Thursday, September 23, 2010

Why can't KCl be given IM or SubQ?

Will it severely burn or irritate tissues?Why can't KCl be given IM or SubQ?
KCl is extremely irritating to tissue and can cause tissue necrosis so it should never be given by the IM or SQ route. Extravasation (tissue infiltration) of KCl solution given intravenously can possibly incentive tissue irritation or necrosis as well.
YES! It's unpromising enough when it must be deliver IV. Liquid tastes ruinous but no other choice when need is instantaneous.
Ouch! That would hurt even more!
In our ER, we use K-Dur (40 mEq tabs) or K-Elixir instead. Lets say you're giving a K+ bolus for a K+ < 3.3 (or whatever) and you don't own a central column. Rather than giving 10 mEq KCl in 100cc over 1 hr X 2 doses (and checking serum K+ 4hrs post dose), it make sense to give it po. In the ICU I work within, RNs can give KCL boluses minus a physician's order (up to 20 mEq contained by 100 cc NS via central dash for K+ < 3.5 but > 3.1 ... <3.1 requires a physician's order).
Of course, the oral route is not bioequivalent, but before an hour, give or take a few 20 mEq have be absorbed -- near a (painful) peripheral IV, one and only 10 mEq has be given over an hour.
If the patient can't swallow, we return with an order for an NGT (stomach tubes are smaller number invasive than Salems), and give the K-elixir (or crushed and dissolved K-Dur).
That's what we started doing more or less a year ago.
If you don't dilute it with at lowest possible a liter of fluid it will kill the tolerant. Even when diluting it is still very irritating to the vein. Just another note for ya. KCl is what they use surrounded by lethal injections
It burns close to hell in dilute IV solutions.

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