Assessing the guidelines for potassium replacement in pediatric oncology patients receiving amphotericin B

To examine the practice of potassium chloride (KCl) replacement in pediatric oncology patients receiving amphotericin B (amp-B). A retrospective observational chart review was conducted of patients who received amp-B on the oncology unit between August 2000 and May 2001. A survey was distributed to pediatric oncology pharmacists at other pediatric institutions to assess KCl infusion guidelines across North America. Twenty hypokalemic episodes were identified within 22 patient admissions. Fifty-five percent used KCl replacement (by all combined routes) at rates exceeding the institution's guidelines. Other pediatric institutions varied with respect to the maximum rates and concentration of KCl permitted on non-intensive care units. Based on the data from this review, the KCl administration guidelines for our hospital were changed. We now allow a maximum peripheral line concentration of 60 mEq/L, a maximum central line concentration of 120 mEq/L and a maximum KCl infusion rate of 0.4 mEq/kg/hr without the requirement of a heart monitor. Parenteral Nutrition is now restricted to maximum potassium concentration of 80 mEq/L and fluid-restricted patients are restricted to a maximum concentration of 150 mEq/L.