A healthcare prescriber orders potassium infusions.

Potassium infusions are administered by a registered nurse or healthcare prescriber who is knowledgeable about administering potassium.

Before administration, the potassium infusion must be verified by two of the above providers to check child’s identification, weight, healthcare prescriber order, drug concentration, and rate of infusion.

Principles of pharmacologic management (see Chapter 6) are followed.

Intravenous (IV) potassium is administered to achieve and maintain electrolyte balance.

Serum potassium concentrations should always be interpreted using the child’s current pH. If the pH is to be corrected, potassium supplementation should be dependent on the results of the pH correction. For example, a low potassium concentration may be adequate if the child is alkalotic and the alkalosis is going to be corrected; therefore, potassium replacement may not be necessary.

Hypokalemia may be treated orally or parenterally. Nonsymptomatic hypokalemia should be treated, whenever possible, with oral supplementation.

Hypokalemia-related dysrhythmias should be treated with IV supplementation with the patient continuously monitored in a critical care setting. Because potassium contributes to the resting membrane potential of the cells, this may result in acute and dramatic fluctuations in serum potassium levels that can precipitate life-threatening dysrhythmias.

Monitoring of vital signs and cardiac response to the potassium acute infusion requires facilities, equipment, and resources to perform the following before, during, and after the potassium infusion:

Continuous electrocardiogram (ECG) monitoring of heart rate and rhythm

Pediatric advanced life support

Treatment of life-threatening dysrhythmias

The maximum concentration for acute potassium infusions should be no greater than 0.4 mEq/mL for central line infusion and 0.2 mEq/mL for peripheral line infusion.

The maximum acute infusion rate should be 0.5 mEq/kg per dose or less (infused over an hour or more).

Emergency drugs and equipment must be available for immediate use in the event of adverse drug reactions, potential complications, or emergency situations that require advanced life support (see Chapter 25).