POTASSIUM CHLORIDE 15% = KCl 15% injectable

Last updated: July 2021

Prescription under medical supervision


Indications

– Treatment of severe hypokalaemia (arrhythmia, marked muscular weakness and/or serum potassium level ≤ 2.5 mmol/litre)

Forms and strengths, route of administration

– Ampoule containing 15% potassium chloride hypertonic solution (150 mg/ml, 10 ml = 2 mmol/ml), i.e. 1.5 g of potassium chloride (KCl) per 10 ml ampoule
– Ionic composition:
• potassium (K+): 20 mmol per 10 ml ampoule (20 mEq)
• chloride (Cl): 20 mmol per 10 ml ampoule (20 mEq)
– Check concentration before use: potassium chloride also comes in ampoules containing 7.5%, 10%, 11.2% and 20% solutions.

– Potassium chloride must always be administered by slow IV infusion, diluted in 0.9% sodium chloride.
– For dilution:
• The potassium concentration in the infusion fluid should not exceed 40 mmol/litre.
• Mix thoroughly the potassium and the 0.9% sodium chloride solution by inverting at least 5 times the infusion bottle or bag.
NEVER USE BY DIRECT UNDILUTED IV OR IM OR SC INJECTION.

Dosage and duration

Dosage depends on the severity of hypokalaemia and the patient’s underlying condition. For information:

– Child over one month: 0.2 mmol/kg/hour for 3 hours
Each mmol of potassium is diluted in 25 ml of 0.9% sodium chloride.
Examples:

10 kg

0.2 (mmol) x 10 (kg) = 2 mmol/hour x 3 hours = 6 mmol
6 mmol (= 3 ml of 15% KCl solution) diluted in 150 ml of NaCl 0.9% and administered over 3 hours

15 kg

0.2 (mmol) x 15 (kg) = 3 mmol/hour x 3 hours = 9 mmol
9 mmol (= 4.5 ml of 15% KCl solution) diluted in 225 ml of NaCl 0.9% and administered over 3 hours

– Adult: 40 mmol (= 2 ampoules of 10 ml of 15% KCl) in one litre of 0.9% sodium chloride, to be administered over 4 hours

– Do not exceed 10 mmol/hour. The infusion may be repeated if severe symptoms persist or if the serum potassium level remains < 3 mmol/litre.

Contra-indications, adverse effects, precautions

– Administer with caution to older adults.
– Administer with caution and reduce the dose in patients with renal impairment (increased risk of hyperkalaemia).
– May cause:
• pain at infusion site, venous irritation and phlebitis (use a large peripheral vein to reduce these risks);
• in the event of too rapid administration or overdose: hyperkalaemia, cardiac conduction and rhythm disorders, potentially fatal;
• in the event of extravasation: necrosis.
– Monitor closely:
• infusion rate; use an infusion pump or syringe pump if possible to prevent unintentional bolus;
• infusion site for redness and inflammation.
– Monitor electrolytes if possible to determine the need for further infusions and to avoid hyperkalaemia.

Remarks

– Higher dose or infusion rate requires continuous electrocardiogram monitoring.
– Potassium chloride is also used to prevent hypokalaemia in patients unable to meet their daily requirements by oral route : daily K+ requirements are 2 to 3 mmol/kg daily in children and 1 to 2 mmol/kg daily in adults.
– A 7.5% potassium solution contains 1 mmol of K+/ml; a 10% solution contains 1.34 mmol/ml ; a 11.2% solution contains 1.5 mmol of K+/ml; a 20% solution contains 2.68 mmol of K+/ml.
Storage: below 25 °C