Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3823
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Potassium Chloride and Dextrose (Injection, Solution)
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These solutions should be administered only by intravenous
infusion and as directed by the physician. The dose and rate of injection
are dependent upon the age, weight and clinical condition of the patient.
If the serum potassium level is greater than 2.5 mEq/liter, potassium
should be given at a rate not to exceed 10 mEq/hour in a concentration
less than 30 mEq/liter. Somewhat faster rates and greater concentrations
(usually up to 40 mEq/liter) of potassium may be indicated in patients
with more severe potassium deficiency. The total 24-hour dose should
not generally exceed 200 mEq of potassium. As reported in the literature, the dosage and constant infusion rate
of intravenous dextrose must be selected with caution in pediatric
patients, particularly neonates and low birth weight infants, because
of the increased risk of hyperglycemia/hypoglycemia.<br/>Drug Interactions: Additives may be incompatible. Consult with pharmacist,
if available. When introducing additives, use aseptic technique, mix
thoroughly and do not store. The presence of
calcium limits their compatibility with certain drugs that form precipitates
of calcium salts, and also prohibits their simultaneous infusion through
the same administration set as blood because of the likelihood of
coagulation. Parenteral drug products should
be inspected visually for particulate matter and discoloration prior
to administration, whenever solution and container permit. (See PRECAUTIONS.)
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| dailymed-instance:descripti... |
Intravenous solutions with potassium chloride (I.V.
solutions with KCl) are sterile and nonpyrogenic solutions in water
for injection. They are for administration by intravenous infusion
only. See Table for summary of content and characteristics
of these solutions. The solutions contain no
bacteriostat, antimicrobial agent or added buffer and each is intended
only for use as a single-dose injection. When smaller doses are required
the unused portion should be discarded. These
solutions are parenteral fluid, nutrient and/or electrolyte replenishers. Dextrose, USP is chemically designated D-glucose, monohydrate
(CHO���HO),
a hexose sugar freely soluble in water. It has the following structural
formula: Potassium Chloride, USP is chemically designated KCl, a white granular
powder freely soluble in water. Sodium Chloride,
USP is chemically designated NaCl, a white crystalline powder freely
soluble in water. Calcium Chloride, USP is chemically
designated calcium chloride dihydrate (CaCl���2HO), white fragments or granules freely soluble in water. Sodium Lactate, USP is chemically designated monosodium
lactate [CHCH(OH)COONa], a 60% aqueous solution miscible
in water. It has the following structural formula: Water for Injection, USP is chemically designated
H0. The flexible plastic container
is fabricated from a specially formulated polyvinylchloride. Water
can permeate from inside the container into the overwrap but not in
amounts sufficient to affect the solution significantly. Solutions
in contact with the plastic container may leach out certain chemical
components from the plastic in very small amounts; however, biological
testing was supportive of the safety of the plastic container materials.
Exposure to temperatures above 25��C/77��F during transport
and storage will lead to minor losses in moisture content. Higher
temperatures lead to greater losses. It is unlikely that these minor
losses will lead to clinically significant changes within the expiration
period.
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When administered intravenously, these solutions
provide a source of water and electrolytes with carbohydrate calories. Solutions containing carbohydrate in the form of dextrose
restore blood glucose levels and provide calories. Carbohydrate in
the form of dextrose may aid in minimizing liver glycogen depletion
and exerts a protein-sparing action. Dextrose injected parenterally
undergoes oxidation to carbon dioxide and water. Calcium chloride in water dissociates to provide calcium (Ca) and chloride (Cl) ions. They are normal
constituents of the body fluids and are dependent on various physiologic
mechanisms for maintenance of balance between intake and output. Approximately
80% of body calcium is excreted in the feces as insoluble salts; urinary
excretion accounts for the remaining 20%. Sodium
lactate provides sodium (Na) and lactate (CHO) ions. The lactate anion is in
equilibrium with pyruvate and has an alkalizing effect resulting from
simultaneous removal by the liver of lactate and hydrogen ions. In
the liver, lactate is metabolized to glycogen which is ultimately
converted to carbon dioxide and water by oxidative metabolism. The
sodium (Na) ion combines with bicarbonate ion produced
from carbon dioxide of the body and thus retains bicarbonate to combat
metabolic acidosis (bicarbonate deficiency). The normal plasma level
of lactate ranges from 0.9 to 1.9 mEqK/liter. Intravenous solutions containing potassium chloride are particularly
intended to provide needed potassium cation (K). Potassium
is the chief cation of body cells (160 mEq/liter of intracellular
water). It is found in low concentration in plasma and extracellular
fluids (3.5 to 5.0 mEq/liter in a healthy adult). Potassium plays
an important role in electrolyte balance. Normally about 80 to 90%
of the potassium intake is excreted in the urine; the remainder in
the stools and to a small extent, in the perspiration. The kidney
does not conserve potassiumwell so that during fasting or in patients
on a potassium-free diet, potassium loss from the body continues resulting
in potassium depletion. A deficiency of either potassium or chloride
will lead to a deficit of the other. Sodium
chloride in water dissociates to provide sodium (Na) and
chloride (Cl) ions. Sodium (Na) is
the principal cation of the extracellular fluid and plays a large
part in the therapy of fluid and electrolyte disturbances. Chloride
(Cl��) has an integral role in buffering action when oxygen and
carbon dioxide exchange occurs in the red blood cells. The distribution
and excretion of sodium (Na) and chloride (Cl) are largely under the control of the kidney which maintains a balance
between intake and output. Water is an essential
constituent of all body tissues and accounts for approximately 70%
of total body weight. Average normal adult daily requirement ranges
from two to three liters (1.0 to 1.5 liters each for insensible
water loss by perspiration and urine production). Water balance is maintained by various regulatory mechanisms. Water
distribution depends primarily on the concentration of electrolytes
in the body compartments and sodium (Na) plays a major
role in maintaining physiologic equilibrium.
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Solutions containing potassium chloride are contraindicated
in diseases where high potassium levels may be encountered. Solutions containing lactate are NOT FOR USE IN THE TREATMENT
OF LACTIC ACIDOSIS.
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Intravenous solutions with potassium chloride (I.V.
solution with KCl) are supplied in single-dose flexible plastic containers.
See Table: Potassium
Chloride in Lactated Ringer's and 5% Dextrose Injection, USP Potassium Chloride in Lactated Ringer's and 5% Dextrose Injection, USP
(Continued) May contain HCl for pH adjustment. Store at 20 to 25��C (68 to 77��F). [See USP Controlled Room
Temperature.] Protect from freezing.
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Clinical evaluation and periodic laboratory determinations
are necessary to monitor changes in fluid balance, electrolyte concentrations
and acid-base balance during prolonged parenteral therapy or whenever
the condition of the patient warrants such evaluation. Solutions containing dextrose should be used with caution
in patients with known subclinical or overt diabetes mellitus. Caution must be exercised in the administration of parenteral
fluids, especially those containing sodium ions, to patients receiving
corticosteroids or corticotropin. Potassium replacement therapy should be guided primarily
by serial electrocardiograms. Plasma potassium levels are not necessarily
indicative of tissue potassium levels. High plasma concentrations of potassium may cause death through cardiac
depression, arrhythmias or arrest. Potassium-containing
solutions should be used with caution in the presence of cardiac disease,
particularly in digitalized patients or in the presence of renal disease. Solutions containing lactate ions should be used with
caution as excess administration may result in metabolic alkalosis. Care should be exercised to insure that the needle (or
catheter) is well within the lumen of the vein and that extravasation
does not occur. Do not administer unless solution
is clear and container is undamaged. Discard unused portion.<br/>Pregnancy Category C.: Animal reproduction studies
have not been conducted with dextrose, potassium chloride or Lactated
Ringer's Injection. It is also not known whether dextrose, potassium
chloride or Lactated Ringer's Injection can cause fetal harm when
administered to a pregnant woman or can affect reproduction capacity.
Dextrose, potassium chloride or Lactated Ringer's Injection should
be given to a pregnant woman only if clearly needed.<br/>Pediatric Use:: The safety and effectiveness in the pediatric population
are based on the similarity of the clinical conditions of the pediatric
and adult populations. In neonates or very small infants the volume
of fluid may affect fluid and electrolyte balance. Frequent monitoring of serum glucose concentrations is required when
dextrose is prescribed to pediatric patients, particularly neonates
and low birth weight infants. In very low birth
weight infants, excessive or rapid administration of dextrose injection
may result in increased serum osmolality and possible intracerebral
hemorrhage.
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In the event of potassium overdosage, discontinue
the infusion immediately and institute intensive corrective therapy
to reduce serum potassium levels. (See WARNINGS and PRECAUTIONS.)
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| dailymed-instance:genericMe... |
Potassium Chloride, sodium chloride, calcium chloride, sodium
lactate and Dextrose monohydrate
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Potassium Chloride and Dextrose (Injection, Solution)
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| dailymed-instance:adverseRe... |
Reactions which may occur because of the solutions
or technique of administration include febrile response, infection
at the site of injection, venous thrombosis or phlebitis extending
from the site of injection, extravasation and hypervolemia. If an adverse reaction does occur, discontinue the infusion,
evaluate the patient, institute appropriate therapeutic countermeasures
and save the remainder of the fluid for examination if deemed necessary. Nausea, vomiting, abdominal pain and diarrhea have been
reported with potassium therapy. The signs and symptoms of potassium
intoxication include paresthesias of the extremities, flaccid paralysis,
listlessness, mental confusion, weakness and heaviness of the legs,
hypotension, cardiac arrhythmias, heart block, electrocardiographic
abnormalities such as disappearance of P waves, spreading and slurring
of the QRS complex with development of a biphasic curve and cardiac
arrest. Potassium-containing solutions are intrinsically
irritating to tissues. Therefore, extreme care should be taken to
avoid perivascular infiltration. Local tissue necrosis and subsequent
sloughing may result if extravasation occurs. Chemical phlebitis and
venospasm have also been reported. Should perivascular
infiltration occur, I.V. administration at that site should be discontinued
at once. Local infiltration of the affected area with procaine hydrochloride,
1%, to which hyaluronidase may be added, will often reduce venospasm
and dilute the potassium remaining in the tissues locally. Local application
of heat may also be helpful.
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Solutions containing calcium ions should not be administered
simultaneously through the same administration set as blood because
of the likelihood of coagulation. Solutions
which contain potassium ions should be used with great care, if at
all, in patients with hyperkalemia, severe renal failure and in conditions
in which potassium retention is present. To
avoid potassium intoxication, do not infuse these solutions rapidly.
In patients with severe renal insufficiency or adrenal insufficiency,
administration of potassium chloride may cause potassium intoxication. Solutions containing sodium ions should be used with great
care, if at all, in patients with congestive heart failure, severe
renal insufficiency and in clinical states in which there exists edema
with sodium retention. In patients with diminished
renal function, administration of solutions containing sodium or potassium
ions may result in sodium or potassium retention. Solutions containing lactate ions should be used with great care
in patients with metabolic or respiratory alkalosis. The administration
of lactate ions should be done with great care where there is an increased
level or an impaired utilization of lactate ions, as in severe hepatic
insufficiency. The intravenous administration
of these solutions can cause fluid and/or solute overloading resulting
in dilution of serum electrolyte concentrations, overhydration, congested
states or pulmonary edema. The risk of dilutional
states is inversely proportional to the electrolyte concentration
of administered parenteral solutions. The risk of solute overload
causing congested states with peripheral and pulmonary edema is directly
proportional to the electrolyte concentrations of such solutions.
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These solutions are indicated in patients requiring
parenteral administration of potassium chloride and the replacement
of extracellular losses of fluids and electrolytes with minimal carbohydrate
calories.
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Potassium Chloride and Dextrose
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