Intra-peritoneal administration of potassium and magnesium: A practical method to supplement these electrolytes in peritoneal dialysis patients

Background. Malnutrition and gastrointestinal (GI) losses are frequently encountered in peritoneal dialysis patients, leading to hypokalemia and hypomagnesemia. Oral supplementation is limited by patients' compliance, as well as GI side effects. Methods. Among the 27 patients on continuous cyclic peritoneal dialysis (CCPD) in whom we had one-year data, 15 (55%) were on oral potassium (K) supplements and 10 (37%) were on oral magnesium (Mg) supplements. Hypokalemia and hypomagnesemia persisted in 3 (11%) patients despite oral supplementation. We examined the efficacy and tolerability of intra-peritoneal (IP) K and Mg administration. Four grams of magnesium sulfate (MgSO4) and/or 60-80 mEq of potassium chloride (KCl) were added to a 2 liter, 2.5% peritoneal dialysis solution bag, and it was used as the last dwell in five CCPD patients. We serially measured serum K and Mg concentrations at 2, 4, and 6-8 hour intervals, drained the fluid, and measured serum concentrations at 20-24 hours. Results. Mean serum K concentration increased from a baseline of 3.2 mEq/L to 4.1, 4.2, 4.1, and 4.2 mEq/L at 2, 4, 6-8, and 20-24 hours post IP administration of' KCl, respectively. Similarly, mean serum Mg concentration increased from a baseline of 1.5 mg/dL to 2.5, 2.9, 2.6, and 2 mg/dL at 2, 4, 6-8, and 20-24 hours post-lP administration of MgSO4, respectively. Patients tolerated IP replacement very well, and there were no adverse events. Serum K and Mg concentrations normalized in all patients. Conclusion. IP administration is a safe, practical, and effective method to supplement K and Mg in peritoneal dialysis patients.