Rapid potassium repletion in a pericoding patient with severely low K of 1.5 due to mismanaged DKA at outside hospital. How fast would you replete it? What is the fastest you have ever repleted K?

[u/Little_Blackberry588]

I repleted 40 meq via central line in less than an hour, bringing it up to 1.9. The pharmacist is reporting me for dangerously fast repletion. What I can tell you is the patient was able to breath much better shortly after the potassium was given. Pretty sure the potassium was so low he was losing function of his diaphragm. Any thoughts from docs or crit care who have experience with a similar case?

[u/db_ggmm]

Keep in mind that probably 99% of safety events / reporting processes are performed / filled out by individuals who have about 10% of the total story. In some sense, it needs to be this way, because realistically an Rx verifying pharmacist in the bowels of the hospital does not have the time, energy, or expertise to collect and review all the details of the event followed by lit review of the evidence to come to an informed conclusion about a specific event. Well intentioned or not (and sometimes not), "safety reports" are inherently performed from a position of ignorance, sometimes willfully so, as every person in the hospital is overworked to the bone.