POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% AND SODIUM CHLORIDE 0.33% IN PLASTIC CONTAINER
Clinical safety rating: safe
No significant drug interactions Can cause hypernatremia and fluid overload.
Potassium is the major intracellular cation. It is essential for maintaining cell membrane potential, nerve impulse transmission, muscle contraction, and acid-base balance. Dextrose provides a source of calories and may decrease protein and nitrogen losses. Sodium chloride maintains extracellular fluid volume and osmolality.
| Metabolism | Potassium is not metabolized; it is primarily excreted by the kidneys. Dextrose is metabolized via glycolysis and oxidative phosphorylation. Sodium chloride is not metabolized. |
| Excretion | Potassium is primarily excreted renally (>90%) as potassium ions; also undergoes minimal fecal and biliary elimination. Excretion is regulated by renal function, aldosterone, and acid-base status. |
| Half-life | The terminal elimination half-life of potassium is approximately 8 hours; however, potassium equilibration between intracellular and extracellular compartments takes 15-24 hours. In clinical contexts, distribution half-life is more relevant for intravenous administration. |
| Protein binding | Potassium is not significantly protein-bound (<2%); it exists primarily as free ions in plasma. |
| Volume of Distribution | 0.5-0.8 L/kg; approximates total body water. Clinical meaning: indicates extensive distribution into intracellular space (98% of total body potassium is intracellular); Vd is increased in conditions with cellular potassium depletion. |
| Bioavailability | Intravenous: 100%. Oral: 100% (well absorbed); however, oral potassium chloride is considered 70-80% bioavailable due to slow-release formulations and potential incomplete absorption; immediate-release liquid/powder formulations have near-complete absorption. |
| Onset of Action | Intravenous administration: onset within seconds to minutes for correction of hypokalemia, with electrocardiographic improvement typically within 1-2 minutes. |
| Duration of Action | Intravenous: effects on serum potassium concentration persist for 1-2 hours after bolus due to rapid redistribution; continuous infusion is required for sustained effect. Duration of correction depends on total body deficit and ongoing losses. |
Administer intravenously at a rate of 100-200 mL/hour (5-10 mmol potassium/hour) based on serum potassium levels and patient tolerance. Typical adult dose: 1 liter of the solution provides 10 mEq potassium, 50 g dextrose, and 77 mEq sodium; adjust according to electrolyte needs.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (eGFR <30 mL/min) unless close monitoring. For eGFR 30-50 mL/min: reduce infusion rate to 50-100 mL/hour and monitor potassium levels every 4 hours. For eGFR >50 mL/min: standard dosing with caution. |
| Liver impairment | No specific dose adjustment required for Child-Pugh A or B; for Child-Pugh C: use with caution due to risk of fluid overload and electrolyte imbalances; monitor potassium and glucose levels. |
| Pediatric use | Weight-based: 0.5-1 mEq/kg potassium chloride per day, infused as a diluted solution at a rate not exceeding 0.5 mEq/kg/hour. Administer 2.5-5 mL/kg/hour of the given solution based on dextrose and sodium requirements. |
| Geriatric use | Start at lower infusion rates (50-100 mL/hour) due to increased risk of volume overload and renal impairment. Monitor serum potassium, glucose, and fluid status closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Components are endogenous and excreted into breast milk in concentrations similar to maternal plasma. No adverse effects on nursing infant expected with maternal use. M/P ratio: Not applicable as endogenous substances. Safe during breastfeeding at standard doses. |
| Teratogenic Risk | Potassium chloride, dextrose, and sodium chloride are components of intravenous fluids. No teratogenicity is expected with standard therapeutic use. Dextrose may provide glucose to fetus; no known risk. Sodium chloride is essential; excess may cause maternal fluid overload but not teratogenic. Potassium chloride at replacement doses is not associated with fetal harm. First trimester: No evidence of teratogenicity. Second and third trimesters: No known risks; use with caution for maternal conditions like preeclampsia or diabetes. |
■ FDA Black Box Warning
Concentrated potassium solutions must be diluted and administered slowly to avoid fatal hyperkalemia. Do not administer undiluted potassium chloride; rapid infusion may cause cardiac arrest.
| Common Effects | fluid replacement |
| Serious Effects |
Hyperkalemia, severe renal failure with oliguria or anuria, untreated Addison's disease, acute dehydration, heat cramps, patients receiving potassium-sparing diuretics or potassium supplements.
| Precautions | Monitor serum potassium levels frequently. Use with caution in patients with renal impairment, cardiac disease, or conditions predisposing to hyperkalemia. Avoid extravasation may cause tissue necrosis. Rapid infusion may cause hyperkalemia and cardiac arrhythmias. |
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| Fetal Monitoring | Monitor maternal vital signs, serum electrolytes, fluid balance, blood glucose, and urine output. Fetal monitoring: Consider fetal heart rate monitoring in high-risk pregnancies (e.g., preeclampsia, diabetes). Assess for signs of fluid overload (pulmonary edema) or electrolyte disturbances. |
| Fertility Effects | No known effects on fertility with standard therapeutic use. No adverse reproductive impact reported. Fertility unaffected by potassium, dextrose, or sodium chloride at physiological doses. |