Peer-reviewed veterinary case report
How accurate is potassium in IV fluids for pets?
By Hoehne, S N et al.·Published in Journal of veterinary internal medicine·2015·William R. Pritchard Veterinary Medical Teaching Hospital, United States·View original on PubMed →
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Original publication title: Accuracy of potassium supplementation of fluids administered intravenously.
Plain-English summary
This study looked at how accurately potassium is added to IV fluids given to dogs and cats in the hospital. Researchers found that when potassium was added to the fluids without mixing them well, the actual amount of potassium delivered could be much higher than intended, sometimes dangerously so. In fact, in almost a third of the samples, the potassium levels were significantly different from what was meant to be given. However, when the fluids were mixed properly, the potassium levels were much closer to what was intended. The findings suggest that it's very important for veterinarians to follow strict guidelines for mixing potassium into IV fluids to avoid serious health risks.
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. ANIMALS: 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 AND CLINICAL IMPORTANCE: 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.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/25857327/