Complications of Potassium Infusion in PICU Patients with Diabetic Ketoacidosis: An Observational Study

Amirali Barkhordarioon; Effat Hosseinali Beigi; Mahtab Ramezani; Paniz Pourpashang; Maryam Ghodsi

doi:10.18502/aacc.v12i2.20951

Amirali Barkhordarioon School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Effat Hosseinali Beigi Department of Pediatric Intensive Care, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mahtab Ramezani School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Paniz Pourpashang Department of Pediatric Nephrology, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Maryam Ghodsi Department of Pediatric Intensive Care, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v12i2.20951

Keywords: Diabetic ketoacidosis; Potassium replacement therapy; Hypokalemia; Pediatric intensive care; Phlebitis

Abstract

Background: The most severe complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA). Hypokalemia, a common electrolyte disturbance in DKA, can be life-threatening and often worsens during treatment. A significant clinical debate exists regarding the optimal route of potassium administration—central versus peripheral lines. Current guidelines recommend aggressive potassium replacement but lack consensus on the safest administration method. This study investigated the safety and complications of high-concentration peripheral potassium administration in pediatric DKA patients within an intensive care setting.

Methods: This observational study, conducted at the PICU of Bahrami Children's Hospital, enrolled 55 pediatric patients with DKA requiring high-concentration potassium supplementation (50, 60, or 70 mEq/L) through peripheral veins. Potassium chloride was administered in normal saline with dosing stratified by serum potassium levels checked every 2 hours. Primary analyses examined associations between infusion-related complications (phlebitis, pain, erythema, burning sensation) and potassium concentration, infusion duration, DKA severity, and patient characteristics.

Results: Among 55 patients (mean age: 8.7 ± 4.1 years; 52.7% male), 32 patients (58.2%) received 50 mEq/L, 21 patients (38.2%) received 60 mEq/L, and 2 patients (3.6%) received 70 mEq/L. Of these, 25 patients (45.5%) required infusion duration exceeding 6 hours. Hypokalemia occurred in 30.9% of patients, with higher prevalence in severe DKA (44.4%). A total of eight patients (14.5%) experienced a total of 10 infusion-related complications. These included one case of phlebitis (1.8%), five cases of injection site pain (9.1%), and four cases of burning sensation (7.3%). Infusion duration exceeding 6 hours significantly increased complication risk (OR: 5.7; 95% CI: 2.01-16.56; p=0.042), with combined high concentration and extended duration showing elevated risk (adjusted OR: 3.1; 95% CI: 1.86-5.24; p=0.003).

Conclusion: In pediatric DKA patients receiving care in the PICU setting, peripheral potassium infusion at concentrations up to 60 mEq/L demonstrates acceptable safety outcomes when administration duration remains under 6 hours and rigorous monitoring protocols are implemented. However, for infusions exceeding 6 hours, our findings suggest careful consideration of alternative approaches may be warranted, particularly at higher concentrations.