Kay-Cee-L

Action

Maintains acid-base balance, isotonicity, and electrophysiologic balance throughout body tissues; crucial to nerve impulse transmission and contraction of cardiac, skeletal, and smooth muscle. Also essential for normal renal function and carbohydrate metabolism.

Availability

Capsules (extended-release): 8 mEq, 10 mEq

Powder for oral solution: 20 mEq, 25 mEq

Parenteral injection (concentrate): 2 mEq/ml

Parenteral solution: 0.1 mEq/ml, 0.2 mEq/ml, 0.3 mEq/ml, 0.4 mEq/ml

Potassium chloride in 5% dextrose injection: 10 mEq/L, 20 mEq/L, 30 mEq/L, 40 mEq/L

Potassium chloride in 0.9% sodium chloride injection: 20 mEq/L, 40 mEq/L

Potassium chloride in dextrose and lactated Ringer's injection: various strengths

Potassium chloride in dextrose and sodium chloride injection: various strengths

Solution (oral): 6.7 mEq, 10 mEq, 13.3 mEq, 15 mEq, 20 mEq, 30 mEq, 40 mEq

Tablets: 500 mg, 595 mg

Tablets (effervescent): 25 mEq, 50 mEq

Tablets (extended-release): 8 mEq, 10 mEq, 20 mEq

Tablets (extended-release crystals): 10 mEq, 20 mEq

Tablets (extended-release, film coated): 8 mEq, 10 mEq

Tablets (film-coated): 2.5 mEq, 10 mEq

Indications and dosages

➣ To prevent potassium depletion

Adults: Dosage highly individualized. Usual single dosage is 20 mEq/day P.O. in divided doses.

➣ Potassium depletion; diabetic acidosis; metabolic alkalosis; arrhythmias; periodic paralysis attacks; hyperadren-ocorticism; primary aldosteronism; healing phase of scalds or burns; over-medication with adrenocorticoids, testosterone, or corticotropin

Adults: Dosage highly individualized. 40 to 100 mEq/day P.O. in divided doses, not to exceed 20 mEq in a single dose. For serum potassium level above 2.5 mEq/L, 40 mEq/L as additive to I.V. infusion at a maximum rate of 10 mEq/hour; maximum daily dosage is 200 mEq. For serum potassium level less than 2 mEq/L, 80 mEq/L as additive to I.V. infusion at a maximum rate of 40 mEq/hour (with cardiac monitoring); maximum daily dosage is 400 mEq.

Children: Dosage highly individualized; give up to 3 mEq/kg or 40 mEq/m²/day as additive to I.V. infusion.

Contraindications

• Hypersensitivity to tartrazine or alcohol (with some products)

• Acute dehydration

• Heat cramps

• Hyperkalemia

• Hyperkalemic familial periodic paralysis

• Severe renal impairment

• Severe hemolytic reactions

• Severe tissue trauma

• Untreated Addison's disease

• Esophageal compression caused by enlarged left atrium (with wax matrix forms)

• Concurrent use of potassium-sparing diuretics, angiotensin-enzyme converting (ACE) inhibitors, or salt substitutes containing potassium

Precautions

Use cautiously in:

• cardiac disease, renal impairment, diabetes mellitus, hypomagnesemia

• pregnant or breastfeeding patients

• children (safety and efficacy not established).

Administration

See Know that I.V. potassium chloride is a high-alert drug.

See Give I.V. form as additive by infusion only. Never give undiluted or by I.V. push or I.M. route. Use peripheral line and infuse at a maximum rate of 40 mEq/hour (with cardiac monitoring).

See Dilute in compatible I.V. solution per manufacturer's instructions. Administer slowly to reduce risk of fatal hyperkalemia.

See To ensure that potassium is well mixed in compatible solution, don't add potassium to I.V. bottle in hanging position.

See Be aware that maximum infusion rate without cardiac monitoring is 20 mEq/hour. Rates above 20 mEq/hour require cardiac monitoring.

• Make sure patient is well-hydrated and urinating before starting therapy.

• If patient complains of burning with I.V. administration, decrease flow rate.

• Give P.O. form with meals and a full glass of water or juice, to minimize GI upset.

• Ensure that patient swallows wax-matrix tablets completely, to avoid serious esophageal problems.

• Don't give wax matrix tablets to patients who have swallowing problems or possible esophageal compression.

• Be aware that potassium preparations aren't interchangeable.

• Know that dosages are expressed in mEq of potassium and that potassium chloride contains 13.4 mEq potassium/g.

Adverse reactions

CNS: confusion, unusual fatigue, restlessness, asthenia, flaccid paralysis, paresthesia, absent reflexes

CV: ECG changes, hypotension, arrhythmias, heart block, cardiac arrest

GI: nausea, vomiting, diarrhea, abdominal discomfort, flatulence

Metabolic: hyperkalemia

Musculoskeletal: weakness and heaviness of legs

Respiratory: respiratory paralysis Other: irritation at I.V. site

Interactions

Drug-drug. ACE inhibitors, potassium-sparing diuretics, other potassium-containing preparations: increased risk of hyperkalemia

Drug-diagnostic tests. Potassium: increased level

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Dandelion: increased risk of hyperkalemia

Licorice: decreased response to potassium

Patient monitoring

• Monitor renal function, fluid intake and output, and potassium, creatinine, and blood urea nitrogen levels.

• Assess vital signs and ECG. Stay alert for arrhythmias.

• Monitor neurologic status. Watch for neurologic complications.

• Monitor I.V. site for irritation.

See Know that potassium is contra-indicated in patients with severe renal impairment and must be used with extreme caution (if at all) in patients with any degree of renal impairment, because of risk of life-threatening hyperkalemia.

Patient teaching

• Instruct patient to mix and dissolve powder completely in 3 to 8 oz of water or juice.

• Tell patient to swallow extended-release capsules whole without crushing or chewing them.

• Instruct patient to take oral form with or just after a meal, with a glass of water or fruit juice.

• Tell patient to sip diluted liquid form over 5 to 10 minutes.

• Advise patient to report nausea, vomiting, confusion, numbness and tingling, unusual fatigue or weakness, or a heavy feeling in legs.

• Tell patient to minimize GI upset by eating frequent, small servings of food and drinking plenty of fluids.

• Inform patient that although wax matrix form may appear in stool, drug has already been absorbed.

• Advise patient not to use salt substitutes.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.