Potassium supplementation is a common practice in critically ill children, especially those with heart disease. Intravenous potassium supplementation is the standard route of administration in most intensive care units. Although the enteral route is safer and thus may be a reasonable alternative, data on the efficacy of enteral potassium administration are lacking.
A change of practice to encourage use of enteral potassium was instituted in the cardiac intensive care unit at Texas Children's Hospital, and a review of this practice change was undertaken. The primary outcome of interest was the comparable efficacy of enteral and intravenous potassium administration. Patient demographic data, including urine output, diuretic use, route of potassium administration, and adverse events were documented and analyzed.
Seventy-six patients met inclusion criteria and received 399 bolus doses of potassium (166 intravenous and 233 enteral). No patients became hyperkalemic after either route of administration. The increase in serum potassium was similar in both groups of patients. Side effects of the two routes of administration were not different.
The efficacy of enteral potassium is comparable to intravenous potassium for potassium replacement in pediatric patients after congenital heart surgery.
[Show abstract][Hide abstract] ABSTRACT: Potassium chloride (KCl) supplementation is common among critically ill children. Intravenous (IV) KCl supplementation for pediatric patients is poorly characterized. This study aimed to examine the efficacy and safety of IV KCL and to determine factors affecting patient responses to IV KCL in the pediatric cardiac intensive care unit (CICU). A retrospective review of 211 children (794 KCl doses) undergoing cardiac surgery or a hospital stay for heart failure in the CICU of a tertiary care teaching and referral children's hospital in 2011 was performed. Demographic data, weight, height, creatinine, and concomitant medications during each KCl dose were recorded and analyzed. Body surface area (BSA), creatinine clearance, and change in [K(+)] were calculated. The median age of the children was 4 months (range, 10 days-18 years). In this study, 151 KCl doses were administered to neonates (19 %), 307 doses (39 %) to females, and 510 doses (64 %) to patients with a BSA smaller than 0.33 m(2) (a group with relative renal insufficiency). The mean KCl dose was 0.97 ± 0.006 mEq/kg. No adverse events were associated with IV KCl administration. Blood/plasma [K(+)] increased 0.8 ± 0.02 mEq/L. The responses to KCl did not differ significantly between males and females, between neonates and children, or between patients with a BSA smaller than 0.33 m(2) and those with a BSA of 0.33 m(2) or larger. The responses to IV KCl were attenuated by concomitant furosemide (p = 0.01), amphotericin B (p < 0.01), and KCl in parenteral nutrition (p < 0.01). The responses were augmented by concomitant enalapril (p = 0.03), ethacrynic acid (p < 0.001), and hemodialysis (p < 0.01). Intravenous KCl can be administered safely for CICU patients. Responses to KCl are altered when it is given with certain medications. Intravenous KCl should be used cautiously in children receiving angiotensin-converting enzyme inhibitors. Future studies are needed for further characterization of factors affecting responses to IV KCl in children.
[Show abstract][Hide abstract] ABSTRACT: Only a small fraction of acutely ill children are hospitalized with an electrolyte disorder as their primary diagnosis. However, many patients encounter secondary homeostatic imbalances that involve one or more of the following: sodium, potassium, calcium, magnesium and phosphorous. Abnormalities in the serum concentrations of these electrolytes could result from an underlying disease process; however, more frequently they are the result of complications, end organ injury or iatrogenic interventions such as fluid and electrolyte therapy, medications, or applications of critical care technology (positive pressure ventilation or renal replacement therapy), and should therefore be anticipated and prevented. Because of the fragile state of many of the pediatric intensive care unit (PICU) patients, electrolyte imbalances may have profound effects on patient outcomes, and in their extreme forms may be life-threatening. Careful, stepwise management is essential, as aggressive correction may at times result in further injury. This chapter outlines the pathophysiology and management of electrolyte disorders in the PICU. The authors have attempted to include a practical diagnostic and therapeutic approach to the most common disorders, but also provide a comprehensive differential diagnosis that would enable the practicing clinician to capture less common etiologies for electrolyte abnormalities in critically ill children.
Pediatric Critical Care Medicine, 02/2014: pages 147-171; , ISBN: 978-1-4471-6415-9
[Show abstract][Hide abstract] ABSTRACT: Background Hypokalaemia is frequently encountered in the daily clinical practices of a paediatric cardiac intensive care unit (PCICU). It is a strong independent predictor of mortality in patients with heart failure. Thus, prompt potassium replacement therapy holds pivotal importance in therapy for hypokalaemia. Although intravenous potassium replacement (IVPR) in hypokalaemia is the preferred route in most intensive care settings, it is associated with known safety risks and can lead to arrhythmias, cardiac arrest and death if inappropriately administered. Enteral potassium replacement (EPR), with its superior safety profile, may be a better alternative to IVPR.
Outcome Primary outcome To compare the efficacy EPR and IVPR for treatment of hypokalaemia. Secondary outcome measures include a comparison of adverse effects (hyperkalaemia, diarrhoea, gastrointestinal bleeds, nausea and vomiting) after EPR and IVPR and a comparison of the number of dose/s required to achieve resolution of hypokalaemia for each episode of hypokalaemia.
Methods and analysis The Enteral Versus Intravenous Potassium Supplementation trial is designed as a randomised, controlled, non-blinded trial with two arms. Intervention arms will be block randomised on alternate weeks for IVPR and EPR. Recruited patients will receive treatment accordingly. For analysis, the percentage change in serum potassium levels in mEq/L after each event of potassium replacement in both arms will be used as an end point to compare the efficacy EPR and IVPR for treatment of hypokalaemia.
Study setting The study will be conducted at the PCICU at the Aga Khan University Hospital, Karachi.
Ethics and dissemination This study has been approved by the Ethics Review Committee and Clinical Trials Unit at The Aga Khan University with respect to scientific content and compliance with applicable research and human subjects regulations.
Trial registration number This trial is registered at Clinical Trials.Gov. Registration number: NCT02015962.
BMJ Open 09/2014; 4(9):e005124. DOI:10.1136/bmjopen-2014-005124 · 2.27 Impact Factor
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