title: Preventing hypokalemia in critically ill patients.
abstract: BACKGROUND
  Many therapies used in critical care cause potassium depletion. Current practice relies on potassium replacement protocols after a patient becomes hypokalemic. Potassium bolus therapy creates risk for patients, is costly, and increases nurses' workload.
  
  
  OBJECTIVE
  To determine if administering potassium preemptively in maintenance intravenous fluid would prevent episodes of hypokalemia and reduce the need for potassium boluses.
  
  
  METHODS
  Medical records of 267 patients with normal potassium and creatinine levels at admission who did not receive total parenteral nutrition were reviewed. The 156 patients who met the study criteria were categorized by group: those who received potassium via maintenance intravenous fluid (treatment; n = 76) and those who did not (control; n = 80). The treatment group had potassium chloride or acetate added to intravenous fluid delivered at 36 to 72 mmol/d.
  
  
  RESULTS
  The 2 groups did not differ significantly in age, race, sex, or admitting diagnosis. Type of diagnosis, length of stay, and potassium and creatinine levels at admission did not affect the number of potassium boluses for either group. The patients given maintenance potassium preemptively received significantly fewer (P < .001) potassium boluses (0.8) than did the control group (2.73), for a mean savings of $231 per patient for the treatment group.
  
  
  CONCLUSIONS
  Patients with normal potassium and creatinine levels at admission benefitted from a maintenance intravenous dose of potassium of 72 to 144 mmol/L per day. Compared with control patients, patients receiving this dose avoided detrimental hypokalemic events, had fewer invasive procedures and lower costs, and required less nursing care.
authors.affiliation: Carrie J. Scotto is an associate professor, School of Nursing, and Mark Fridline is an associate instructor, Department of Statistics, University of Akron, Akron, Ohio. Cinderella J. Menhart is a staff nurse in the intensive care unit, and Howard A. Klions is a medical intensivist, Western Reserve Hospital, Summa Health System, Cuyahoga Falls, Ohio.
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Scotto
authors.forename: Mark
authors.initials: M
authors.lastname: Fridline
authors.forename: Cinderella J
authors.initials: CJ
authors.lastname: Menhart
authors.forename: Howard A
authors.initials: HA
authors.lastname: Klions
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003401:Creatine / Q000097:blood; D003422:Critical Care / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007008:Hypokalemia / Q000517:prevention & control*; D007262:Infusions, Intravenous; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009820:Ohio; D011188:Potassium / Q000097:blood; D019347:Potassium Acetate / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011189:Potassium Chloride; D019347:Potassium Acetate; D003401:Creatine; D011188:Potassium