POTASSIUM CHLORIDE

POTASSIUM CHLORIDE (poe-tass'ee-um) Apo-K , K-10, Kalium Durules , Kaochlor, Kaochlor-20 Concentrate, Kaon-Cl, KCl 5% and 20%, K-Long , Klor, Klor-10%, Klor-Con, Kloride, Klorvess, Klotrix, K-Dur, K-Lyte/Cl, K-tab, Micro-K Extentabs, SK-Potassium Chloride, Slo-Pot , Slow-K POTASSIUM GLUCONATe Kaon, Kaylixir Classifications: electrolytic and water balance agent; Therapeutic: electrolyte replacement Pregnancy Category: C

Availability

Chloride: 6.7 mEq, 8 mEq, 10 mEq, 20 mEq sustained release tablets; 500 mg, 595 mg tablets; 20 mEq, 25 mEq, 50 mEq effervescent tablets; 20 mEq/15 mL, 40 mEq/15 mL, 45 mEq/15 mL liquid; 15 mEq, 20 mEq, 25 mEq powder; 2 mEq/mL injection; 10 mEq, 20 mEq, 30 mEq, 40 mEq, 60 mEq, 90 mEq vials;

Gluconate: 20 mEq/15 mL liquid

Action

Principal intracellular cation; essential for maintenance of intracellular isotonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, maintenance of normal kidney function, and for enzyme activity. Plays a prominent role in both formation and correction of imbalances in acid–base metabolism.

Therapeutic Effect

Effective in treatment of hypokalemia. Effectiveness measured by serum potassium concentration greater than 3.5 mEq/liter.

Uses

To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy. Also indicated when potassium is depleted by severe vomiting, diarrhea; intestinal drainage, fistulas, or malabsorption; prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic alkalosis (chloride, not the gluconate).

Contraindications

Severe renal impairment; severe hemolytic reactions; untreated Addison's disease; crush syndrome; early postoperative oliguria (except during GI drainage); adynamic ileus; acute dehydration; heat cramps, hyperkalemia, patients receiving potassium-sparing diuretics, digitalis intoxication with AV conduction disturbance; pregnancy (category C).

Cautious Use

Cardiac or kidney disease; systemic acidosis; slow-release potassium preparations in presence of delayed GI transit or Meckel's diverticulum; extensive tissue breakdown (such as severe burns); lactation.

Route & Dosage

Hypokalemia Adult: PO 10–100 mEq/d in divided doses IV 10–60 mEq/h diluted to at least 10–20 mEq/100 mL of solution (max: 200–400 mEq/d, monitor higher doses carefully) Child: PO 1–3 mEq/kg/d in divided doses; sustained release tablets not recommended IV Up to 3 mEq/kg/24 h at a rate <0.02 mEq/kg/min

Administration

Oral

• Give while patient is sitting up or standing (never in recumbent position) to prevent drug–induced esophagitis. Some patients find it difficult to swallow the large sized KCl tablet.
• Do not crush or allow to chew any potassium salt tablets. Observe to make sure patient does not suck tablet (oral ulcerations have been reported if tablet is allowed to dissolve in mouth).
• Swallow whole tablet with a large glass of water or fruit juice (if allowed) to wash drug down and to start esophageal peristalsis.
• Follow directions for diluting various liquid forms of KCl exactly. In general, dilute each 20 mEq potassium in at least 90 mL water or juice and allowed to completely before administration.
• Dilute liquid forms as directed before giving it through nasogastric tube.

Intravenous PREPARE: IV Infusion: ??Add desired amount to 100–1000 mL IV solution (compatible with all standard solutions). Note: In crticial situations, DO NOT use D5W, use NS instead. ??Usual maximum is 80 mEq/1000 mL, however, 40 mEq/L is preferred to lessen irritation to veins. Note: NEVER add KCl to an IV bag/bottle which is hanging. After adding KCl invert bag/bottle several times to ensure even distribution.  ADMINISTER: IV Infusion for Adult/Child: ??KCl is never given IV push or in concentrated amounts by any route. ??Infuse at rate not to exceed 10 mEq/h. Adult patients with severe potassium depletion may be able to tolerate 20 mEq/h. ??Too rapid infusion may cause fatal hyperkalemia. IV Infusion for Adult: Infuse at rate not to exceed 10 mEq/h; in emergency situations, may infuse very cautiously up to 40 mEq/h with continuous cardiac monitoring.  IV Infusion for Child: Infuse at a rate not to exceed 0.5–1.0 mEq/kg/h.   INCOMPATIBILITIES Solution/additive: Furosemide, pentobarbital, phenobarbital, succinylcholine. Y-site: Amphotericin B cholesteryl complex, azithromycin, chlordiazepoxide, chlorpromazine, diazepam, ergotamine, methylprednisolone, phenytoin. Take extreme care to prevent extravasation and infiltration. At first sign, discontinue infusion and select another site.

Adverse Effects (≥1%)

GI: Nausea, vomiting, diarrhea, abdominal distention. Body as a Whole: Pain, mental confusion, irritability, listlessness, paresthesias of extremities, muscle weakness and heaviness of limbs, difficulty in swallowing, flaccid paralysis. Urogenital: Oliguria, anuria. Hematologic: Hyperkalemia. Respiratory: Respiratory distress. CV: Hypotension, bradycardia; cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides. ECG changes in hyperkalemia: Tenting (peaking) of T wave (especially in right precordial leads), lowering of R with deepening of S waves and depression of RST; prolonged P-R interval, widened QRS complex, decreased amplitude and disappearance of P waves, prolonged QT interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death.

Interactions

Drug: potassium-sparing diuretics, angiotensin-converting enzyme (ace) inhibitors may cause hyperkalemia.

Pharmacokinetics

Absorption: Readily from upper GI tract. Elimination: 90% in urine, 10% in feces.

Nursing Implications

Assessment & Drug Effects

• Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician.
• Lab test: Frequent serum electrolytes are warranted.
• Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis).
• Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia.
• Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F); may result from any therapeutic dosage, and the patient may be asymptomatic.
• The risk of hyperkalemia with potassium supplement increases (1) in older adults because of decremental changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases, and (3) when kidney function is significantly compromised.

Patient & Family Education

• Do not be alarmed when the tablet carcass appears in your stool. The sustained release tablet (e.g., Slow-K) utilizes a wax matrix as carrier for KCl crystals that passes through the digestive system.
• Learn about sources of potassium with special reference to foods and OTC drugs.
• Avoid licorice; large amounts can cause both hypokalemia and sodium retention.
• Do not use any salt substitute unless it is specifically ordered by the physician. These contain a substantial amount of potassium and electrolytes other than sodium.
• Do not self-prescribe laxatives. Chronic laxative use has been associated with diarrhea-induced potassium loss.
• Notify physician of persistent vomiting because losses of potassium can occur.
• Report continuing signs of potassium deficit to physician: Weakness, fatigue, polyuria, polydipsia.
• Advise dentist or new physician that a potassium drug has been prescribed as long-term maintenance therapy.
• Do not open foil-wrapped powders and tablets before use.

---

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug