Reducing Pain Experienced During Potassium Chloride Infusion in the Emergency Department

Hypokalemia is a common electrolyte abnormality encountered in the clinical setting. It can lead to cardiac arrhythmias, muscle weakness, and rhabdomyolysis (1-5). The causes of hypokalemia can be broadly classified into decreased intake, increased entry into cells due to causes such as increase in extracellular pH, increased β-adrenergic activity or insulin administration, and increased losses from sweating, and the gastrointestinal or renal systems (6). In addition to the diagnosis and treatment of the underlying cause(s) of hypokalemia, replacement of the potassium deficit is necessary when managing these patients. This urgency of replacement therapy will depend on the severity of hypokalemia, the rate of decline in serum potassium concentration, and associated comorbidities of the patient. Potassium can be administered as potassium chloride, potassium phosphate, potassium bicarbonate potassium gluconate or its precursors (potassium citrate, potassium acetate) (7, 8). Potassium chloride has been the mainstay of replacement therapy for two main reasons: