# A client with serum K+ 2.8 mEq/L is ordered KCl 40 mEq IV. Which administration practice is safest?

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with serum K+ 2.8 mEq/L is ordered KCl 40 mEq IV. Which administration practice is safest?

## Option

1. Administer the 40 mEq dose undiluted via IV push over 5 minutes while monitoring cardiac rhythm continuously
2. Infuse via peripheral line at maximum 10 mEq/hr (central line 20 mEq/hr) using a pump, with continuous cardiac monitoring **✔ Correct answer**
3. Infuse the 40 mEq dose via peripheral line over 2 hours using an IV pump while maintaining continuous cardiac monitoring
4. Infuse the 40 mEq dose via peripheral line at 10 mEq per hour using an IV pump without continuous cardiac monitoring

**Correct answer: 2**

## Explanation

Correct (2): KCl is on the ISMP high-alert list. NEVER push IV. Maximum infusion peripheral 10 mEq/hr, central 20 mEq/hr (with monitoring; up to 40 mEq/hr only in coded units). Use a pump and continuous cardiac monitor. Dilute appropriately. (1,3,4) FATAL.

## In-depth explanation

Memory Tip KCl = "Killer if Pushed." High-alert; verify pump, line, dilution, monitor. Burning at IV site = slow rate or move to larger vein.

## Clinical scenario

Scenario 60-year-old male with hypokalemia (K+ 2.8 mEq/L), no arrhythmia, urine output 50 mL/hr. KCl 40 mEq IV ordered.

## Key concepts

- **IV potassium chloride** — High-alert medication; cardiac arrest risk if pushed.
- **KCl maximum rate** — Peripheral 10 mEq/hr, central 20 mEq/hr standard.
- **KCl infiltration** — Burning sign; reduce rate or change site to larger vein; never push.

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