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Since most foods contain a good supply of potassium, potassium deficiency (hypokalemia) is unlikely to be caused by an unbalanced diet. Possible causes include cushing's syndrome (due to an adrenal gland disorder) and fanconi's syndrome (the result of a congenital kidney defect). The cause could also be an excessive dose of cortisone, prolonged vomiting or diarrhea, or thiazide diuretics, which are administered for treatment of hypertension. Signs of potassium deficiency can include weakness and lethargy, rapid pulse, nausea, diarrhea, and tingling sensations.
If the body absorbs enough potassium but the element is not distributed properly, various disorders may develop. Thus an abnormally low content of potassium in the blood may result in an intermittent temporary paralysis of the muscles, known as familial periodic paralysis.
Potassium deficiency can be treated by administration of potassium supplements. There is a large variety of these preparations. Some are liquids, some are powders to be dissolved in liquids, and some are slow-release tablets that dissolve in the intestine. All can cause gastrointestinal irritation. For many persons on diuretic therapy for hypertension, potassium deficiency can be avoided by increasing their consumption of potassium-containing foods, such as bananas, dates, prunes, and raisins, and potassium supplements are not needed. Potassium supplements are never given to patients receiving potassium-sparing diuretics such as amiloride, spironolactone, or triamterene. If the difficulty lies in the body's use of potassium, treatment is concerned with the primary cause of the deficiency.
Pharmacologic class: Mineral, electrolyte
Therapeutic class: Electrolyte replacement, nutritional supplement
Pregnancy risk category C
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.
Capsules (extended-release): 8 mEq, 10 mEq
Powder for oral solution: 20 mEq, 25 mEq
Parenteral injection (concentrate): 2 mEq/ml
Parenteral solution: 0.1 mEq/ml, 0.2 mEq/ml, 0.3 mEq/ml, 0.4 mEq/ml
Potassium chloride in 5% dextrose injection: 10 mEq/L, 20 mEq/L, 30 mEq/L, 40 mEq/L
Potassium chloride in 0.9% sodium chloride injection: 20 mEq/L, 40 mEq/L
Potassium chloride in dextrose and lactated Ringer's injection: various strengths
Potassium chloride in dextrose and sodium chloride injection: various strengths
Solution (oral): 6.7 mEq, 10 mEq, 13.3 mEq, 15 mEq, 20 mEq, 30 mEq, 40 mEq
Tablets: 500 mg, 595 mg
Tablets (effervescent): 25 mEq, 50 mEq
Tablets (extended-release): 8 mEq, 10 mEq, 20 mEq
Tablets (extended-release crystals): 10 mEq, 20 mEq
Tablets (extended-release, film coated): 8 mEq, 10 mEq
Tablets (film-coated): 2.5 mEq, 10 mEq
Indications and dosages
➣ To prevent potassium depletion
Adults: Dosage highly individualized. Usual single dosage is 20 mEq/day P.O. in divided doses.
➣ Potassium depletion; diabetic acidosis; metabolic alkalosis; arrhythmias; periodic paralysis attacks; hyperadren-ocorticism; primary aldosteronism; healing phase of scalds or burns; over-medication with adrenocorticoids, testosterone, or corticotropin
Adults: Dosage highly individualized. 40 to 100 mEq/day P.O. in divided doses, not to exceed 20 mEq in a single dose. For serum potassium level above 2.5 mEq/L, 40 mEq/L as additive to I.V. infusion at a maximum rate of 10 mEq/hour; maximum daily dosage is 200 mEq. For serum potassium level less than 2 mEq/L, 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; give up to 3 mEq/kg or 40 mEq/m2/day as additive to I.V. infusion.
• Hypersensitivity to tartrazine or alcohol (with some products)
• Acute dehydration
• Heat cramps
• Hyperkalemic familial periodic paralysis
• Severe renal impairment
• Severe hemolytic reactions
• Severe tissue trauma
• Untreated Addison's disease
• Esophageal compression caused by enlarged left atrium (with wax matrix forms)
• Concurrent use of potassium-sparing diuretics, angiotensin-enzyme converting (ACE) inhibitors, or salt substitutes containing potassium
Use cautiously in:
• cardiac disease, renal impairment, diabetes mellitus, hypomagnesemia
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
☞ Know that I.V. potassium chloride is a high-alert drug.
☞ Give I.V. form as additive by infusion only. Never give undiluted or by I.V. push or I.M. route. Use peripheral line and infuse at a maximum rate of 40 mEq/hour (with cardiac monitoring).
☞ Dilute in compatible I.V. solution per manufacturer's instructions. Administer slowly to reduce risk of fatal hyperkalemia.
☞ To ensure that potassium is well mixed in compatible solution, don't add potassium to I.V. bottle in hanging position.
☞ Be aware that maximum infusion rate without cardiac monitoring is 20 mEq/hour. Rates above 20 mEq/hour require cardiac monitoring.
• Make sure patient is well-hydrated and urinating before starting therapy.
• If patient complains of burning with I.V. administration, decrease flow rate.
• Give P.O. form with meals and a full glass of water or juice, to minimize GI upset.
• Ensure that patient swallows wax-matrix tablets completely, to avoid serious esophageal problems.
• Don't give wax matrix tablets to patients who have swallowing problems or possible esophageal compression.
• Be aware that potassium preparations aren't interchangeable.
• Know that dosages are expressed in mEq of potassium and that potassium chloride contains 13.4 mEq potassium/g.
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
Musculoskeletal: weakness and heaviness of legs
Respiratory: respiratory paralysis Other: irritation at I.V. site
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
• Monitor renal function, fluid intake and output, and potassium, creatinine, and blood urea nitrogen levels.
• Assess vital signs and ECG. Stay alert for arrhythmias.
• Monitor neurologic status. Watch for neurologic complications.
• Monitor I.V. site for irritation.
☞ Know that potassium is contra-indicated in patients with 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.
• Instruct patient to mix and dissolve powder completely in 3 to 8 oz of water or juice.
• Tell patient to swallow extended-release capsules whole without crushing or chewing them.
• Instruct patient to take oral form with or just after a meal, with a glass of water or fruit juice.
• Tell patient to sip diluted liquid form over 5 to 10 minutes.
• Advise patient to report nausea, vomiting, confusion, numbness and tingling, unusual fatigue or weakness, or a heavy feeling in legs.
• Tell patient to minimize GI upset by eating frequent, small servings of food and drinking plenty of fluids.
• Inform patient that although wax matrix form may appear in stool, drug has already been absorbed.
• Advise patient not to use 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.