title: Accuracy of potassium supplementation of fluids administered intravenously.
abstract: BACKGROUND
  Potassium (K+) supplementation of isotonic crystalloid fluids in daily fluid therapy is commonly performed, yet its accuracy in veterinary medicine is undetermined.
  
  
  OBJECTIVE
  To investigate the accuracy of K+ supplementation in isotonic crystalloid fluids.
  
  
  METHODS
  None.
  
  
  METHODS
  Observational study. 210 bags of fluid supplemented with KCl being administered to hospitalized dogs and cats intravenously (IV) were sampled over a 3-month period. Measured K+ concentration ([K+]) was compared to the intended [K+] of the bag. In a second experiment, 60 stock fluid bags were supplemented to achieve a concentration of 20 mmol/L K+, mixed well and [K+] was measured. In another 12 bags of 0.9% NaCl, K+ was added without mixing the bag, and [K+ ] of the delivered fluid was measured at regular time points during constant rate infusion.
  
  
  RESULTS
  The measured [K+] was significantly higher than intended [K+] (mean difference 9.0 mmol/L, range 6.5 to >280 mmol/L, P < .0001). In 28% of clinical samples measured [K+] was ≥5 mmol/L different than intended [K+]. With adequate mixing, K+ supplementation of fluids can be accurate with the mean difference between measured and intended [K+] of 0.7 (95% CI -0.32 to 1.7) mmol/L. When not mixed, K(+) supplementation of 20 mmol/L can lead to very high [K+] of delivered fluid (up to 1410 mmol/L).
  
  
  CONCLUSIONS
  Inadequate mixing following K+ supplementation of fluid bags can lead to potentially life threatening IV infused [K+]. Standard protocols for K+ supplementation should be established to ensure adequate mixing.
authors: William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA.
authors: S N
authors: SN
authors: Hoehne
authors: Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA.
authors: K
authors: K
authors: Hopper
authors: Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA.
authors: S E
authors: SE
authors: Epstein
mesh_terms: D000818:Animals; D002371:Cat Diseases / Q000628:therapy*; D002415:Cats; D000077324:Crystalloid Solutions; D004283:Dog Diseases / Q000628:therapy*; D004285:Dogs; D005440:Fluid Therapy / Q000662:veterinary*; D007262:Infusions, Intravenous / Q000662:veterinary*; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000737:chemistry; D011188:Potassium / Q000008:administration & dosage* / Q000032:analysis / Q000097:blood; D015203:Reproducibility of Results
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D011188:Potassium
keywords: Additives; Crystalloid fluids; Electrolytes; Hyperkalemia; Mixing