The Journal of Informed Pharmacotherapy 2002;11:406.
Smith J, B.Sc.(Pharm), Don Hamilton, B.Sc.(Pharm), Roxane Carr, B.Sc.(Pharm) Pharm.D.
Department of Pharmacy, Children's and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.
To examine the practice of potassium chloride (KCl) replacement in pediatric oncology patients receiving amphotericin B (amp-B); including a review of adherence to the KCl replacement guidelines in our institution as well as a review of the literature and other pediatric institutions' KCl replacement protocols.
A Canadian teaching institution.
A retrospective chart review was conducted of patients who received amp-B on the oncology ward between August 27, 2000 and May 17, 2001. A literature search was conducted. A survey of pediatric oncology pharmacists at other pediatric institutions was done to assess KCl infusion guidelines in other institutions across North America.
A total of 20 hypokalemic episodes were identified within 22 patient admissions. Of these episodes, 55% used KCl replacement at rates exceeding our institution's current guidelines. Physicians were adherent to providing proper documentation of each episode requiring an interim policy for a rate exceeding our hospital guidelines. A consensus on the maximum rate of KCl that can be safely infused in a non-critical care ward could not be found in the literature. Other pediatric institutions varied with respect to the maximum rates and concentration of KCl permitted on non-intensive care wards..
Based on the data from this review, the intravenous KCl administration guidelines for our hospital were changed. We now allow a maximum peripheral line concentration of 60 mmol/L (as per current protocol), a maximum central line concentration of 120 mmol/L (increased from 80 mmol/L), and a maximum KCl infusion rate of 0.4 mmol/kg/hr (increased from 0.3 mmol/kg/hr) without the requirement of a heart monitor. TPN is now restricted to maximum concentration of 80 mmol/L and fluid restricted patients are restricted to a maximum concentration of 150 mmol/L. As the methodology of this study provided only an estimation of the KCl requirement in a select population, it is important that the effects from the changes of the new guidelines are frequently monitored. It is also important that physician, nursing, and pharmacy staffs are well educated on the new guidelines and continuously monitor for efficacy and toxicity of IV KCl therapy.
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