potassium chloride (Rx)

Brand and Other Names:KDur, Slow K, more...Kaon Cl 10, KCl, K10, Klor-Con M, Klor Con M10, Klor Con M15, Klor Con M20, KlorCon, Klotrix, KTab, MicroK, K8
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 20mEq

tablet, extended-release

  • 8mEq
  • 10mEq
  • 15mEq
  • 20mEq

solution, oral

  • 20mEq/15mL
  • 40mEq/15mL

packet, oral

  • 20mEq

capsules, extended-release

  • 8mEq
  • 10mEq

premix IV in plastic container

  • 10mEq
  • 20mEq
  • 30mEq
  • 40mEq

Hypokalemia

Mild to moderate

  • Capsules or tablets: 40-100 mEq PO qDay in divided doses; single dose not to exceed 25 mEq to minimize GI discomfort
  • Oral solution: 40-100 mEq PO qDay in 2 to 5 divided doses; limit single doses to 40 mEq/dose; not to exceed 200 mEq/24hr
  • Aternatively, 10-20 mEq PO BID/QID (20-80 mEq/day)

Severe hypokalemia

  • 40 mEq PO TID/QID; may also administer 20 mEq PO BID/TID in addition to IV potassium administration with careful monitoring; doses >40 mEq are typically not well tolerated orally, resulting in GI irritation and nausea

Hypokalemia Prophylaxis

20-40 mEq PO qDay or divided BID

Dosing considerations

  • Dosing varies; adjust to serum potassium levels

IV intermittent infusions

≤10 mEq/hr; repeat as needed based on lab values done frequently; central line infusion and continuous ECG monitoring recommended for infusions >10 mEq/hr

10 mEq of potassium chloride increases serum potassium levels by approximately 0.1 mEq/.L

Dosing based on serum potassium

  • 2.5-3.5 mEq/L: 10 mEq/hr maximum infusion rate; 40 mEq/L mazimum concentration; not to exceed 200 mEq dose/24hr
  • <2.5 mEq/L or symptomatic hypokalemia (excluding emergency treatment of cardiac arrest): 40 mEq/hr maximum infusion rate (central line only) in presence of continuous ECG monitoring and frequent lab monitoring; patients may require up to 400 mEq/24hr

Dosing Modifications

Hepatic impairment

  • Patients with cirrhosis should usually be started at low end of dosing range, and serum potassium level should be monitored frequently

Renal impairment

  • Patients with impaired renal function, particularly if patient is on RAAS inhibitors or nonsteroidal anti-inflammatory drugs, should usually be started at low end of dosing range because of potential for development of hyperkalemia; serum potassium level should be monitored frequently; renal function should be assessed periodically

Dosage Forms & Strengths

tablet

  • 20mEq

tablet, extended-release

  • 8mEq
  • 10mEq
  • 15mEq
  • 20mEq

solution, oral

  • 20mEq/15mL
  • 40mEq/15mL

packet, oral

  • 20mEq

capsules, extended-release

  • 8mEq
  • 10mEq

premixed IV in plastic container

  • 10mEq
  • 20mEq
  • 30mEq
  • 40mEq

Hypokalemia prophylaxis

For ongoing drug losses, including diuretic

>1 month: 1-2 mEq/kg qDay of BID; single dose not to exceed usual adult single dose of 20 mEq/dose, although some patients may require a single dose up to 40 mEq/dose or higher based on lab values and ongoing losses  

Hypokalemia

Mild to moderate

  • >1 month: 2-5 mEq/kg PO in divided doses; not to exceed 1-2 mEq/kg as single dose or 20 mEq/kg, whichever is less; consider IV administration if deficit severe or ongoing losses great  

Severe

  • 0.5-1 mEq/kg/dose; not to exceed 40 mEq/dose; infuse at 0.5 mEq/kg/hr; evaluate serum concentrations 1-2 hr after completion of infusion; repeat as necessary based on lab values; severe depletion or ongoing losses may require >200% of normal daily maintenance
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Interactions

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            Adverse Effects

            Frequency Not Defined

            Arrhythmias

            Bleeding

            Diarrhea

            Dyspepsia

            Hyperkalemia

            Nausea

            Rash

            Vomiting

            Postmarketing Reports

            Flatulence

            Abdominal pain/discomfort

            Perforation

            Gastrointestinal obstruction

            Gastrointestinal ulceration

            Gastrointestinal perforation

            Hyponatremia

            Hyponatremic encephalopathy

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            Warnings

            Contraindications

            Hypersensitivity

            Untreated Addison disease

            Hyperkalemia

            Concomitant use with triamterene and amiloride

            Renal failure

            Cautions

            IV administration

            Depending on volume and rate of IV infusion, and patient’s underlying clinical condition, intravenous administration of potassium chloride in sodium chloride can cause electrolyte disturbances such as overhydration/hypervolemia and congested states including central (e.g., pulmonary edema) and peripheral edema

            Solutions containing sodium ions should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there is sodium retention with edema

            Administration of sodium and potassium in patients with or at risk of severe renal impairment, may result in hypernatremia, hyperkalemia and/or fluid overload; avoid potassium chloride in sodium chloride Injection, USP in patients with severe renal impairment

            If use cannot be avoided, monitor patients with severe renal impairment for development of these adverse reactions

            Rapid correction of hypernatremia is potentially dangerous with risk of serious neurologic complications; excessively rapid correction of hypernatremia is also associated with a risk for serious neurologic complications such as osmotic demyelination syndrome (ODS) with risk of seizures and cerebral edema

            Rapid correction of hyponatremia is potentially dangerous with risk of serious neurologic complications; brain adaptations reducing risk of cerebral edema make the brain vulnerable to injury when chronic hyponatremia is too rapidly corrected, which is known as osmotic demyelination syndrome (ODS); to avoid complications, monitor serum sodium and chloride concentrations, fluid status, acid-base balance, and signs of neurologic complications

            Avoid potassium chloride in sodium chloride injection, USP in patients with or at risk for fluid and/or solute overloading; if use cannot be avoided, monitor fluid balance, electrolyte concentrations and acid base balance as needed and especially during prolonged use

            Solutions containing potassium ions should be used with great care, if at all, in patients with hyperkalemia, severe renal failure, and in conditions in which potassium retention is present

            The risk for hyponatremia is increased in pediatric patients, elderly patients, postoperative patients, those with psychogenic polydipsia, and in patients treated with medications that increase risk of hyponatremia (such as diuretics, certain antiepileptic and psychotropic medications)

            Use with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank cardiac decompensation

            Extraordinary electrolyte losses such as may occur during protracted nasogastric suction, vomiting, diarrhea or gastrointestinal fistula drainage may necessitate additional electrolyte supplementation

            Additional essential electrolytes, minerals and vitamins should be supplied as needed

            Sodium-containing solutions should be administered with caution to patients receiving corticosteroids or corticotropin, or to other salt-retaining patients

            Care should be exercised in administering solutions containing sodium or potassium to patients with renal or cardiovascular insufficiency, with or without congestive heart failure, particularly if they are postoperative or elderly

            Potassium therapy should be guided primarily by serial electrocardiograms, especially in patients receiving digitalis

            Serum potassium levels are not necessarily indicative of tissue potassium levels

            Solutions containing potassium should be used with caution in the presence of cardiac disease, particularly when accompanied by renal disease

            Potassium chloride in sodium chloride may cause hyponatremia; hyponatremia can lead to acute hyponatremic encephalopathy characterized by headache, nausea, seizures, lethargy, and vomiting; patients with brain edema are at particular risk of severe, irreversible and life-threatening brain injury

            Solutions containing dextrose should be used with caution in patients with overt or known subclinical diabetes mellitus, or carbohydrate intolerance for any reason

            Perform continuous cardiac monitoring in patients requiring highly concentrated solutions and perform frequent testing for serum potassium and acid-base balance, especially if they receive digitalis

            Avoid potassium chloride injection in patients with or at risk for hyponatremia; if use cannot be avoided, monitor serum sodium concentrations

            Extravasation

            • Care must be taken when infusing concentrated potassium solutions, including potassium chloride injection, to prevent paravenous administration or extravasation; such solutions may be associated with tissue damage, which may be severe and include vascular, nerve, and tendon damage, leading to surgical intervention, including amputation
            • Secondary complications including pulmonary embolism from thrombophlebitis reported as a consequence of tissue damage from potassium chloride

            Oral administration

            • Solid oral dosage forms of potassium chloride can produce ulcerative and/or stenotic lesions of gastrointestinal tract, particularly if drug maintains contact with gastrointestinal mucosa for prolonged periods; consider use of liquid potassium in patients with dysphagia, swallowing disorders, or severe gastrointestinal motility disorders
            • If severe vomiting, abdominal pain, distention, or gastrointestinal bleeding occurs, discontinue therapy and consider possibility of ulceration, obstruction or perforation
            • Oral formulation should not be taken on an empty stomach because of its potential for gastric irritation
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            Pregnancy & Lactation

            Pregnancy

            There are no human data related to use of potassium chloride extended-release capsules during pregnancy; animal reproductive studies not conducted; potassium supplementation that does not lead to hyperkalemia is not expected to cause fetal harm

            Lactation

            Normal potassium ion content of human milk is about 13 mEq per liter; since oral potassium becomes part of the body potassium pool, as long as body potassium is not excessive, contribution of potassium chloride supplementation should have little or no effect on level in human milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Essential in physiologic processes

            Elimination

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Additive: Ampho B

            Y-site: Diazepam

            IV Compatibilities

            Additive: Aminophylline, amiodarone, Ca gluconate, cimetidine, clindamycin, dobutamine, dopamine, erythromycin, furosemide, heparin, hydrocortisone, lidocaine, norepinephrine, Na bicarb, vancomycin, verapamil

            Y-site: Amiodarone, aminophylline, ampicillin, atropine, Ca gluconate, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, lidocaine, morphine, norepinephrine, Na bicarb

            Not spec.: Cefazolin, tetracycline

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.