potassium supplements (parenteral)

Therapeutic Classification: mineral and electrolyte replacements/supplements

High Alert

Treatment/prevention of potassium depletion.
Arrhythmias due to digoxin toxicity.

Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.
Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

Therapeutic effects:

Replacement.
Prevention of deficiency.

Absorption: Well absorbed following oral administration.

Distribution: Enters extracellular fluid; then actively transported into cells.

Metabolism/Excretion: Excreted by the kidneys.

Half-Life: Unknown.

(increase in serum potassium levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–2 hr	unknown
IV	rapid	end of infusion	unknown

Contraindicated in:

Hyperkalemia;
Severe renal impairment;
Untreated Addison’s disease;
Severe tissue trauma;
Hyperkalemic familial periodic paralysis;
Potassium acetate injection contains aluminum, which may become toxic with prolonged use to high risk groups (renal impairment, premature neonates).

Use Cautiously in:

Cardiac disease;
Renal impairment;
Hypomagnesemia (may make correction of hypokalemia more difficult);
Patients receiving potassium-sparing drugs.

CV: ECG changes, ARRHYTHMIAS

Local: irritation at IV site

Neuro: confusion, paralysis, paresthesia, restlessness, weakness

Drug-drug:

Use with potassium-sparing diuretics or ACE inhibitors or angiotensin II receptor antagonists may lead to hyperkalemia.
Anticholinergics may ↑ GI mucosal lesions in patients taking wax-matrix potassium chloride preparations.

Normal Daily Requirements

Treatment of Hypokalemia

Expressed as mEq of potassium. Potassium acetate contains 10.2 mEq/g; potassium chloride contains 13.4 mEq potassium/g.
IV (Adults ): 40–80 mEq/day.
IV (Children ): 2–3 mEq/kg/day.
IV (Neonates ): 2–6 mEq/kg/day.
IV (Adults ): 10–20 mEq/dose (maximum: 40 mEq/dose) to infuse over 2–3 hr (maximum infusion rate: 40 mEq/hr).
IV (Neonates , Infants and Children): 0.5–1 mEq/kg/dose (maximum 30 mEq/dose) as an infusion to infuse at 0.3–0.5 mEq/kg/hr (maximum infusion rate 1 mEq/kg/hr).

Potassium Acetate

(Generic available)

Concentrate for injection (contains aluminum): 2 mEq/mL in 20-, 50-, and 100-mL vials; 4 mEq/mL in 50-mL vials

Potassium Chloride

(Generic available)

Concentrate for injection: 0.1 mEq/mL in 10-mEq ampules and vials; 0.2 mEq/mL in 10- and 20-mEq ampules and vials; 0.3 mEq/mL in 30-mEq ampules and vials; 0.4 mEq/mL in 20- and 40-mEq ampules and vials; 1.5 mEq/mL; 2 mEq/mL; 3 mEq/mL
Solution for IV infusion: 10 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers; 20 mEq/L in dextrose/saline/LRs in 250-, 500-, and 100-mL containers; 30 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers; 40 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers

Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and hyperkalemia (see Toxicity and Overdose).
Monitor pulse, BP, and ECG periodically during IV therapy.

Lab Test Considerations:

Monitor serum potassium before and periodically during therapy. Monitor renal function, serum bicarbonate, and pH. Determine serum magnesium level if patient has refractory hypokalemia; hypomagnesemia should be corrected to facilitate effectiveness of potassium replacement. Monitor serum chloride because hypochloremia may occur if replacing potassium without concurrent chloride.

Toxicity and Overdose:

Symptoms of toxicity are those of hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea; peaked T waves; depressed ST segments; prolonged QT segments; widened QRS complexes; loss of P waves; and cardiac arrhythmias).
- Treatment includes discontinuation of potassium, administration of sodium bicarbonate to correct acidosis, dextrose and insulin to facilitate passage of potassium into cells, calcium salts to reverse ECG effects (in patients who are not receiving digoxin), sodium polystyrene used as an exchange resin, and/or dialysis for patient with impaired renal function.

May be diluted in dextrose, saline, Ringer’s solution, LR, dextrose/saline, dextrose/Ringer’s solution, and dextrose/LR combinations. Commercially available premixed with many of the above IV solutions.

acyclovir
aldesleukin
allopurinol
amifostine
aminophylline
amiodarone
ampicillin
atropine
aztreonam
betamethasone
calcium gluconate
chlordiazepoxide
chlorpromazine
ciprofloxacin
cisatracurium
cladribine
cyanocobalamin
digoxin
diltiazem
diphenhydramine
dobutamine
docetaxel
dopamine
doxorubicin liposome
droperidol
enalaprilat
epinephrine
esmolol
conjugated estrogens
ethacrynate sodium
etoposide phosphate
famotidine
fentanyl
filgrastim
fludarabine
fluorouracil
furosemide
gemcitabine
granisetron
heparin
hydralazine
idarubicin
indomethacin
insulin
isoproterenol
labetalol
lidocaine
linezolid
lorazepam
magnesium sulfate
melphalan
menadiol
meperidine
methoxamine
methylergonovine
midazolam
milrinone
minocycline
morphine
neostigmine
norepinephrine
ondansetron
oxacillin
oxytocin
paclitaxel
penicillin G potassium
phytonadione
piperacillin/tazobactam
procainamide
prochlorperazine
propofol
propranolol
pyridostigmine
remifentanil
sargramostim
scopolamine
sodium bicarbonate
succinylcholine
tacrolimus
theophylline
thiotepa
tirofiban
trimethaphan
vinorelbine
warfarin
zidovudine

Y-Site Incompatibility:

calcium gluconate
cimetidine
lidocaine
sodium bicarbonate
vitamin B complex with C

Medication errors involving too rapid infusion or bolus IV administration of potassium chloride have resulted in fatalities. See IV administration guidelines below.
IV: Assess for extravasation; severe pain and tissue necrosis may occur.
Never administer potassium IV push or bolus.

Potassium Acetate

Do not administer undiluted. Each single dose must be diluted and thoroughly mixed in 100–1000 mL of dextrose, saline, Ringer’s or LR, dextrose/saline, dextrose/Ringer's, or LR combinations. Usually limited to 80 mEq/L via peripheral line (200 mEq/L via central line).
Rate:
Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children on general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children).

Potassium Chloride

Do not administer concentrations of ≥1.5 mEq/mL undiluted; may cause cardiac arrest. Concentrated products have black caps on vials or black stripes above constriction on ampules and are labeled with a warning about dilution requirement. Each single dose must be diluted and thoroughly mixed in 100–1000 mL of IV solution. Usually limited to 80 mEq/L via peripheral line (200 mEq/L via central line)
.
- Concentrations of 0.1 and 0.4 mEq/mL are intended for administration via calibrated infusion device and do not require dilution.
Rate:
Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children in general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children in a peripheral line. May use higher concentrations via central line). Use an infusion pump.

Advise patient regarding sources of dietary potassium (see Food Sources for Specific Nutrients). Encourage compliance with recommended diet.
Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dosage may require adjustment.
Emphasize the importance of regular follow-up exams to monitor serum levels and progress.

Prevention and correction of serum potassium depletion.
Cessation of arrhythmias caused by digoxin toxicity.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆