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Enteral potassium supplementation in a pediatric cardiac intensive care unit: evaluation of a practice change
Brady S Moffett1, Erin McDade, Joseph W Rossano
1Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA. bsmoffet@texaschildrens.org
Insights
Enteral potassium supplementation is as effective as intravenous for pediatric heart surgery patients. This safer route provides comparable efficacy and similar side effect profiles, supporting its use in intensive care settings.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Cardiology
- Clinical Nutrition
Background:
- Potassium supplementation is crucial for critically ill children, particularly those with heart disease.
- Intravenous (IV) potassium is the standard but carries risks; enteral potassium is a safer alternative.
- Limited data exist on the efficacy of enteral potassium administration in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of enteral potassium administration compared to IV potassium in pediatric patients post-congenital heart surgery.
- To assess the impact of a practice change encouraging enteral potassium use.
Main Methods:
- Retrospective review of patients receiving potassium in a cardiac intensive care unit.
- Comparison of serum potassium levels, urine output, diuretic use, and adverse events between enteral and IV potassium groups.
- Analysis of 76 patients receiving 399 total potassium boluses (166 IV, 233 enteral).
Main Results:
- No instances of hyperkalemia were observed with either administration route.
- Serum potassium increases were comparable between patients receiving enteral and IV potassium.
- No significant differences in side effects were noted between the two routes.
Conclusions:
- Enteral potassium administration is an effective and comparable alternative to IV potassium for electrolyte replacement in pediatric cardiac surgery patients.
- The findings support the use of enteral potassium as a safe and effective practice in pediatric intensive care units.
Background:
Potassium supplementation is a common practice in critically ill children, especially those with heart disease. Intravenous potassium supplementation is the standard route of administration in most intensive care units. Although the enteral route is safer and thus may be a reasonable alternative, data on the efficacy of enteral potassium administration are lacking.
Methods:
A change of practice to encourage use of enteral potassium was instituted in the cardiac intensive care unit at Texas Children's Hospital, and a review of this practice change was undertaken. The primary outcome of interest was the comparable efficacy of enteral and intravenous potassium administration. Patient demographic data, including urine output, diuretic use, route of potassium administration, and adverse events were documented and analyzed.
Results:
Seventy-six patients met inclusion criteria and received 399 bolus doses of potassium (166 intravenous and 233 enteral). No patients became hyperkalemic after either route of administration. The increase in serum potassium was similar in both groups of patients. Side effects of the two routes of administration were not different.
Conclusions:
The efficacy of enteral potassium is comparable to intravenous potassium for potassium replacement in pediatric patients after congenital heart surgery.
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