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Evaluation of Parenteral Potassium Supplementation in Pediatric Patients
Amanda A Clouser1, Cristian D Merchan1, Ferras Bashqoy2
1Department of Pharmacy (AAC, CDM, JP), NYU Langone Health, New York, NY.
Insights
Parenteral potassium chloride (KCl) supplementation in pediatric patients showed a direct correlation with increased potassium levels. Higher KCl doses (1 mEq/kg) resulted in greater potassium changes, with a low incidence of hyperkalemia.
Area of Science:
- Pediatric critical care medicine
- Clinical pharmacology
- Electrolyte management
Background:
- Parenteral potassium chloride (KCl) supplementation is crucial for managing hypokalemia in pediatric patients.
- Limited data exists on the precise impact of KCl dosing on serum potassium levels in non-cardiac pediatric populations.
Purpose of the Study:
- To evaluate the effect of parenteral KCl supplementation on serum potassium (K+) concentrations in non-cardiac pediatric patients.
- To identify factors influencing the K+ response to KCl and assess hyperkalemia incidence.
Main Methods:
- Retrospective, single-center study of 102 infants and children receiving parenteral KCl (0.5 or 1 mEq/kg).
- Data collected between January 2017 and December 2019.
- Analysis of serum K+ changes and correlation with KCl dose and timing of K+ measurement.
Main Results:
- KCl doses of 1 mEq/kg and 0.5 mEq/kg were associated with median K+ changes of 0.8 mEq/L and 0.5 mEq/L, respectively.
- Higher K+ changes observed when serum K+ was measured within 4 hours post-infusion (0.8 mEq/L vs. 0.6 mEq/L, p < 0.01).
- Low incidence of hyperkalemia reported across all KCl administrations.
Conclusions:
- Parenteral KCl supplementation demonstrates a dose-dependent effect on serum K+ levels in pediatric patients.
- Timing of post-infusion K+ measurement influences observed changes.
- KCl supplementation is safe and effective for correcting hypokalemia in this population, with careful monitoring recommended.
Objective:
The primary objective was to evaluate the effect of parenteral potassium chloride (KCl) supplementation on potassium (K+) concentrations in a non-cardiac pediatric population. Secondary outcomes were to identify variables that may influence response to KCl supplementation (i.e., change in K+ concentration after KCl administration) and assess the incidence of hyperkalemia.
Methods:
This single-center, retrospective study evaluated infants and children who received parenteral KCl supplementation of 0.5 or 1 mEq/kg between January 2017 and December 2019.
Results:
The study included 102 patients with a median age of 1 year (IQR, 0.4-3.9) and weight of 9.1 kg (IQR, 4.9-14.2) who received 288 parenteral KCl administrations. One hundred seventy-three administrations were in the 1 mEq/kg group, and 115 administrations were in the 0.5 mEq/kg group. The median changes in K+ were 0.8 and 0.5 mEq/L in the 1 mEq/kg and 0.5 mEq/kg groups, respectively. Patients who had a repeat K+ concentration within 4 hours of the end of a 1 to 2-hour infusion had a higher median change in K+ compared with those who had a concentration drawn after this time frame (0.8 vs 0.6 mEq/L; p < 0.01).
Conclusions:
There is a paucity of data on the correlation between parenteral KCl supplementation and change in K+ concentrations in pediatric patients. Our study demonstrated an association between KCl supplementation doses of 1 and 0.5 mEq/kg and changes in K+ of 0.8 and 0.5 mEq/L, respectively, in non-cardiac pediatric patients, with low observed incidence of hyperkalemia.
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