Why can't KCl be given IM or SubQ?

Question

Will it severely burn or irritate tissues?

Answer 1

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 cause tissue irritation or necrosis as well.

Answer 2

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 have a central line. Rather than giving 10 mEq KCl in 100cc over 1 hr X 2 doses (and checking serum K+ 4hrs post dose), it makes sense to give it po. In the ICU I work in, RNs can give KCL boluses without a physician's order (up to 20 mEq in 100 cc NS via central line 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, about 20 mEq have been absorbed -- with a (painful) peripheral IV, only 10 mEq has been given over an hour.

If the patient can't swallow, we get an order for an NGT (stomach tubes are less invasive than Salems), and give the K-elixir (or crushed and dissolved K-Dur).

That's what we started doing about a year ago.

Answer 3

If you don't dilute it with at least a liter of fluid it will kill the patient. Even when diluting it is still very irritating to the veins. Just another note for ya.... KCl is what they use in lethal injections

Answer 4

YES! It's bad enough when it must be delivered IV. Liquid tastes terrible but no other choice when need is immediate.

Answer 5

It burns like hell in dilute IV solutions.