POTASSIUM CHLORIDE 20MEQ IN DEXTROSE 5% AND SODIUM CHLORIDE 0.225% IN PLASTIC CONTAINER
Clinical safety rating: safe
No significant drug interactions Can cause hypernatremia and fluid overload.
Potassium chloride provides potassium ions, which are essential for maintaining cellular membrane potential, nerve impulse transmission, muscle contraction, and acid-base balance. Dextrose 5% provides a source of calories and water, while sodium chloride 0.225% provides sodium and chloride ions to maintain electrolyte balance.
| Metabolism | Potassium is not metabolized; it is excreted primarily renally (90%) with minor fecal loss. Dextrose undergoes glycolysis and subsequent metabolism via the citric acid cycle. |
| Excretion | Renal excretion: >90% as potassium ions via distal tubular secretion and glomerular filtration. Fecal: <10%. Biliary: negligible (under 1%). |
| Half-life | Potassium has no classic elimination half-life; its clearance is highly dependent on renal function, acid-base status, and hormonal influences (insulin, aldosterone). In normal renal function, rapid redistribution and excretion yield an effective half-life of approximately 2-4 hours for an acute load. In chronic kidney disease, half-life may extend to >24 hours. |
| Protein binding | Potassium is minimally bound to plasma proteins (<2%); it exists predominantly as free ions in solution. |
| Volume of Distribution | Approximately 0.5-0.7 L/kg in adults (total body water). Clinically, potassium is primarily intracellular (98% of total body stores); the Vd reflects distribution across all fluid compartments but is not a linear parameter for loading doses. |
| Bioavailability | Oral: 90-100% (well absorbed from gastrointestinal tract). Intravenous: 100%. |
| Onset of Action | Intravenous: Onset within minutes (infusion-dependent); serum potassium begins to rise during infusion. Oral: Onset within 30-60 minutes after ingestion. |
| Duration of Action | Intravenous: Duration of pharmacodynamic effect (elevated serum K+) persists for 1-2 hours after infusion ends, followed by redistribution and renal elimination. Oral: Duration of effect is 4-6 hours for an immediate-release dose, with sustained levels if multiple doses or extended-release formulations are used. |
Intravenous infusion: 20 mEq potassium chloride in 1000 mL D5-0.225% NaCl at a rate not exceeding 10 mEq/hour and 200 mEq/24 hours.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 30-50 mL/min: Administer with caution, reduce dose by 50% or extend dosing interval. GFR <30 mL/min: Avoid use or reduce dose by 75% with serum potassium monitoring. |
| Liver impairment | No specific adjustment required for Child-Pugh class A or B; use with caution in class C due to risk of hyperkalemia from renal impairment. |
| Pediatric use | Dose: 0.5-1 mEq/kg per dose, maximum 20 mEq per dose; administered as a slow IV infusion over 2-4 hours, not exceeding 0.5 mEq/kg/hour. |
| Geriatric use | Use lower end of dosing range due to age-related renal decline; monitor potassium levels closely. Typical maximum infusion rate: 5-10 mEq/hour. |
| 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 | Potassium chloride, dextrose, and sodium chloride are normal constituents of breast milk. Potassium levels in milk are not significantly altered by maternal supplementation. M/P ratio not established. Compatible with breastfeeding. |
| Teratogenic Risk | Potassium chloride, dextrose, and sodium chloride are not associated with teratogenicity when used appropriately. Potassium is essential for fetal development, but hyperkalemia or hypokalemia may cause fetal arrhythmias. Dextrose and sodium chloride are standard components of parenteral nutrition; no teratogenic risk reported in trimesters 1-3. |
■ FDA Black Box Warning
Potassium chloride injection should be administered only in carefully diluted solutions via a large central vein to avoid fatal hyperkalemia and cardiac arrest. Concentrated potassium solutions should not be administered undiluted.
| Common Effects | fluid replacement |
| Serious Effects |
["Hyperkalemia (serum potassium >5.5 mEq/L)","Severe renal impairment (oliguria or anuria)","Acute dehydration or heat cramps","Conditions where potassium administration may be harmful (e.g., severe hemolytic anemia, adrenal insufficiency, concurrent potassium-sparing diuretics)","Patients with known hypersensitivity to any component"]
| Precautions | ["Risk of hyperkalemia, especially in patients with renal impairment, adrenal insufficiency, or rapid infusion. Monitor serum potassium levels.","Extravasation can cause tissue necrosis. Use central line for concentrated solutions.","Dextrose-containing solutions may cause hyperglycemia, particularly in diabetic patients.","Sodium chloride content may exacerbate conditions such as heart failure, hypertension, or edema."] |
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| Fetal Monitoring | Monitor maternal serum potassium, glucose, sodium, and chloride levels; renal function; urine output; fetal heart rate tracing during infusion to detect maternal or fetal electrolyte disturbances or fluid overload. |
| Fertility Effects | No known adverse effects on fertility when used at therapeutic doses for electrolyte maintenance. |