Objectives 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...
The patients given maintenance potassium preemptively received significantly fewer (P less than .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.
Hang normal saline as the maintenance IV fluid on patients with good kidneys and no potassium supplement or potassium sparing drugs on board and they are likely to be hypokalmemic the next morning. If straight normal saline with no additives is the default IV fluid these days it may be driven by CPOE. Customizing IV fluids is more difficult if you don't have a unit secretary to enter it for you.
Via Hospital Medicine Virtual Journal Club.