In this section
Diabetic Ketoacidosis (DKA)
Hypokalaemia is defined as a plasma potassium level less than 3.5 mmol/L.
The goals of treating hypokalaemia are to:
Prolonged IV fluids not containing potassium
Loop diuretics (eg frusemide)
In general, children eating a variety of foods will meet their daily potassium requirements.
Consider the addition of potassium to maintenance fluids (see
Intravenous Fluids) for children who are:
Identify underlying cause and correct where possible
Assess for signs/symptoms of hypokalaemia
Assess fluid status as a baseline
Note: serum potassium level can be falsely elevated in haemolysed/finger prick samples, so a venous sample should be taken if clinical suspicion of hypokalaemia
Perform ECG if signs/symptoms of hypokalaemia, risk of cardiac arrhythmia, or serum potassium
If serum potassium is 3.0 mmol/L - 3.4 mmol/L in a well child, it is reasonable to either:
In children with stable haemodynamics and no ECG changes, aim for a gradual correction over 24-48 hours.
Correct serum magnesium as necessary.
Oral/enteral is the preferred route of administration
Consider intravenous replacement if:
1 - 2 mmol/kg/dose orally (maximum 20 mmol per dose)
Dose may be repeated, after checking serum potassium level, to a maximum of 5 mmol/kg/DAY (maximum daily dose 50 mmol)
Controlled release enteric coated
eg Slow K®
Repeat serum potassium level: For acute oral potassium replacement, consider repeat serum potassium level at a time interval guided by the clinical context and the expected serum potassium rise.
(specific to RCH)
0.2 mmol/kg/hour for 3 hours (maximum 10 mmol/hour)
Note: Dose likely to require intravenous fluid rate greater than maintenance fluid rate
1 - 4 mmol/kg/day (maximum 10 mmol/hour)
Doses greater than 4 mmol/kg/day should be discussed with a Senior Clinician or local retrieval service
Check serum potassium level before administering further potassium
Continue to monitor serum potassium levels at a frequency guided by the response and clinical situation
0.4 mmol/kg/hour for 1 - 2 hours (maximum 20 mmol/hour)
Note: Dose likely to require concentrated potassium infusion (see below) and central line
1 hour after replacement commencement
1 hour after replacement completion
For children with DKA: please refer to
Diabetic Ketoacidosis (DKA)
Use premixed fluid bags where possible (various concentrations available)
When adding potassium chloride to an IV fluid bag, mix well by inverting the bag at least 10 times
Clearly label all bags, syringes, pumps and lines that contain potassium to avoid inadvertent flushing
There are a number of concentrated potassium formulations available
Only administer in areas where there is a clear protocol for administration and monitoring
Contact local retrieval service for further advice
Use should be approved by a Senior Clinician
ECG monitoring required
Ensure regular monitoring of:
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.