POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER

Clinical safety rating: caution

Comprehensive clinical and safety monograph for POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER (POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER).

How it works

Potassium is the principal intracellular cation and is essential for maintaining cellular membrane potential, nerve impulse transmission, and muscle contraction. Dextrose provides calories and may prevent ketosis.

What the body does with it

Metabolism	Potassium is not metabolized; it is excreted primarily by the kidneys. Dextrose undergoes glycolysis and oxidation to carbon dioxide and water.
Excretion	Renal: >90% of potassium intake is excreted by the kidneys, primarily via distal tubular secretion; fecal: <10%; minor sweat losses. In this formulation (KCl 0.22% in D5W), the potassium content is 2 mEq per 100 mL (approximately 20 mEq/L).
Half-life	The elimination half-life of potassium is not applicable in the traditional sense because potassium is an endogenous ion under tight homeostatic control. After intravenous infusion of a potassium load, the plasma concentration declines with a distribution phase of about 1-2 hours, followed by a slower elimination phase reflecting cellular uptake and renal excretion, with a terminal half-life of approximately 6-8 hours in patients with normal renal function.
Protein binding	Negligible (<5%). Potassium is not significantly bound to plasma proteins; it exists as free ion in serum.
Volume of Distribution	Approximately 0.5-0.6 L/kg (total body water); reflects distribution throughout extracellular and intracellular spaces. Potassium is predominantly intracellular (98% of total body potassium is in cells); Vd for administered potassium is large due to cellular uptake.
Bioavailability	Intravenous: 100% (complete bioavailability). Oral: about 90% absorbed; however, this formulation is for IV administration only.
Onset of Action	Intravenous: Correction of hypokalemia begins within minutes after starting infusion; clinical effect (e.g., improvement in muscle weakness, ECG changes) seen within 30-60 minutes at appropriate infusion rates (usual rate: 10-20 mEq/h; max 40 mEq/h with cardiac monitoring).
Duration of Action	Intravenous: Effect persists for the duration of infusion and several hours thereafter; potassium levels gradually return to baseline over 6-12 hours post-infusion, depending on ongoing losses and cellular uptake. Continuous infusion required for sustained correction of severe depletion.

Classification & Brands

Dosing & administration

Intravenous; typical adult dose is 10-20 mEq/hour, not exceeding 40 mEq/hour or 150 mEq/day, with continuous cardiac monitoring and serum potassium monitoring.

Dosage form	INJECTABLE
Renal impairment	GFR > 50 mL/min: no adjustment; GFR 10-50 mL/min: reduce total daily dose by 25-50%; GFR < 10 mL/min: reduce dose by 50-75% and monitor potassium closely. Avoid if anuria.
Liver impairment	No specific adjustment based on Child-Pugh score; however, monitor potassium levels and renal function closely due to potential hepatorenal syndrome.
Pediatric use	Intravenous; 0.2-0.5 mEq/kg/hour, not exceeding 1 mEq/kg/hour or 40 mEq/m²/hour; adjust based on serum potassium and clinical status.
Geriatric use	Cautious dosing: initial dose at lower end of adult range (10 mEq/hour) with close monitoring of renal function and serum potassium due to decreased renal reserve and higher risk of hyperkalemia.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER (POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER).

Breastfeeding	Potassium and dextrose are normal constituents of breast milk. No adverse effects anticipated. Use considered safe during breastfeeding. M/P ratio not established.
Teratogenic Risk	Potassium chloride and dextrose are not known to be teratogenic. No fetal risks have been identified in any trimester. Dextrose is a physiological nutrient. Overdose or rapid infusion may cause maternal electrolyte imbalance potentially affecting fetus.

Warnings & precautions

■ FDA Black Box Warning

Potassium chloride injection concentrate must be diluted before use to avoid fatal hyperkalemia.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hyperkalemia","Severe renal failure with oliguria or anuria","Adrenal insufficiency","Concomitant use of potassium-sparing diuretics","Crush syndrome","Severe hemolytic reactions"]

Clinical Precautions

Precautions

["Hyperkalemia risk; monitor serum potassium levels","Cardiotoxicity; ECG monitoring recommended","Risk of extravasation; do not administer intramuscularly","Use with caution in renal impairment, adrenal insufficiency, or conditions predisposing to hyperkalemia","Do not administer if solution is discolored or contains particulate matter"]

Clinical Tips & Counseling

Drug interactions

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POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER

Clinical safety rating: caution

Comprehensive clinical and safety monograph for POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER (POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER).

How it works

What the body does with it

Metabolism	Potassium is not metabolized; it is excreted primarily by the kidneys. Dextrose undergoes glycolysis and oxidation to carbon dioxide and water.
Excretion	Renal: >90% of potassium intake is excreted by the kidneys, primarily via distal tubular secretion; fecal: <10%; minor sweat losses. In this formulation (KCl 0.22% in D5W), the potassium content is 2 mEq per 100 mL (approximately 20 mEq/L).
Half-life	The elimination half-life of potassium is not applicable in the traditional sense because potassium is an endogenous ion under tight homeostatic control. After intravenous infusion of a potassium load, the plasma concentration declines with a distribution phase of about 1-2 hours, followed by a slower elimination phase reflecting cellular uptake and renal excretion, with a terminal half-life of approximately 6-8 hours in patients with normal renal function.
Protein binding	Negligible (<5%). Potassium is not significantly bound to plasma proteins; it exists as free ion in serum.
Volume of Distribution	Approximately 0.5-0.6 L/kg (total body water); reflects distribution throughout extracellular and intracellular spaces. Potassium is predominantly intracellular (98% of total body potassium is in cells); Vd for administered potassium is large due to cellular uptake.
Bioavailability	Intravenous: 100% (complete bioavailability). Oral: about 90% absorbed; however, this formulation is for IV administration only.
Onset of Action	Intravenous: Correction of hypokalemia begins within minutes after starting infusion; clinical effect (e.g., improvement in muscle weakness, ECG changes) seen within 30-60 minutes at appropriate infusion rates (usual rate: 10-20 mEq/h; max 40 mEq/h with cardiac monitoring).
Duration of Action	Intravenous: Effect persists for the duration of infusion and several hours thereafter; potassium levels gradually return to baseline over 6-12 hours post-infusion, depending on ongoing losses and cellular uptake. Continuous infusion required for sustained correction of severe depletion.

Classification & Brands

Dosing & administration

Intravenous; typical adult dose is 10-20 mEq/hour, not exceeding 40 mEq/hour or 150 mEq/day, with continuous cardiac monitoring and serum potassium monitoring.

Dosage form	INJECTABLE
Renal impairment	GFR > 50 mL/min: no adjustment; GFR 10-50 mL/min: reduce total daily dose by 25-50%; GFR < 10 mL/min: reduce dose by 50-75% and monitor potassium closely. Avoid if anuria.
Liver impairment	No specific adjustment based on Child-Pugh score; however, monitor potassium levels and renal function closely due to potential hepatorenal syndrome.
Pediatric use	Intravenous; 0.2-0.5 mEq/kg/hour, not exceeding 1 mEq/kg/hour or 40 mEq/m²/hour; adjust based on serum potassium and clinical status.
Geriatric use	Cautious dosing: initial dose at lower end of adult range (10 mEq/hour) with close monitoring of renal function and serum potassium due to decreased renal reserve and higher risk of hyperkalemia.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER (POTASSIUM CHLORIDE 0.22% IN DEXTROSE 5% IN PLASTIC CONTAINER).

Breastfeeding	Potassium and dextrose are normal constituents of breast milk. No adverse effects anticipated. Use considered safe during breastfeeding. M/P ratio not established.
Teratogenic Risk	Potassium chloride and dextrose are not known to be teratogenic. No fetal risks have been identified in any trimester. Dextrose is a physiological nutrient. Overdose or rapid infusion may cause maternal electrolyte imbalance potentially affecting fetus.

Warnings & precautions

■ FDA Black Box Warning

Potassium chloride injection concentrate must be diluted before use to avoid fatal hyperkalemia.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hyperkalemia","Severe renal failure with oliguria or anuria","Adrenal insufficiency","Concomitant use of potassium-sparing diuretics","Crush syndrome","Severe hemolytic reactions"]