Potassium Supplements

Brand Names

Cena-K; Gen-K; K+8; K+10; Kaochlor; Kaochlor-Eff; Kaon-Cl; Kato; Kay Ciel; Kaylixir; K+Care; ET; K-Dur; K-Electrolyte; K-G Elixir; K-Gen; K-Lease; K-Lor; Klor-Con 10; Klor-Con 20; Klor-Con/25; Klorvess; Klorvess; Klyte/Cl; Klotrix; K-lyte; K-lyte; K-lyte DS; K-norm; Kolyum; k-tab; micro-K, Micro-k LS; Potasalan; rum-k; S-F Kaon; Slow-K; Ten-K; Tri-K; Trikates; Twin-K.

Available Salts

Potassium Acetate; Potassium Bicarbonate; Potassium Chloride; Potassium Citrate; Potassium Gluconate

Synonyms

KCl (potassium Chloride)

Generic available

Yes

Therapeutic Category

Electrolyte Supplement, Oral; Electrolyte Supplement, Parenteral; Potassium Salt

Use

Potassium Deficiency; treatment or prevention of hypokalemia

Pregnancy Risk Factor - C

Contraindications

Severe renal impairment; untreated Addison’s disease; heat cramps; hyperkalemia; severe tissue trauma; solid oral dosage forms are contraindicated in patients in whom there is a structural, pathological, and/or pharmacological cause for delay or arrest in passage through the GI tract; an oral liquid, potassium preparation should be used in patients with esophageal compression or delayed gastric emptying time.

Warnings

Potassium injections should be administered only in patients with adequate urine flow; injection must be diluted before I.V. use and infused slowly (see administration); some oral products contain the dye tartrazine (avoid use in sensitive individuals).

Precautions

Use with caution in patients with cardiac disease, patients receiving potassium-sparing drugs; patients must be on a cardiac monitor during intermittent infusions.

Adverse Reactions

Cardiovascular (with rapid IV administration): Arrhythmias and cardiac arrest, heart block, hypotension.

Central Nervous System: Mental Confusion

Endocrine & Metabolic: Hyperkalemia, metabolic alkalosis (acetate salt),

Gastrointestinal: (With oral administration) Nausea, vomiting, diarrhea, abdominal pain, GI lesions, flatulence.

Local: Pain at the site of injection, Phlebitis

Neuromuscular & Skeletal: Muscle weakness, paresthesias, flaccid paralysis.

Drug Interactions

Potassium-sparing diuretics, salt substitutes, captopril, and enalapril may result in increased serum potassium.

Mechanism of Action

Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal, and smooth muscles; and maintenance of normal renal function, acid-base balance (acetate forum), carbohydrate metabolism, and gastric secretion.

Pharmacokinetics

Absorption: Well from upper GI tract; enters cell via active transport from extracellular fluid.

Usual Dosage

I.V. doses should be incorporated into the patient’s maintenance I.V. fluids; intermittent I.V. potassium administration should be reserved for severe depletion situations and requires EKG monitoring. Doses listed as mEq of potassium. When using microencapsulated or wax matrix formulations, use no more than 20 mEq as a single dose.

Normal Daily Requirement: Oral, I.V.

Neonates and Infants: 2-6 mEq/kg/day
Children: 2-3 mEq/kg/day
Adults 40-80 mEq/day

Prevention of hypokalemia during diuretic therapy: Oral

Neonates, Infants, and Children: 1-2 mEq/kg/day in 1-2 divided doses
Adults: 20-40 mEq/day in 1-2 divided doses

Treatment of hypokalemia: Oral, IV

Neonates, Infants, and Children: 2-5 mEq/kg/day in divided doses
Adults: 40-100 mEq/day in divided doses

Treatment of hypokalemia: I.V. intermittent infusion (must be diluted prior to administration)

Neonates, Infants, and Children: 0.5-1 mEq/kg/dose (maximum dose: 30 mEq) to infuse at 0.3-0.5 mEq/kg/hour (maximum dose: 1 mEq/kg/hour)
Adults: 10-20 mEq/dose (maximum dose: 40 mEq/dose) to infuse over 2-3 hours. (maximum dose: 40 mEq over 1 hour)

Administration

Oral: Sustained release and wax matrix tables should be swallowed whole, do not crush or chew; effervescent tablets must be dissolved in water before use; administer with food; granules can be diluted or dissolved in water or juice; do not administer liquid full strength, must be diluted in 2-6 parts of water or juice.

Parenteral: Potassium MUST be diluted prior to parenteral administration; maximum recommended concentration (peripheral line): 80 mEq/L; Maximum recommended concentration (central line): 150 mEq/L or 15 mEq/100mL; in severely fluid restricted patients (with central lines): 200 mEq/L or 20 mEq/100mL has been used; maximum rate of infusion, see Usual Dosage, IV, intermittent infusion.

Potassium Dosage/Rate of Infusion Guidelines

Serum Potassium	Maximum Infusion Rate	Maximum Concentration	Maximum 24 hour dose
>2.5 mEq/L	10 mEq/h	40 mEq/L	200 mEq
<2.5 mEq/L	40 mEq/h	80 mEq/L	400 mEq

Monitoring Parameters

Serum potassium, glucose, chloride, pH, urine output (if indicated), cardiac monitor (if intermittent IV infusion or potassium IV infusion rates >0.25 mEq/kg/hour.

Patient Information

Swallow tablets whole, do not crush or chew; take with food, water, or juice

Nursing Implications

Maximum concentration (peripheral line): 80 mEq/L; usual rate: 10 mEq/hour; maximum concentration (central line): 30 mEq/100 mL; may not be given I.V. push or I.V. retrograde; oral liquid potassium supplements should be diluted (2-6 parts diluent) with water or fruit juice during administration; wax matrix tablets must be swallowed and not allowed to dissolve in mouth.

Special Geriatric Considerations

Older adults may require less potassium than younger adults due to decreased renal function; for older adults who do not respond to replacement therapy, check serum magnesium; due to long-term diuretic use, older adults may be hypomagnesemic

Dosage Forms

Potassium Acetate: Injection: 2 mEq/mL

Potassium Chloride:

Capsule, controlled release:

Micro-K: 600mg (8mEq)

K-Lease, K-Norm, Micro-K 10: 750mg (10mEq)

Injection, concentrate: 2mEq/mL (5mL, 10mL, 20mL, 50mL, 100 mL)

Liquid

Cena-K, Kaochlor, Kaochlor SF, Kay Ciel, Klorvess, Potasalan; 20mEq/15mL 10% (118mL, 480mL, 3840mL)

Rum K: 30mEq/15mL 15% (480mL, 3840mL)

Cena-K, Kaon-Cl: 40mEq/15mL 20% (480mL, 3840mL)

Powder

K + Care: 15 mEq per packet

Gen-K, Kato, Kay Ciel, K + Care, K-Lor, Klor-Con, Micro-K LS: 20mEq per packet

K+Care, Klor-Con/25, K-Lyte/Cl: 25mEq per packet

Tablet, Controlled Release:

Kaon-Cl: 500mg (6.7 mEq)

Klor-Con 8, K+8, Slow-K: 600mg (8mEq)

K+10, Kaon-Cl 10, K-Dur 10, Klor Con 10, Klotrix, K-Tab, Ten-K: 750mg (10mEq)

K-Dur 20, Klor-Con 20: 1500mg (20mEq)

Potassium Bicarbonate:

Tablet for oral solution: 6.5 mEq potassium, 25mEq bicarbonate (K+care, K-Electrolyte, K-Gen, K-Lyte, Klor-Con/EF); 25mEq potassium (K+Care ET)

Potassium Bicarbonate and Potassium Chloride:

Granules for solution: 20mEq potassium per packet

Tablets for solution: 20mEq potassium (Klorvess), 25mEq potassium (K-Lyte/CL), 50mEq potassium (K-Lyte/CL 50)

Tablet, Extended Release: 750mg (10mEq)

Potassium Gluconate

Elixir:

20mEq/15mL (5mL, 10mL, 118mL, 480mL, 4000mL)(K-G elixir, Kaon Elixir)

Tablet:

500mg, 595mg

Potassium Bicarbonate and Potassium Citrate:

Tablet for solution: 50mEq potassium (K-Lyte DS)

Potassium Chloride and Potassium Gluconate:

Solution: 6.7mEq potassium per 5mL (Kolyum)

Potassium Citrate and Potassium Gluconate:

Solution 6.7mEq potassium per 5mL (Twin-K)

Potassium Bicarbonate, potassium chloride, and potassium citrate:

Tablet for solution: 20mEq potassium (Kaochlor-Eff)

Potassium acetate, potassium bicarbonate, and potassium citrate:

Solution: 15mEq/5mL (Tri-K, Trikates)

References

Hamill RJ, Robinson LM, Wexler HR, et al, "Efficacy and Safety of Potassium Infusion Therapy in Hypokalemic Critically Ill Patients, " Crit Care Med, 1991, 19 (5):694-9.

Khilnani P, "Electrolyte Abnormalities in Critically Ill Children," Crit Care Med 1992, 20(2):241-50.

Pediatric Dosage Handbook, 7th Edition, 2000-2001, Lexi-Comp Inc, American Pharmaceutical Association.

May 2, 2008 · Filed Under Potassium

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