Potassium Replacement Therapy
Indications And Clinical Uses: The treatment of potassium depletion found in patients with hypokalemia and metabolic alkalosis, digitalis intoxication, inadequate dietary potassium intake and those patients receiving digitalis and diuretics, e.g. congestive heart failure, and hepatic cirrhosis with ascites. For treatment of hypertensive patients undergoing longterm diuretic therapy, hyperaldosteronism states with normal renal function, potassium losing nephropathy and certain diarrheal states.
Contra-Indications: In ventricular fibrillation, hyperkalemia of any etiology, in association with Addison’s disease, salt losing adrenal hyperplasia, in extensive tissue breakdown as in severe burns, acute dehydration and heat cramps. Renal impairment with oliguria or azotemia. Increased sensitivity to potassium administration, e.g., in congenital paramyotonia or adynamia episodica hereditaria.
Manufacturers’ Warnings In Clinical States: In patients with impaired mechanisms for excreting potassium, e.g. chronic renal disease, administration of potassium salts can produce hyperkalemia and cardiac arrest. This occurs most commonly in patients given i.v. potassium but may also occur in patients given oral potassium. Potentially fatal hyperkalemia can develop rapidly and be asymptomatic. Careful monitoring of the serum potassium concentration and appropriate dosage adjustment is recommended.
Caution is advised with concomitant administration of potassium and potassium sparing diuretics e.g., spironolactone or triamterene, since hyperkalemia may develop. Hypokalemia in patients with metabolic acidosis should be treated with an alkalinizing potassium salt such as the acetate, bicarbonate, gluconate or citrate.
Precautions: The treatment of potassium depletion, particularly in the presence of cardiac disease, renal disease or acidosis, requires careful attention to acid base balance and appropriate monitoring of serum electrolytes, the ECG and the patient’s clinical status.
Use potassium with caution in diseases associated with heart block since increased serum potassium may increase the degree of block.
Adverse Reactions: Nausea, vomiting, and diarrhea have been reported. These symptoms are due to irritation of the gastrointestinal tract and are best avoided by increasing fluid intake when possible, taking the dose with meals or reducing the dose. Severe adverse effects reported with potassium preparations have been hyperkalemia, intestinal esophageal and gastric ulceration.
Symptoms And Treatment Of Overdose: Symptoms and Treatment: In patients under normal conditions of exertion, concentrations of potassium in the blood of greater than 4 mEq/L, and in the urine of greater than 2 g/24 hours, may indicate hyperkalemia. Paresthesia of the extremities, listlessness, mental confusion, weakness, paralysis, hypotension, cardiac arrhythmias, heart block and cardiac arrest may occur. ECG changes include increased amplitude and peaking of the T waves, depression of the ST segment, reduction in the amplitude of the R wave, widening of the QRS complex, prolongation of the PR interval and a decrease in the amplitude and ultimately disappearance of the P wave. Widening of the QRS complex is one of the most ominous signs and indicates the need for aggressive treatment.
Frequently hyperkalemia is asymptomatic and may be manifested only by increased serum potassium concentration and characteristic electrocardiographic changes as above.
Treatment of Hyperkalemia:
- Eliminate foods and medications containing potassium, and discontinue potassium sparing diuretics.
- I.V. administration of 300 to 500 mL/hour of 10% dextrose solution containing 10 to 20 units of crystalline insulin/1 000 mL.
- Correct acidosis, if present, with i.v. sodium bicarbonate.
- Use exchange resins, hemodialysis or peritoneal dialysis.
- In the presence of life threatening cardiac arrhythmias, to antagonize the cardiac toxicity, administer i.v. 10 to 50 mL calcium gluconate 10% over 1 to 5 minutes. Continuous ECG monitoring is mandatory.
In cases of digitalization, too rapid a lowering of plasma potassium concentration can cause digitalis toxicity.
Dosage And Administration: The usual adult dosage is 20 mEq in 90 mL or more of water twice daily after meals. Citrus fruit juices or citrated soft drinks may be used in place of water to dilute Roychlor-10%. Larger single doses, for example, 40 mEq, should be given with 240 mL of water after meals to minimize the possibility of a saline laxative effect. If given concomitantly in chronic diuretic therapy, administer on alternating days.
Prevention of hypokalemia: supplementary, approximately 20 to 40 mEq/day.
Treatment of depletion: 40 to a maximum of 100 mEq daily.
Availability And Storage: Each 15 mL of clear, yellow colored liquid supplies: 20 mEq each of elemental potassium and chloride (as potassium chloride 1.5 g) with sugar and flavoring. Unit Dose package of 15 mL, bottles of 500 and 2 400 mL.
ROYCHLOR® Waymar Potassium Chloride Potassium Replacement Therapy