Potassium Infusion Guidelines

Adult and Pediatric Infusion Rates

The American Diabetes Association recommends D5NS (5% Dextrose in Normal Saline) infusion at 4-14 mL/kg/hour in adults, with the specific rate depending on the patient's hydration status and corrected serum sodium 1, 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 1, 3
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) 3
D5NS fluid should be changed to 5% dextrose and 0.45-0.75% NaCl once serum glucose reaches a high level in pediatric patients 3

Monitor fluid input/output and hemodynamic parameters to assess response to fluid replacement 1, 2
Fluid replacement should correct estimated deficits within the first 24 hours, with induced change in serum osmolality not exceeding 3 mOsm/kg/hour 1, 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