What is the recommended infusion rate for D5NS (5% Dextrose in Normal Saline) with KCL (Potassium Chloride)?

Recommended Infusion Rate for D5NS with KCl

For adult patients, KCl in D5NS should be administered at a maximum rate of 10 mEq/hour (not exceeding 200 mEq/24 hours) when serum potassium is >2.5 mEq/L, using a calibrated infusion device. 1

Adult Infusion Guidelines

• For standard potassium replacement in adults with serum potassium >2.5 mEq/L, administer KCl at a rate not exceeding 10 mEq/hour or 200 mEq for a 24-hour period 1
• For urgent cases where serum potassium is <2 mEq/L or severe hypokalemia threatens (with ECG changes or muscle paralysis), rates up to 40 mEq/hour or 400 mEq/24 hours can be administered with continuous ECG monitoring and frequent serum potassium measurements 1
• D5NS (5% Dextrose in Normal Saline) should be infused at 4-14 mL/kg/hour in adults, with the specific rate depending on the patient's hydration status and corrected serum sodium 2
• Once renal function is assured, the infusion should include 20-30 mEq/L potassium (typically as 2/3 KCl and 1/3 KPO4) until the patient is stable and can tolerate oral supplementation 2

Pediatric Infusion Guidelines

• For pediatric patients, KCl infusion rates should not exceed 0.4 mEq/kg/hour without cardiac monitoring 3
• Maximum KCl concentration for peripheral administration in children is 60 mEq/L; for central line administration, 120 mEq/L is acceptable 3
• D5NS fluid should be changed to 5% dextrose and 0.45-0.75% NaCl once serum glucose reaches 250 mg/dL in pediatric patients 2
• For pediatric patients with DKA, once renal function is assured and serum potassium is known, the infusion should include 20-40 mEq/L potassium (2/3 KCl or potassium acetate and 1/3 KPO4) 2

Administration Safety Considerations

• Always administer intravenously using a calibrated infusion device at a slow, controlled rate 1
• Central venous administration is preferred whenever possible to ensure thorough dilution by the bloodstream and avoid extravasation 1
• Highest concentrations (300 and 400 mEq/L) should be exclusively administered via central route 1
• Parenteral solutions should be visually inspected for particulate matter and discoloration 1
• Use of a final filter is recommended during administration of all parenteral solutions where possible 1
• Do not add supplementary medication to KCl solutions 1

Monitoring Requirements

• Continuous ECG monitoring is essential when administering high-dose or high-concentration potassium infusions 1, 4
• Frequent monitoring of serum potassium levels is necessary to avoid hyperkalemia 1, 5
• Monitor fluid input/output and hemodynamic parameters to assess response to fluid replacement 2
• The mean increment in serum potassium level per 20 mEq infusion is approximately 0.25 mmol/L 4

Clinical Considerations

• Concentrated KCl infusions (200 mEq/L) at 20 mEq/hour have been shown to be relatively safe in ICU patients with appropriate monitoring 5, 4
• Using saline rather than D5W as a diluent may increase the incidence of hypernatremia and hyperchloremia 6
• Fluid replacement should correct estimated deficits within the first 24 hours, with induced change in serum osmolality not exceeding 3 mOsm/kg/hour 2
• In patients with renal or cardiac compromise, careful monitoring of serum osmolality and frequent assessment of cardiac, renal, and mental status must be performed during fluid resuscitation to avoid iatrogenic fluid overload 2