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January 1991

Rapid Correction of Hypokalemia: A Note of Caution

Author Affiliations

College Park, Md

Arch Intern Med. 1991;151(1):203. doi:10.1001/archinte.1991.00400010183039

To the Editor —  Kruse and Carlson1 recently reported the results of their interesting study regarding the safety and efficacy of rapidly infusing concentrated potassium chloride solutions for the treatment of hypokalemia. They concluded that such an approach can be employed safely when administered cautiously in an intensive care unit. However, I believe that this conclusion may be premature.Due to the retrospective nature of the study, frequent serial serum potassium concentrations were not available during and after the infusions. Indeed, in some patients postinfusion serum samples were first obtained as late as 12 hours after completion of the infusion, and the majority were collected within 4 hours. This is an important shortcoming of the study. Cellular uptake of potassium loads provides the major early defense against hyperkalemia, particularly in patients with renal failure.2 This cellular uptake of potassium, as well as its subsequent urinary excretion, is a

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