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/Davidhaslhof]

AHA has an ACLS guideline for this:

https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-217

“If cardiac arrest from hypokalemia is imminent (ie, malignant ventricular arrhythmias), rapid replacement of potassium is required. Give an initial infusion of 2 mEq/min, followed by another 10 mEq IV over 5 to 10 minutes. In the patient’s chart, document that rapid infusion is intentional in response to life-threatening hypokalemia. Once the patient is stabilized, reduce the infusion to continue potassium replacement more gradually.”

[u/MrPBH → u/[deleted]]

"For suspected hypokalemia" is the key phrase. They don't want you giving potassium on a hunch.

If they have proven severe hypokalemia, one should correct it aggressively. High initial rates (60-80 per hour is what I learned, but others have quoted research showing up to 120 per hour as safe) are indicated to rapidly correct the threat to life.

After the patient stabilizes, you can slow your roll and give oral potassium until their total body deficit is repleted.