretics, ACE inhibitors). |
| Molecular Weight | Potassium chloride: 74.55 Da; Dextrose: 180.16 Da; Sodium chloride: 58.44 Da |
Intravenous infusion; rate not to exceed 0.5-1 mEq/kg/hour (maximum 10-20 mEq/hour) with continuous ECG monitoring; typical adult dose: 20-40 mEq potassium chloride in 1 L of the specified solution infused over 4-6 hours.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <30 mL/min) with oliguria or anuria; use with caution in mild-moderate impairment (GFR 30-59 mL/min) with reduced infusion rates and frequent monitoring of serum potassium and renal function. |
| Liver impairment | No specific dose adjustment for Child-Pugh class A or B; use with caution in severe hepatic impairment (Child-Pugh class C) due to increased risk of fluid overload and electrolyte disturbances; consider reduced infusion rates and monitoring. |
| Pediatric use | Intravenous infusion; usual dose: 0.5-1 mEq/kg per day, adjusted based on serum potassium; maximum infusion rate: 0.5 mEq/kg/hour (not to exceed 10 mEq per dose). Requires continuous ECG monitoring and use of infusion pump. |
| Geriatric use | Use lower initial doses and slower infusion rates (maximum 10 mEq/hour) due to decreased renal function and higher risk of hyperkalemia; monitor serum potassium and renal function frequently; adjust for comorbidities and concurrent medications. |
| 1st trimester | Potassium chloride, dextrose, and sodium chloride are essential nutrients. Use only if clearly needed; monitor serum electrolytes. |
| 2nd trimester | Safe when used as indicated; avoid excess potassium to prevent hyperkalemia. Use caution in preeclampsia. |
| 3rd trimester | Safe at recommended doses; monitor for fluid/electrolyte imbalance, especially in preterm labor or tocolysis. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | All components cross placenta; potassium and sodium are actively regulated; dextrose crosses by facilitated diffusion. Fetal levels are regulated by maternal homeostasis. |
| Breastfeeding | Potassium, dextrose, and sodium chloride are normal milk constituents; this solution does not present significant risk to infant. Administer only if clearly needed. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Pregnancy category C. Potassium chloride: no known teratogenic effects at therapeutic doses; maternal hyperkalemia can cause fetal bradycardia or arrhythmia. Dextrose: hyperglycemia may be associated with fetal macrosomia, neonatal hypoglycemia, or congenital anomalies if uncontrolled. Sodium chloride: excessive intake may lead to maternal edema or hypertension, potentially affecting placental perfusion. No specific first-trimester risks reported, but use only if clearly needed. Second/third trimester: monitor for electrolyte imbalances and glucose control. |
| Fetal Monitoring | Monitor serum potassium, sodium, glucose, and renal function periodically. Fetal monitoring (non-stress test, biophysical profile) if prolonged use or maternal electrolyte disturbances. Assess for signs of fluid overload (edema, hypertension, pulmonary congestion). |
| Fertility Effects | No known adverse effects on fertility at therapeutic doses. High-dose potassium or severe electrolyte imbalances may impair reproductive function (e.g., anovulation, menstrual irregularities) indirectly. |
■ FDA Black Box Warning
Potassium chloride injection concentrate must be diluted before use. Direct injection of undiluted potassium chloride can cause fatal cardiac arrhythmias.
| Common Effects | fluid replacement |
| Serious Effects |
HyperkalemiaHypernatremiaHyperglycemiaSevere renal impairment with oliguriaEdema with sodium retention
| Precautions | Monitor serum potassium levels to avoid hyperkalemia or hypokalemia, Use with caution in patients with renal impairment, cardiac disease, or conditions predisposing to hyperkalemia, Risk of fluid overload in patients with heart failure or renal impairment, Risk of phlebitis and extravasation, Dextrose-containing solutions may cause hyperglycemia |
| Food/Dietary | Avoid high-potassium foods (bananas, oranges, potatoes, tomatoes) in excessive amounts unless instructed otherwise. Limit intake of salt substitutes that contain potassium chloride. |
| Clinical Pearls | Monitor serum potassium closely in patients with renal impairment; this solution provides approximately 2.9 mEq potassium per 100 mL. Use with caution in patients on digoxin due to arrhythmia risk. Do not administer if solution is cloudy or contains particulates. |
| Patient Advice | This solution is used to replace fluids and electrolytes. · Report any signs of hyperkalemia (muscle weakness, irregular heartbeat) to your health care provider. · Avoid salt substitutes or potassium supplements unless directed by your doctor. · Inform your doctor if you have kidney problems or are on medications like ACE inhibitors or potassium-sparing diuretics. |
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