potassium chloride

poe-TASS-ee-um KLOR-ide

Therapeutic Classification: mineral and electrolyte replacements/supplements

High Alert

Treatment/prevention of potassium depletion.

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. IV administration results in complete availability.

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

Metabolism/Excretion: Excreted by the kidneys.

Half-Life: Unknown.

(↑ in serum potassium concentrations)

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;
Some oral products may contain tartrazine (FDC yellow dye #5) or alcohol; avoid using in patients with known hypersensitivity or intolerance;
Hyperkalemic familial periodic paralysis.

Use Cautiously in:

Cardiac disease;
Renal impairment;
Diabetes mellitus (liquids may contain sugar);
Hypomagnesemia (may make correction of hypokalemia more difficult);
GI hypomotility including dysphagia or esophageal compression from left atrial enlargement (tablets, capsules).

CV: ARRHYTHMIAS, ECG changes

F and E: hyperchloremia, hyperkalemia

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting, tablets, capsules onlyGI ulceration, stenotic lesions

Local: irritation at IV site

Neuro: confusion, paralysis, paresthesia, restlessness, weakness

Drug-drug:

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

Expressed as mEq of potassium.

Normal Daily Requirements

PO (Adults ): 40–80 mEq/day.
PO (Children ): 2–3 mEq/kg/day.
PO (Neonates ): 2–6 mEq/kg/day.

Prevention of Hypokalemia During Diuretic Therapy

PO (Adults ): 20–40 mEq/day in 1–2 divided doses; single dose should not exceed 20 mEq.
PO (Neonates , Infants and Children): 1–2 mEq/kg/day in 1–2 divided doses.

Treatment of Hypokalemia

PO (Adults ): 40–100 mEq/day in divided doses.
PO (Neonates , Infants and Children): 2–5 mEq/kg/day in divided doses.
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).

Extended-release capsules: 8 mEq; 10 mEq
Extended-release tablets: 8 mEq; 10 mEq; 15 mEq; 20 mEq
Oral solution: 20 mEq/15 mL; 40 mEq/15 mL
Powder for oral solution: 20 mEq/pkt
Concentrate for injection: 0.1 mEq/mL; 0.2 mEq/mL; 0.3 mEq/mL; 0.4 mEq/mL; 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/LR 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/symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and hyperkalemia before and during therapy.
Monitor HR, BP, and ECG periodically during IV therapy.
Assess volume status before and during therapy, including intake, output, and daily weight. Correct as indicated.

Lab Test Considerations:

Monitor serum potassium before and periodically during therapy. If serum potassium <2.5 mEq/L, use IV potassium instead of oral to replenish. If hypokalemia is refractory, check serum magnesium and correct hypomagnesemia.
Monitor renal function, bicarbonate, calcium, chloride, magnesium, phosphate, sodium, and acid/base balance periodically during therapy. Correct values as indicated.

Toxicity and Overdose:

Signs/symptoms of toxicity are those of hyperkalemia, including bradycardia, irregular HR, fatigue, weakness, paresthesia, confusion, dyspnea, chest pain, and ECG changes (peaked T waves, depressed ST segments, prolonged QT interval, widened QRS complex, loss of P wave, 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.

High Alert: Medication errors involving too rapid infusion or bolus IV administration of potassium chloride have resulted in fatalities.
Patients with renal tubular acidosis (hyperchloremic acidosis) may require other salts (potassium bicarbonate, potassium citrate, potassium gluconate).
- If hypokalemia is secondary to diuretic therapy, consider ↓ diuretic dose, unless there is a history of significant arrhythmia or concurrent digoxin therapy.
PO: Administer with or after meals to ↓ GI irritation.
- Use of tablets and capsules should be reserved for patients who cannot tolerate liquid preparations. Capsules can be opened and sprinkled on soft food (pudding, applesauce) and swallowed immediately with a glass of water or juice. DNC: Do not chew or crush enteric-coated or extended-release tablets or capsules.
- Dissolve effervescent tablets in 3–8 ounces of cold water. Ensure that effervescent tablet is fully dissolved. Powders and solutions should be diluted in 4–8 ounces of cold water or juice. Instruct patient to drink slowly over 5–10 min.

IV Administration:

IV: High Alert: Never administer potassium IV push or bolus (may cause fatal cardiac arrest). Potassium must be diluted prior to IV administration. In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition/indication and specific institution policy.
Potassium chloride is a vesicant (at concentrations >0.1 mEq/mL). If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry warm compresses. Initiate hyaluronidase antidote for refractory cases in addition to supportive management. For hyaluronidase, inject a total of 1 mL (150 units/mL) intradermally or SUBQ as five separate 0.2-mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30–60 min if no resolution.
Continuous Infusion: High Alert: Do not administer concentrations ≥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 or 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: High Alert: 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 is 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.
Solution Compatibility: May be diluted in D5W, D10W, D5/LR, D5/0.9% NaCl, D5/0.45% NaCl, 0.9% NaCl, 0.45% 0.9% NaCl, and LR. Available premixed with many of the above IV solutions.
Y-Site Compatibility:
- acetaminophen
- acyclovir
- alemtuzumab
- allopurinol
- alprostadil
- amikacin
- aminocaproic acid
- aminophylline
- amphotericin B liposomal
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azathioprine
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefiderocol
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftazidime
- ceftazidime/avibactam
- ceftobiprole
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chlorothiazide
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clevidipine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- edetate calcium disodium
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gemtuzumab ozogamicin
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hydrocortisone
- hydromorphone
- ibuprofen lysine
- idarubicin
- ifosfamide
- imipenem/cilastatin
- indomethacin
- insulin aspart
- insulin regular
- irinotecan
- isavuconazonium
- isoproterenol
- ketamine
- ketorolac
- labetalol
- letermovir
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- meropenem/vaborbactam
- mesna
- methadone
- methohexital
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- micafungin
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- multivitamin
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- omadacycline
- ondansetron
- oritavancin
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- papaverine
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- plazomicin
- posaconazole
- potassium acetate
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- protamine
- pyridoxine
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- sulbactam/durlobactam
- tacrolimus
- tedizolid
- telavancin
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- blinatumomab
- dantrolene
- diazepam
- diazoxide
- dimenhydrinate
- haloperidol
- pentamidine
- phenytoin
- trimethoprim/sulfamethoxazole

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Explain that a missed dose should be taken as soon as remembered within 2 hr or omit and return to regular schedule. Do not double dose.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Advise patient to notify health care provider if GI irritation or ulceration (nausea, vomiting, flatulence, abdominal pain, diarrhea) occurs.
Advise patient to notify health care provider for signs and symptoms of hypokalemia (fatigue, constipation, palpitations, difficulty breathing) and hyperkalemia (abdominal pain, diarrhea, nausea, vomiting, chest pain, irregular heartbeat, extremity weakness or numbness).
Caution patient to avoid salt substitutes or low-salt milk or food unless approved by health care provider. Patient should be advised to read all labels to prevent excess potassium intake.
Advise patient regarding sources of dietary potassium (see Food Sources for Specific Nutrients). Encourage compliance with recommended diet.
Emphasize the importance of regular follow-up exams to monitor serum levels and progress.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Prevention and correction of serum potassium depletion.

Klor-Con, Klor-Con M10, Klor-Con M15, Klor-Con M20, ~~K-Tab,~~ Pokonza, ~~Slow-K~~

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