When should IV potassium supplementation be used to treat hypokalemia?
This may be necessary emergently in hypokalemic periodic paralysis, severe hypokalemia prior to urgent surgery, acute myocardial infarction (MI), and significant ventricular ectopy, or other situations where the gut cannot be used. KCl should not be diluted in dextrose-containing IV fluids, because insulin release can stimulate potassium to shift intracellularly. IV potassium supplementation should be accompanied by continuous EKG monitoring. The recommended maximum rate of IV potassium replacement in most patients should not be more than 10 to 20 mEq of KCl per hour to prevent acute hyperkalemia and sudden death. Initial rapid rate of replacement of 20 to 40 mEq/h can be given cautiously through a central venous catheter with continuous EKG monitoring in patients with life-threatening hypokalemia.