potassium acetate

potassium acetate

K-Vescent, K-Effervescent

Pharmacologic class: Mineral, electrolyte

Therapeutic class: Electrolyte replacement, nutritional supplement

Pregnancy risk category C

Action

Maintains acid-base balance, isotonicity, and electrophysiologic balance throughout body tissues; crucial to nerve impulse transmission and contraction of cardiac, skeletal, and smooth muscle. Also essential for normal renal function and carbohydrate metabolism.

Availability

Concentrate for injection: 2 mEq/ml in 20-, 50-, and 100-ml vials; 4 mEq/ml in 50-ml vials

⊘Indications and dosages

➣ To prevent or treat potassium depletion; diabetic acidosis; metabolic alkalosis; arrhythmias; periodic paralysis attacks; hyperadrenocorticism; primary aldosteronism; healing phase of burns or scalds; overmedication with adrenocorticoids, testosterone, or corticotropin

Adults: Dosage highly individualized. For potassium level above 2.5 mEq/L, give 40 mEq/L as additive to I.V. infusion at a maximum rate of 10 mEq/hour; maximum daily dosage is 200 mEq. For potassium level less than 2 mEq/L, give 80 mEq/L as additive to I.V. infusion at a maximum rate of 40 mEq/hour (with cardiac monitoring); maximum daily dosage is 400 mEq.

Children: Dosage highly individualized; up to 3 mEq/kg or 40 mEq/m²/day as additive to I.V. infusion.

Contraindications

• Acute dehydration
• Heat cramps
• Hyperkalemia
• Hyperkalemic familial periodic paralysis
• Severe renal impairment
• Severe hemolytic reactions
• Untreated Addison's disease
• Severe tissue trauma
• Concurrent use of potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, or salt substitutes containing potassium

Precautions

Use cautiously in:
• cardiac disease, renal impairment, diabetes mellitus, hypomagnesemia
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Make sure patient is well hydrated and urinating before starting therapy.
☞ Give only as additive to I.V. infusion. Never give by I.V. push or I.M. route, and never give undiluted. Use peripheral line with maximum rate of 40 mEq/hour (with cardiac monitoring).
☞ To ensure that potassium is well mixed in compatible solution, don't add potassium to I.V. bottle in hanging position.
☞ Dilute in compatible I.V. solution. Administer slowly to reduce risk of fatal hyperkalemia.
• Know that maximum infusion rate without cardiac monitoring is 20 mEq/hour. Infusion rates above 20 mEq/hour necessitate cardiac monitoring.
• If patient complains of burning with I.V. administration, decrease flow rate.
• Be aware that potassium preparations are not interchangeable.
• Know that dosages are expressed in mEq of potassium and that potassium acetate contains 10.2 mEq/g.

Route	Onset	Peak	Duration
I.V.	Rapid	End of infusion	Unknown

Adverse reactions

CNS: confusion, unusual fatigue, restlessness, asthenia, flaccid paralysis, paresthesia, absent reflexes

CV: ECG changes, hypotension, arrhythmias, heart block, cardiac arrest

GI: nausea, vomiting, diarrhea, abdominal discomfort, flatulence

Metabolic: hyperkalemia

Musculoskeletal: weakness and heaviness of legs

Respiratory: respiratory paralysis

Other: irritation at I.V. site

Interactions

Drug-drug. ACE inhibitors, potassium-sparing diuretics, other potassium-containing preparations: increased risk of hyperkalemia

Drug-diagnostic tests. Potassium: increased level

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Dandelion: increased risk of hyperkalemia

Licorice: decreased response to potassium

Patient monitoring

• Monitor renal function, fluid intake and output, and potassium, creatinine, and blood urea nitrogen levels.
☞ Know that potassium is contraindicated in severe renal impairment and must be used with extreme caution (if at all) in patients with any degree of renal impairment, because of risk of life-threatening hyperkalemia.
• Assess vital signs and ECG. Watch for arrhythmias.
• Evaluate patient's neurologic status. Stay alert for neurologic complications.
• Monitor I.V. site for irritation.

Patient teaching

• Instruct patient to report unusual pain, redness, swelling, or other reactions at infusion site.
• Advise patient to report nausea, vomiting, confusion, numbness and tingling, unusual tiredness or weakness, or heavy feeling in legs.
• Instruct patient to avoid salt substitutes.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.