Urgent potassium replacement
- Patients able to tolerate oral intake: if the patient does not have diabetic ketoacidosis or nonketotic hyperglycemia, potassium repletion is most easily done orally, even in people with severe hypokalemia. The serum potassium concentration can rise acutely by as much as 1 to 1.5 mEq/L after an oral dose of 40 to 60 mEq of potassium. IV potassium chloride may be used as an adjunct to oral replacement if large doses are required, as these can cause gastric irritation.
- Patients unable to tolerate oral intake: IV potassium replacement is required. However, even low rates of administration can sometimes result in hyperkalemia, so caution is required. There is also a potential risk of fluid overload in susceptible patients. The maximum recommended rate of IV potassium administration is 10 to 20 mEq/hour (daily maximum 400 mEq/day).  Faster rates may be considered if there are serious manifestations such as ECG manifestations, muscle weakness, or paralysis. Potassium solutions with concentrations more than 60 mEq/L are often painful, and should be infused into a large vein, preferably a central vein.
- Patients with diabetic ketoacidosis or nonketotic hyperglycemia: IV potassium replacement is needed if hypokalemia occurs, as there are usually marked potassium losses. The maximum recommended rate of IV potassium administration is 10 to 20 mEq/hour (daily maximum 400 mEq/day); higher rates of administration carry a risk hyperkalemia.