What are the guidelines for administering potassium intravenously (IV) at a rate of 10 milliequivalents (meq) per hour?

IV Potassium Administration at 10 mEq/Hour

Administering potassium chloride intravenously at 10 mEq/hour through a peripheral line is generally safe for moderate hypokalemia (K+ 2.5-3.5 mEq/L), but concentrations must not exceed 40 mEq/L peripherally, and all potassium infusions require cardiac monitoring and use of an infusion pump. 1

Critical Safety Requirements

Concentration and Route Limitations

• Peripheral IV administration: Maximum concentration of 40 mEq/L (10 mEq in at least 250 mL) 1
• Central venous administration: Can use higher concentrations up to 200 mEq/L, but central route is preferred whenever possible for concentrated solutions 2
• Never administer undiluted potassium chloride - concentrated vials (100-200 mEq/L) should be removed from patient care areas entirely 1

Maximum Infusion Rates

• Standard rate: 10 mEq/hour is acceptable for peripheral administration when properly diluted 3, 4
• Maximum rate: Up to 20 mEq/hour can be given through central lines for severe hypokalemia (K+ <2.5 mEq/L) 3, 4
• Urgent situations: Rates of 40 mEq/hour have been used in critical care settings through central access only, but this requires intensive monitoring 3

Mandatory Monitoring and Safety Protocols

Double-Check System

• Two healthcare providers must verify product, dose, dilution, labeling, route, and rate before administration (similar to blood transfusion protocols) 1
• Use only premixed solutions from pharmacy whenever possible 1

Cardiac Monitoring

• Continuous ECG monitoring is required during infusion, particularly watching for:
  • Changes in T-wave morphology
  • QT interval changes
  • Arrhythmias (though ventricular ectopy typically decreases with appropriate repletion) 3, 4

Equipment Requirements

• Calibrated infusion pump is mandatory - never rely on gravity drip 2
• Prescription must include specific dilution instructions and infusion rate 1
• Avoid the term "bolus" in all potassium orders 1

Clinical Decision Algorithm

For K+ 2.5-3.5 mEq/L (Moderate Hypokalemia)

• Oral route is preferred if patient has functioning GI tract and no urgent ECG changes 5
• If IV required: 10 mEq/hour peripherally in 250-1000 mL solution 3, 4
• Recheck potassium 1-2 hours after infusion completion 3, 4

For K+ <2.5 mEq/L (Severe Hypokalemia)

• Central venous access is strongly preferred 2
• Can administer 20 mEq/hour through central line 3, 4
• Expect average increase of 0.4-0.5 mEq/L per 20 mEq dose 3, 4
• Continuous cardiac monitoring is non-negotiable 3, 4

Special Circumstances

• Thyrotoxic periodic paralysis: Potassium alone may be insufficient; add propranolol 20 mg orally as beta-blockade addresses the underlying transcellular shift 6
• Symptomatic hypokalemia (muscle weakness, paralysis, ECG changes): Requires urgent IV repletion regardless of exact potassium level 5

Common Pitfalls to Avoid

Extravasation Risk

• Peripheral infiltration of concentrated potassium causes severe tissue necrosis 1
• If extravasation occurs, inject phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 mL normal saline intradermally at the site 1

Inadequate Response

• If potassium remains low after appropriate repletion, check magnesium levels - hypomagnesemia prevents effective potassium repletion 5
• Address underlying cause (diuretics, GI losses, renal losses) concurrently 5

Documentation Requirements

• Prescriptions must specify: exact dose in mEq, total volume, concentration, infusion duration, and route 1
• Incomplete or illegible prescribing is a major source of fatal errors with potassium 1