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Potassium chloride: Drug information

Potassium chloride: Drug information
(For additional information see "Potassium chloride: Patient drug information" and see "Potassium chloride: Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
Brand Names: US
  • K-Tab;
  • Klor-Con;
  • Klor-Con 10;
  • Klor-Con M10;
  • Klor-Con M15;
  • Klor-Con M20;
  • Klor-Con Sprinkle [DSC];
  • Potassium Chloride PROAMP [DSC]
Brand Names: Canada
  • APO-K;
  • Micro-K;
  • Slo-Pot 600
Pharmacologic Category
  • Electrolyte Supplement, Oral;
  • Electrolyte Supplement, Parenteral
Dosing: Adult

Note: All doses in this monograph are expressed as mEq of potassium (1 mEq = 1 mmol potassium). Safety: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. To prevent adverse effects, adhere to standard dilution(s) and rate(s) of administration while closely monitoring serum potassium levels; cardiac monitoring may be required depending on clinical status and infusion rate (eg, >10 mEq/hour [consider all IV potassium sources]); refer to institutional protocols (Kraft 2005).

Diabetic ketoacidosis or hyperosmolar hyperglycemic state, potassium management (off-label use): Note: Regardless of initial measured serum potassium, almost all patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) have a total-body potassium deficit. Guide therapy based on patient condition (eg, kidney function, urine output, serum potassium levels). An example of a dosing regimen is as follows; refer to institutional protocols (Kitabchi 2009).

Serum potassium <3.3 mEq/L: Note: If serum potassium is <3.3 mEq/L on initial presentation, delay insulin until serum potassium reaches ≥3.3 mEq/L.

IV: Initial: 20 to 40 mEq/hour, then supplement as needed and monitor potassium levels frequently (eg, every 1 to 2 hours) until serum potassium ≥3.3 mEq/L (Hirsch 2020; Kitabchi 2009).

Serum potassium 3.3 to 5.2 mEq/L: IV: Add 20 to 30 mEq to each liter of IV fluid (Kitabchi 2009).

Dosage adjustment: Adjust dosage to maintain serum potassium levels within target range (eg, 4 to 5 mEq/L) until DKA/HHS resolves (Kitabchi 2009).

Hypokalemia, treatment: Note: Dosing requires individualization based on serum potassium levels and clinical factors (eg, underlying cause, presence of symptoms, concomitant medications, ongoing potassium losses). Use caution in patients with redistributive hypokalemia (eg, hypokalemic periodic paralysis, theophylline poisoning), as small amounts of administered potassium may result in rebound hyperkalemia and associated cardiotoxicity (Gutmann 2021; Perry 2020). Concurrent hypomagnesemia requires correction to facilitate potassium repletion (Kraft 2005). General guidance is provided below; refer to institutional protocols. After repletion, evaluate need for continued potassium replacement to prevent further episodes of hypokalemia.

Mild to moderate (serum potassium 3 to 3.4 mEq/L):

Oral: 10 to 20 mEq 2 to 4 times daily (Cohn 2000; Kraft 2005; Mount 2020); maximum single dose: 40 mEq (manufacturer's labeling).

IV: Note: Generally used when patient is unable to tolerate oral therapy. Central-line infusion and continuous ECG monitoring highly recommended for infusions >10 mEq/hour (Kraft 2005).

20 mEq every 2 to 3 hours; maximum infusion rate 10 to 20 mEq/hour; usual initial dose: 20 to 60 mEq; base subsequent dosing on serum potassium monitoring (Kraft 2005; Mount 2020; Todd 2009).

Severe (serum potassium <3 mEq/L) or symptomatic: Note: Frequent serum potassium monitoring (eg, every 2 to 4 hours) is recommended to determine subsequent dosing (Kraft 2005; Mount 2020).

Oral (monotherapy or adjunctive with IV): 40 mEq 3 to 4 times daily or 20 mEq every 2 to 3 hours with adjustment based on frequent serum potassium monitoring (Kraft 2005; Mount 2020).

IV: Note: Dosing/infusion rate recommendations vary; central-line infusion and continuous ECG monitoring highly recommended for infusions >10 mEq/hour.

Serum potassium 2.5 to 3 mEq/L: Initial: 10 to 20 mEq/hour; adjust based on frequent serum potassium monitoring; maximum infusion rate: 20 mEq/hour with continuous ECG monitoring (Couture 2013; Hijazi 2005; MacLaren 1999; manufacturer's labeling).

Serum potassium <2.5 mEq/L or life-threatening hypokalemia (not for emergency treatment of cardiac arrest): Initial: 10 to 40 mEq/hour; adjust based on frequent serum potassium monitoring; maximum infusion rate (central line only): 40 mEq/hour with continuous ECG monitoring; some patients may require up to 400 mEq/24 hours (MacLaren 1999; manufacturer's labeling).

Parenteral nutrition (off-label use): Note: Parenteral nutrition ordering requires advanced knowledge of nutrient and other metabolic requirements and should only be prescribed by clinicians trained in assessment and order writing for parenteral nutrition (Guenter 2015).

Standard daily potassium requirement: IV: 1 to 2 mEq/kg/day; adjust daily dose and selection of potassium additive (eg, chloride or acetate) based on serum potassium and clinical considerations; usual maximum: 10 mEq/hour (ASPEN 2019; Siparsky 2020).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Renal Impairment: Adult

Altered kidney function: Mild to severe impairment:

IV: There are no specific dosage adjustments provided in the manufacturer's labeling. Reduce initial dose by at least 50% in patients with kidney impairment (Kraft 2005); use with caution.

Oral: Initiate therapy at the low end of the dosing range, particularly if on other medications known to increase potassium levels; monitor potassium level frequently.

Dosing: Hepatic Impairment: Adult

There are no specific dosage adjustments provided in the manufacturer's labeling; use oral formulations with caution in patients with cirrhosis and start at the low end of dosage range.

Dosing: Pediatric

(For additional information see "Potassium chloride: Pediatric drug information")

Note: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. To prevent adverse effects, adhere to standard dilution(s) and rate(s) of administration while closely monitoring serum potassium levels; cardiac monitoring may be required depending on clinical status and infusion rate.

Maintenance potassium IV doses should be incorporated into the patient's maintenance IV fluids; intermittent IV potassium administration should be reserved for severe depletion situations; continuous ECG monitoring should be used for intermittent IV doses >0.5 mEq/kg/hour. Oral solutions are available in two concentrations: 20 mEq/15 mL (1.33 mEq/mL) and 40 mEq/15 mL (2.67 mEq/mL); use extra precaution; verify product formulation for dosage calculation.

Hypokalemia, prevention for ongoing drug losses (eg, concurrent diuretic therapy): Limited data available: Infants, Children, and Adolescents: Oral: 1 to 2 mEq/kg/day in 1 to 2 divided doses; usual single dose should not exceed usual adult single dose: 20 mEq/dose; although some patients may require a single dose up to 40 mEq/dose (Moffett 2011); some patients may require higher individual daily doses based on lab values and ongoing losses.

Hypokalemia, treatment; mild to moderate: Limited data available: Infants, Children, and Adolescents: Oral: 2 to 5 mEq/kg/day in divided doses; not to exceed 1 to 2 mEq/kg as a single dose or 20 mEq (whichever is less) (ASPEN [Corkins 2015]; Moffett 2011); if deficits are severe or ongoing losses are great, IV potassium route should be considered as preferred route of administration.

Hypokalemia, treatment; severe: Infants, Children, and Adolescents: Intermittent IV infusion: 0.5 to 1 mEq/kg/dose; maximum dose: 40 mEq/dose; infuse at a rate ≤0.5 mEq/kg/hour (see Administration for more detail on rate) (ASPEN [Corkins 2015]; Fuhrman 2017; Kliegman 2016); serum concentrations should be evaluated 1 to 2 hours after completion of infusion; may repeat as needed based on lab values; severe depletion or ongoing losses may require >200% of normal daily maintenance (Knudson 2013).

Parenteral nutrition, maintenance potassium requirement (ASPEN [Mirtallo 2004]):

Infants and Children weighing ≤50 kg: IV: 2 to 4 mEq/kg/day of potassium as an additive to parenteral nutrition solution.

Children weighing >50 kg and Adolescents: IV: 1 to 2 mEq/kg/day of potassium as an additive to parenteral nutrition solution.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Renal Impairment: Pediatric

There are no specific dosage adjustments provided in the manufacturer's labeling. Reduce initial dose by at least 50% in adult patients with renal impairment (Kraft 2005). Contraindicated in patients with renal failure.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Geriatric

Refer to adult dosing. Use with caution, starting at the low end of the dosage range.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule Extended Release, Oral:

Klor-Con Sprinkle: 8 mEq [DSC] [contains brilliant blue fcf (fd&c blue #1)]

Klor-Con Sprinkle: 10 mEq [DSC] [contains fd&c red #40, fd&c yellow #10 (quinoline yellow)]

Generic: 8 mEq, 10 mEq

Packet, Oral:

Klor-Con: 20 mEq (1 ea, 30 ea, 100 ea) [contains fd&c yellow #6 (sunset yellow); orange flavor]

Generic: 20 mEq (1 ea, 30 ea, 100 ea)

Solution, Intravenous:

Potassium Chloride PROAMP: 2 mEq/mL (10 mL [DSC])

Generic: 20 mEq (1000 mL); 40 mEq (1000 mL [DSC]); 0.4 mEq/mL (50 mL [DSC]); 10 mEq/100 mL (100 mL); 10 mEq/50 mL (50 mL); 20 mEq/100 mL (100 mL); 20 mEq/50 mL (50 mL); 40 mEq/100 mL (100 mL); 2 mEq/mL (5 mL, 10 mL, 20 mL, 30 mL, 250 mL); 20 mEq/L (1000 mL); 40 mEq/L (1000 mL [DSC]); Potassium 10 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 20 mEq/L and sodium chloride 0.45% (1000 mL); Potassium 20 mEq/L and sodium chloride 0.9% (1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.2% (500 mL, 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.225% (500 mL [DSC], 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.33% (500 mL [DSC], 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.45% (500 mL, 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL); Potassium 30 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 40 mEq/L and sodium chloride 0.9% (1000 mL); Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL)

Solution, Intravenous [preservative free]:

Generic: 10 mEq/100 mL (100 mL); 10 mEq/50 mL (50 mL); 20 mEq/50 mL (50 mL); 20 mEq/L (1000 mL); Potassium 20 mEq/L and sodium chloride 0.9% (1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.45% (500 mL, 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL); Potassium 40 mEq/L and sodium chloride 0.9% (1000 mL)

Solution, Oral:

Generic: 20 mEq/15 mL (10%) (15 mL, 30 mL, 473 mL, 3800 mL [DSC]); 40 MEQ/15ML (20%) (473 mL); 40 mEq/15 mL (20%) (473 mL)

Tablet Extended Release, Oral:

K-Tab: 8 mEq, 10 mEq [contains fd&c yellow #10 (quinoline yellow)]

K-Tab: 20 mEq

Klor-Con: 8 mEq [contains fd&c blue #1 aluminum lake, fd&c blue #2 aluminum lake]

Klor-Con 10: 10 mEq [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Klor-Con M10: 10 mEq

Klor-Con M15: 15 mEq

Klor-Con M15: 15 mEq [scored]

Klor-Con M20: 20 mEq

Klor-Con M20: 20 mEq [scored]

Generic: 8 mEq, 10 mEq, 15 mEq, 20 mEq

Generic Equivalent Available: US

Yes

Dosage Forms Considerations

750 mg potassium chloride = elemental potassium 390 mg = potassium 10 mEq = potassium 10 mmol

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule Extended Release, Oral:

Micro-K: 8 mEq

Solution, Intravenous:

Generic: 20 mEq (1000 mL); 40 mEq (1000 mL); 0.2 mEq/mL (100 mL); 0.4 mEq/mL (50 mL, 100 mL); 10 mEq/100 mL (100 mL); 2 mEq/mL (10 mL, 20 mL, 100 mL, 250 mL); 20 mEq/L (1000 mL); 40 mEq/L (1000 mL); Potassium 10 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 20 mEq/L and sodium chloride 0.45% (1000 mL); Potassium 20 mEq/L and sodium chloride 0.9% (1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.2% (250 mL, 500 mL, 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.225% (1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.33% (1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.45% (500 mL, 1000 mL); Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL); Potassium 30 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 40 mEq/L and sodium chloride 0.9% (1000 mL); Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL); Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL)

Tablet Extended Release, Oral:

Slo-Pot 600: 8 mEq

Generic: 8 mEq

Administration: Adult

Parenteral: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. Potassium must be diluted prior to parenteral administration. In general, the rate of administration may be dependent on patient condition and specific institution policy.

Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq per 100 mL (Mount 2020). The maximum rate of administration for peripheral infusion is 10 mEq/hour (Kraft 2005). ECG monitoring is recommended for peripheral or central infusions >10 mEq/hour in adults (Kraft 2005). With central line administration, higher concentrations and more rapid rates of infusion may be used; concentrations of 20 to 40 mEq per 100 mL at a maximum rate of 40 mEq/hour via central line have been safely administered (Hamill 1991; Kruse 1990).

Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Hurst 2004; Reynolds 2014); elevate extremity.

Hyaluronidase: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 units/mL) as 5 separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara 1983; Reynolds 2014; Zenk 1981).

Oral: Oral dosage forms should be taken with meals (or immediately after eating) and a full glass of water or other liquid to minimize the risk of GI irritation. Prescribing information for the various oral preparations recommend that no more than 20 to 40 mEq should be given as single dose.

Capsule: MicroK: Swallow whole, do not chew. Capsules may also be opened and contents sprinkled on a spoonful of applesauce or pudding and should be swallowed immediately without chewing.

Powder for oral solution: Klor-Con: Dissolve one packet in at least 120 mL of cold water or other beverage prior to administration. If GI irritation occurs, increase dilution.

Tablet:

K-Tab, Kaon-Cl, Klor-Con: Swallow tablets whole; do not crush, chew, or suck on tablet.

Klor-Con M: Swallow tablets whole; do not crush, chew, or suck on tablet. Tablet may also be broken in half and each half swallowed separately; the whole tablet may be dissolved in ~4 ounces of water (allow ~2 minutes to dissolve, stir well and drink immediately).

Bariatric surgery: Extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. ER tablet should be swallowed whole. Do not crush, chew, or suck on tablet. Take when upright or in sitting position. A capsule formulation is available; it should be swallowed whole or alternatively opened to have contents sprinkled on a spoonful of applesauce or pudding and swallowed immediately without chewing. Klor-con M formulation may be broken in half and each half swallowed separately; the whole tablet may be dissolved in 4 ounces of water after 2 minutes—stir well and drink immediately. Effervescent tablet formulations are not advised after bariatric surgery procedures. Potassium is a known GI irritant. Minimum necessary dose and duration of potassium therapy is recommended to minimize risk of GI irritation or ulceration. Proton pump inhibitor therapy is recommended if therapy is to be continued chronically.

Administration: Pediatric

Oral: Note: Should be taken with meals and a full glass of water or other liquid to minimize the risk of GI irritation. Prescribing information for the various oral preparations recommend that no more than 20 mEq or 25 mEq should be given as single dose.

Capsule: MicroK: Swallow whole, do not chew; may also be opened and contents sprinkled on a spoonful of applesauce or pudding and swallowed immediately without chewing

Oral solution: Available in two concentrations: 20 mEq/15 mL (1.33 mEq/mL) and 40 mEq/15 mL (2.67 mEq/mL); verify product formulation for dosage calculations. Do not administer full strength; must be diluted prior to administration.

Powder (Klor-Con): Dissolve in water or juice

Tablets, Sustained release and wax matrix:

K-Tab, Kaon-Cl-10, Klor-Con: Swallow whole, do not crush or chew; administer with food

Klor-Con M: Tablet may be broken in half and each half swallowed separately; the whole tablet may also be dissolved in water

Parenteral: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. Potassium must be diluted prior to parenteral administration. Do not administer IV push. In general, the dose, concentration of infusion and rate of administration may be dependent on patient condition and specific institution policy.

Infusion rates (including all sources) (Fuhrman 2017; Hamill 1991; Klaus 1989; Kliegman 2016; Kruse 1990; Lafraniere 2006; Schaber 1985):

Noncritical care settings: Usual range: 0.2 to 0.5 mEq/kg/hour up to 10 mEq to 20 mEq/hour have been used.

Critical care settings/situations: Higher rates may be used; maximum rate: 1 mEq/kg/hour up to 40 mEq/hour; continuous cardiac monitoring recommended for rates >0.5 mEq/kg/hour

Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see Management of Drug Extravasations for more details); remove needle/cannula; apply dry cold compresses (Hurst 2004; Reynolds 2014); elevate extremity.

Use: Labeled Indications

Hypokalemia, treatment: Treatment of hypokalemia.

Use: Off-Label: Adult

Diabetic ketoacidosis or hyperosmolar hyperglycemic state, potassium management; Parenteral nutrition

Medication Safety Issues
Sound-alike/look-alike issues:

Kaon-Cl-10 may be confused with kaolin

Kay Ciel may be confused with Kayexalate [DSC]

KCl may be confused with HCl

Klor-Con may be confused with Klaron

microK may be confused with Macrobid, Micronase

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication (IV formulation) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Other safety concerns:

Per The Joint Commission recommendations, concentrated electrolyte solutions should not be available in patient care areas.

Consider special storage requirements for intravenous potassium salts; IV potassium salts have been administered IVP in error, leading to fatal outcomes.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Cardiac arrhythmia, cardiac conduction disturbance, edema, peripheral edema

Endocrine & metabolic: Fluid and electrolyte disturbance, hypervolemia

Gastrointestinal: Abdominal cramps, abdominal distress, abdominal pain, diarrhea, flatulence, gastrointestinal hemorrhage, gastrointestinal irritation, gastrointestinal obstruction, gastrointestinal perforation, gastrointestinal ulcer, nausea, vomiting

Respiratory: Pulmonary edema

Postmarketing: Angioedema, asystole (with rapid administration or hyperkalemia), bradycardia, burning sensation at injection site, chest pain, dyspnea, encephalopathy (hyponatremic), erythema at injection site, hyperkalemia, hypersensitivity reaction, hyponatremia, infusion-site pain, injection site phlebitis, irritation at injection site, skin rash, swelling at injection site, venous thrombosis at injection site, ventricular fibrillation (with rapid administration or hyperkalemia)

Contraindications

IV: Hypersensitivity to potassium chloride or any component of the formulation; clinically significant hyperkalemia, clinically significant hyperglycemia (dextrose-containing solutions only).

Oral: Structural, pathological, and/or pharmacologic cause for delay or arrest in passage through the GI tract (solid oral dosage forms only). Note: The manufacturer's labeling states concomitant use of potassium-sparing diuretics is contraindicated. While this combination should generally be avoided, in select patients under close medical supervision, combined use of potassium supplements and potassium-sparing diuretics may be considered.

Canadian labeling: Additional contraindications (not in US labeling): Injection: Renal impairment with oliguria, anuria, or azotemia; Addison disease (untreated); ventricular fibrillation; salt-losing adrenal hyperplasia; extensive tissue breakdown as in severe burns, acute dehydration, and heat cramps; increased sensitivity to potassium administration (eg, congenital paramyotonia, adynamia episodica hereditaria); hyperadrenalism associated with adrenogenital syndrome; digitalis-induced, second- or third-degree heart block.

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.

• Hyperkalemia: May occur with IV or oral use. Potentially fatal hyperkalemia can develop rapidly and be asymptomatic. Use with caution or avoid use in patients with predisposing conditions for hyperkalemia (eg, chronic or severe renal impairment, extensive burns or tissue injury, heart failure, acute dehydration, systemic acidosis, adrenal insufficiency, or the administration of potassium-sparing diuretics). Monitor serum potassium closely.

• Hypersensitivity/infusion reactions: Hypersensitivity/infusion reactions, including anaphylaxis and chills, may occur with parenteral administration of potassium containing solutions. Discontinue immediately if signs/symptoms of hypersensitivity/infusion reactions develop.

• Hyponatremia: Parenteral administration may cause hyponatremia; risk may be increased in children, elderly patients, postoperatively, in patients with psychogenic polydipsia, and with concurrent use of medications that may decrease sodium (eg, diuretics). Monitor serum sodium as clinically indicated.

Disease-related concerns:

• Acid/base disorders: Use with caution in patients with acid/base alterations or acid/base correction; hyperosmolality or acidosis (or correction of alkalosis) is associated with hyperkalemia (shift of intracellular potassium to extracellular space); monitor serum potassium closely.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias, atrioventricular [AV] block); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.

• Hepatic impairment: Use with caution in patients with cirrhosis; monitor serum potassium more frequently.

• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium closely.

Dosage form specific issues:

• Oral formulations: May cause GI upset and irritation (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation, and/or obstruction. Oral liquid preparations (not solid) should be used in patients with esophageal compression or delayed gastric emptying. Extended-release formulations of potassium chloride may result in a “ghost tablet” in the stool.

Other warnings/precautions:

• Parenteral administration: Do NOT administer undiluted or IV push; inappropriate parenteral administration may be fatal. Refer to appropriate dilution and administration rate recommendations. Use extreme caution with parenteral administration and monitor serum potassium concentrations closely. Evaluate renal function, cardiac and fluid status, and any factors contributing to altered potassium concentrations (eg, acidosis, alkalosis) prior to therapy. Pain and phlebitis may occur during parenteral infusion requiring a decrease in infusion rate or potassium concentration.

Metabolism/Transport Effects

None known.

Drug Interactions

Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination

Drospirenone: Potassium Salts may enhance the hyperkalemic effect of Drospirenone. Risk C: Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in selected patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification

Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Glycopyrrolate (Systemic): May enhance the adverse/toxic effect of Potassium Chloride. This is specific to solid oral dosage forms of potassium chloride. Risk X: Avoid combination

Heparin: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Avoid coadministration of a potassium-sparing diuretic and a potassium salt. This combination should only be used in cases of significant hypokalemia, and only if serum potassium can be closely monitored. Risk D: Consider therapy modification

Pregnancy Considerations

Potassium requirements are the same in pregnant and nonpregnant women. Adverse events have not been observed following use of potassium supplements in healthy women with normal pregnancies. Use caution in pregnant women with other medical conditions (eg, preeclampsia; may be more likely to develop hyperkalemia) (IOM 2004). Potassium supplementation (that does not cause maternal hyperkalemia) would not be expected to cause adverse fetal events.

Breast-Feeding Considerations

Potassium is present in breast milk (IOM 2004). The normal content of potassium in human milk is ~13 mEq/L. Supplementation (that does not cause maternal hyperkalemia) would not be expected to affect normal concentrations.

Dietary Considerations

Administer with plenty of fluid to decrease stomach irritation and discomfort. Some dietary sources of potassium include leafy green vegetables (eg, spinach, cabbage), tomatoes, cucumbers, zucchini, fruits (eg, apples, oranges, and bananas), root vegetables (eg, carrots, radishes), beans, and peas.

Monitoring Parameters

Electrolytes (including serum potassium, calcium, chloride, magnesium, phosphate, sodium), acid/base balance; renal function; cardiac monitor (if intermittent infusion or potassium infusion rates 0.5 mEq/kg/hour in children or >10 mEq/hour in adults); to assess adequate replacement, repeat serum potassium level 2 to 4 hours after dose; monitor potassium levels daily for treatment. Monitor IV infusion site.

Reference Range

Note: Reference ranges may vary depending on the laboratory

Serum potassium: 3.5 to 5.2 mEq/L

Mechanism of Action

Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion

Pharmacodynamics and Pharmacokinetics

Absorption: Well absorbed from upper GI tract

Distribution: Enters cells via active transport from extracellular fluid

Excretion: Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed

Pricing: US

Capsule, controlled release (Potassium Chloride ER Oral)

8 mEq (per each): $0.89 - $0.94

10 mEq (per each): $0.94 - $1.02

Pack (Klor-Con Oral)

20 mEq (per each): $10.74

Pack (Potassium Chloride Oral)

20 mEq (per each): $10.67 - $10.74

Solution (KCl in Dextrose-NaCl Intravenous)

10 mEq/L 5-0.45%-% (per mL): $0.01

20 mEq/L 5-0.2%-% (per mL): $0.01

20 mEq/L 5-0.225%-% (per mL): $0.01

20 mEq/L 5-0.45%-% (per mL): $0.00 - $0.01

20 mEq/L 5-0.9%-% (per mL): $0.00 - $0.01

30 mEq/L 5-0.45%-% (per mL): $0.00 - $0.01

40 mEq/L 5-0.45%-% (per mL): $0.01

40 mEq/L 5-0.9%-% (per mL): $0.01

Solution (Potassium Chloride in Dextrose Intravenous)

20 mEq/L 5% (per mL): $0.00 - $0.01

Solution (Potassium Chloride in NaCl Intravenous)

20 mEq/L 0.45% (per mL): $0.01

20 mEq/L 0.9% (per mL): $0.00 - $0.01

40 mEq/L 0.9% (per mL): $0.01

Solution (Potassium Chloride Intravenous)

2 mEq/mL (per mL): $0.21 - $0.39

10 mEq/100 mL (per mL): $0.04 - $0.14

10 mEq/50 mL (per mL): $0.09 - $0.29

20 mEq/100 mL (per mL): $0.04 - $0.14

20 mEq/50 mL (per mL): $0.08 - $0.29

40 mEq/100 mL (per mL): $0.04 - $0.14

Solution (Potassium Chloride Oral)

20 MEQ/15ML (10%) (per mL): $0.43 - $1.16

40 MEQ/15ML (20%) (per mL): $1.62 - $1.86

Tablet, controlled release (K-Tab Oral)

8 mEq (per each): $0.66

10 mEq (per each): $1.01

20 mEq (per each): $0.99

Tablet, controlled release (Klor-Con 10 Oral)

10 mEq (per each): $0.65

Tablet, controlled release (Klor-Con M10 Oral)

10 mEq (per each): $0.62

Tablet, controlled release (Klor-Con M15 Oral)

15 mEq (per each): $1.06

Tablet, controlled release (Klor-Con M20 Oral)

20 mEq (per each): $0.63

Tablet, controlled release (Klor-Con Oral)

8 mEq (per each): $0.54

Tablet, controlled release (Potassium Chloride Crys ER Oral)

10 mEq (per each): $0.14 - $0.69

15 mEq (per each): $0.16

20 mEq (per each): $0.27 - $0.86

Tablet, controlled release (Potassium Chloride ER Oral)

8 mEq (per each): $0.47 - $0.80

10 mEq (per each): $0.38 - $0.85

20 mEq (per each): $0.47 - $0.63

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Addi-K (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TH, TN, TZ, UG, ZM);
  • Alkay ER (LK);
  • Apo-K (HK, JO, MY, SG);
  • Beacon K (MY);
  • Budaxiu (CN);
  • Chloropotassuril (BE);
  • Clor-K-Zat (MX);
  • Clotassio (BR);
  • Co-Salt (AR);
  • Control K (AR);
  • Corpotasin (MX);
  • Crysta K (BD);
  • Di Jia (CN);
  • Diffu-K (FR);
  • Duro-K (AU);
  • Dyna-K (PH);
  • Electro K (BD);
  • Enpott (TH);
  • Flexivial (ZA);
  • Geo (EG);
  • Gluco-K (AR);
  • Ionclor (BR);
  • K-Card (IN);
  • K-Chlor (PH);
  • K-Contin (BF, BJ, CI, ET, GH, GM, GN, KE, KR, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM);
  • K-Contin Continus (AE);
  • K-Dur (MX);
  • K-Norm (PH);
  • K-Retard (UY);
  • K-Supply (JP);
  • K-Tab (PK);
  • Kadalex (IT);
  • Kaion Retard (CL);
  • Kaldyum (HU, PL);
  • Kaleorid (DK, FI, FR, IS, NO, SE);
  • Kali-Sterop (BE);
  • Kaligen (PH);
  • Kalinor-Retard P (DE);
  • Kalinorm (FI);
  • Kaliolite (MX);
  • Kalipoz (PL, UA);
  • Kalitabs (DK);
  • Kalium (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, PH, SC, SD, SL, SN, TN, TZ, UG, ZM);
  • Kalium-R (HN, HU);
  • Kalnormin (CZ);
  • Kalytes (PH);
  • Katelin (PL);
  • Kation (UY);
  • Kay-Cee-L (GB, IE, MT);
  • Kay-Ciel (IN);
  • Kaylyte (TH);
  • KCL Retard (BH, HN, IQ, IR, IT, LB, LY, OM, SA, SY, YE);
  • Kelefusin (MX);
  • Keylyte (IN);
  • KSR (HK, ID);
  • Lejia (CN);
  • Lento-Kalium (IT);
  • Micro-Kalium Retard (AT);
  • Orakit (AR);
  • Perennum (PY);
  • Plenisk-K (ZA);
  • Plus Kalium Retard (CH);
  • Pota-K (EG);
  • Potasion (ES);
  • Potassin (JO);
  • Potassride (TH);
  • Potazek (PL);
  • Potklor (IN);
  • Potrelease TR (MY);
  • Rekawan (DE);
  • Sando-K (GB);
  • Sandoz K (ZA);
  • Slow-K (AR, AT, AU, BB, BF, BH, BJ, BM, BR, BS, BZ, CI, CL, EG, ET, GB, GH, GM, GN, GY, IE, IL, IQ, IR, JM, KE, KW, LB, LR, LY, MA, ML, MR, MT, MU, MW, MY, NE, NG, NL, OM, PR, SA, SC, SD, SG, SL, SN, SR, SY, TN, TT, TW, TZ, UG, UY, YE, ZA, ZM, ZW);
  • Slow-K MR (CY, TR);
  • Span-K (AU, HK, MY, NZ, PH, SG);
  • Susta-K (ZW);
  • Sylvite (PH);
  • Tascit (LK);
  • Xian Jia (CN);
  • Xin Jian Ju (CN);
  • Zerosodio (BR)


For country abbreviations used in Lexicomp (show table)

REFERENCES

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  22. Klor-Con M extended-release tablet (potassium chloride) [prescribing information]. Maple Grove, MN: Upsher-Smith Laboratories LLC; October 2020.
  23. Klor-Con M tablet (potassium chloride) [prescribing information]. Princeton, NJ: Sandoz Inc; October 2020.
  24. Klor-Con Powder (potassium chloride) [prescribing information]. Maple Grove, MN: Upsher-Smith Laboratories LLC; March 2020.
  25. Klor-Con Sprinkle (potassium chloride) [prescribing information]. Maple Grove, MN: Upsher-Smith Labs; September 2017.
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