POTASSIUM SUPPLEMENTS (parenteral)

General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Pronunciation:
poe-tass-ee-um

potassium acetate

potassium chloride

Ther. Class.

mineral and electrolyte replacements/supplements

Indications

Treatment/prevention of potassium depletion.
Arrhythmias due to digoxin toxicity.

Action

Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.
Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

Therapeutic Effect(s):

Replacement.
Prevention of deficiency.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Enters extracellular fluid; then actively transported into cells.

Metabolism and Excretion: Excreted by the kidneys.

Half-life: Unknown.

TIME/ACTION PROFILE (increase in serum potassium levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–2 hr	unknown
IV	rapid	end of infusion	unknown

Contraindication/Precautions

Contraindicated in:

Hyperkalemia
Severe renal impairment
Untreated Addison's disease
Severe tissue trauma
Hyperkalemic familial periodic paralysis
Potassium acetate injection contains aluminum, which may become toxic with prolonged use to high risk groups (renal impairment, premature neonates).

Use Cautiously in:

Cardiac disease
Renal impairment
Hypomagnesemia (may make correction of hypokalemia more difficult)
Patients receiving potassium-sparing drugs.

Adverse Reactions/Side Effects

CV: ECG changes, ARRHYTHMIAS

Local: irritation at IV site

Neuro: confusion, paralysis, paresthesia, restlessness, weakness

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Use with potassium-sparing diuretics or ACE inhibitors or angiotensin II receptor antagonists may lead to hyperkalemia.
Anticholinergics may ↑ GI mucosal lesions in patients taking wax-matrix potassium chloride preparations.

Route/Dosage

Expressed as mEq of potassium. Potassium acetate contains 10.2 mEq/g; potassium chloride contains 13.4 mEq potassium/g.

Normal Daily Requirements

IV (Adults): 40–80 mEq/day.

IV (Children): 2–3 mEq/kg/day.

IV (Neonates): 2–6 mEq/kg/day.

Treatment of Hypokalemia

IV (Adults): 10–20 mEq/dose (maximum: 40 mEq/dose) to infuse over 2–3 hr (maximum infusion rate: 40 mEq/hr).

IV (Neonates , Infants and Children): 0.5–1 mEq/kg/dose (maximum 30 mEq/dose) as an infusion to infuse at 0.3–0.5 mEq/kg/hr (maximum infusion rate 1 mEq/kg/hr).

Availability

Potassium Acetate

Concentrate for injection (contains aluminum): 2 mEq/mL in 20-, 50-, and 100-mL vials, 4 mEq/mL in 50-mL vials

Potassium Chloride

Concentrate for injection: 0.1 mEq/mL in 10-mEq ampules and vials, 0.2 mEq/mL in 10- and 20-mEq ampules and vials, 0.3 mEq/mL in 30-mEq ampules and vials, 0.4 mEq/mL in 20- and 40-mEq ampules and vials, 1.5 mEq/mL, 2 mEq/mL, 3 mEq/mL

Solution for IV infusion: 10 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers, 20 mEq/L in dextrose/saline/LRs in 250-, 500-, and 100-mL containers, 30 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers, 40 mEq/L in various dextrose and saline solutions in 250-, 500-, and 100-mL containers

Assessment

Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and hyperkalemia (see Toxicity and Overdose).
Monitor pulse, BP, and ECG periodically during IV therapy.

Lab Test Considerations:

Monitor serum potassium before and periodically during therapy. Monitor renal function, serum bicarbonate, and pH. Determine serum magnesium level if patient has refractory hypokalemia; hypomagnesemia should be corrected to facilitate effectiveness of potassium replacement. Monitor serum chloride because hypochloremia may occur if replacing potassium without concurrent chloride.

Toxicity and Overdose:

Symptoms of toxicity are those of hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea; peaked T waves; depressed ST segments; prolonged QT segments; widened QRS complexes; loss of P waves; and cardiac arrhythmias).

Treatment includes discontinuation of potassium, administration of sodium bicarbonate to correct acidosis, dextrose and insulin to facilitate passage of potassium into cells, calcium salts to reverse ECG effects (in patients who are not receiving digoxin), sodium polystyrene used as an exchange resin, and/or dialysis for patient with impaired renal function.

Implementation

High Alert: Medication errors involving too rapid infusion or bolus IV administration of potassium chloride have resulted in fatalities. See IV administration guidelines below.
IV Assess for extravasation; severe pain and tissue necrosis may occur.High Alert: Never administer potassium IV push or bolus.
Rate: High Alert: Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children on general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children).
Rate: High Alert: Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children in general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children in a peripheral line. May use higher concentrations via central line). Use an infusion pump.
Solution Compatibility: May be diluted in dextrose, saline, Ringer's solution, LR, dextrose/saline, dextrose/Ringer's solution, and dextrose/LR combinations. Commercially available premixed with many of the above IV solutions.
Y-Site Compatibility:
- acyclovir
- MORE...
  - aldesleukin
  - allopurinol
  - amifostine
  - aminophylline
  - amiodarone
  - ampicillin
  - atropine
  - aztreonam
  - betamethasone
  - calcium gluconate
  - chlordiazepoxide
  - chlorpromazine
  - ciprofloxacin
  - cisatracurium
  - cladribine
  - cyanocobalamin
  - digoxin
  - diltiazem
  - diphenhydramine
  - dobutamine
  - docetaxel
  - dopamine
  - doxorubicin liposome
  - droperidol
  - enalaprilat
  - epinephrine
  - esmolol
  - conjugated estrogens
  - ethacrynate sodium
  - etoposide phosphate
  - famotidine
  - fentanyl
  - filgrastim
  - fludarabine
  - fluorouracil
  - furosemide
  - gemcitabine
  - granisetron
  - heparin
  - hydralazine
  - idarubicin
  - indomethacin
  - insulin
  - isoproterenol
  - labetalol
  - lidocaine
  - linezolid
  - lorazepam
  - magnesium sulfate
  - melphalan
  - menadiol
  - meperidine
  - methoxamine
  - methylergonovine
  - midazolam
  - milrinone
  - minocycline
  - morphine
  - neostigmine
  - norepinephrine
  - ondansetron
  - oxacillin
  - oxytocin
  - paclitaxel
  - penicillin G potassium
  - phytonadione
  - piperacillin/tazobactam
  - procainamide
  - prochlorperazine
  - propofol
  - propranolol
  - pyridostigmine
  - remifentanil
  - sargramostim
  - scopolamine
  - sodium bicarbonate
  - succinylcholine
  - tacrolimus
  - theophylline
  - thiotepa
  - tirofiban
  - trimethaphan
  - vinorelbine
  - warfarin
  - zidovudine
Y-Site Incompatibility:
- amphotericin B cholesteryl sulfate complex
- diazepam
- MORE...
  - ergotamine tartrate
  - phenytoin
Additive Compatibility:
- calcium gluconate
- cimetidine
- lidocaine
- sodium bicarbonate
- vitamin B complex with C

Potassium Acetate

Continuous Infusion: High Alert: Do not administer undiluted. Each single dose must be diluted and thoroughly mixed in 100–1000 mL of dextrose, saline, Ringer's or LR, dextrose/saline, dextrose/Ringer's, or LR combinations. Usually limited to 80 mEq/L via peripheral line (200 mEq/L via central line).
Rate: High Alert: Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children on general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children).
Rate: High Alert: Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children in general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children in a peripheral line. May use higher concentrations via central line). Use an infusion pump.
Solution Compatibility: May be diluted in dextrose, saline, Ringer's solution, LR, dextrose/saline, dextrose/Ringer's solution, and dextrose/LR combinations. Commercially available premixed with many of the above IV solutions.
Y-Site Compatibility:
- acyclovir
- MORE...
  - aldesleukin
  - allopurinol
  - amifostine
  - aminophylline
  - amiodarone
  - ampicillin
  - atropine
  - aztreonam
  - betamethasone
  - calcium gluconate
  - chlordiazepoxide
  - chlorpromazine
  - ciprofloxacin
  - cisatracurium
  - cladribine
  - cyanocobalamin
  - digoxin
  - diltiazem
  - diphenhydramine
  - dobutamine
  - docetaxel
  - dopamine
  - doxorubicin liposome
  - droperidol
  - enalaprilat
  - epinephrine
  - esmolol
  - conjugated estrogens
  - ethacrynate sodium
  - etoposide phosphate
  - famotidine
  - fentanyl
  - filgrastim
  - fludarabine
  - fluorouracil
  - furosemide
  - gemcitabine
  - granisetron
  - heparin
  - hydralazine
  - idarubicin
  - indomethacin
  - insulin
  - isoproterenol
  - labetalol
  - lidocaine
  - linezolid
  - lorazepam
  - magnesium sulfate
  - melphalan
  - menadiol
  - meperidine
  - methoxamine
  - methylergonovine
  - midazolam
  - milrinone
  - minocycline
  - morphine
  - neostigmine
  - norepinephrine
  - ondansetron
  - oxacillin
  - oxytocin
  - paclitaxel
  - penicillin G potassium
  - phytonadione
  - piperacillin/tazobactam
  - procainamide
  - prochlorperazine
  - propofol
  - propranolol
  - pyridostigmine
  - remifentanil
  - sargramostim
  - scopolamine
  - sodium bicarbonate
  - succinylcholine
  - tacrolimus
  - theophylline
  - thiotepa
  - tirofiban
  - trimethaphan
  - vinorelbine
  - warfarin
  - zidovudine
Y-Site Incompatibility:
- amphotericin B cholesteryl sulfate complex
- diazepam
- MORE...
  - ergotamine tartrate
  - phenytoin
Additive Compatibility:
- calcium gluconate
- cimetidine
- lidocaine
- sodium bicarbonate
- vitamin B complex with C

Potassium Chloride

Continuous Infusion:
High Alert: Do not administer concentrations of ≥1.5 mEq/mL undiluted; may cause cardiac arrest. Concentrated products have black caps on vials or black stripes above constriction on ampules and are labeled with a warning about dilution requirement. Each single dose must be diluted and thoroughly mixed in 100–1000 mL of IV solution. Usually limited to 80 mEq/L via peripheral line (200 mEq/L via central line).
- Concentrations of 0.1 and 0.4 mEq/mL are intended for administration via calibrated infusion device and do not require dilution.
Rate: High Alert: Infuse slowly, at a rate up to 10 mEq/hr in adults or 0.5 mEq/kg/hr in children in general care areas. Check hospital policy for maximum infusion rates (maximum rate in monitored setting 40 mEq/hr in adults or 1 mEq/kg/hr in children in a peripheral line. May use higher concentrations via central line). Use an infusion pump.
Solution Compatibility: May be diluted in dextrose, saline, Ringer's solution, LR, dextrose/saline, dextrose/Ringer's solution, and dextrose/LR combinations. Commercially available premixed with many of the above IV solutions.
Y-Site Compatibility:
- acyclovir
- MORE...
  - aldesleukin
  - allopurinol
  - amifostine
  - aminophylline
  - amiodarone
  - ampicillin
  - atropine
  - aztreonam
  - betamethasone
  - calcium gluconate
  - chlordiazepoxide
  - chlorpromazine
  - ciprofloxacin
  - cisatracurium
  - cladribine
  - cyanocobalamin
  - digoxin
  - diltiazem
  - diphenhydramine
  - dobutamine
  - docetaxel
  - dopamine
  - doxorubicin liposome
  - droperidol
  - enalaprilat
  - epinephrine
  - esmolol
  - conjugated estrogens
  - ethacrynate sodium
  - etoposide phosphate
  - famotidine
  - fentanyl
  - filgrastim
  - fludarabine
  - fluorouracil
  - furosemide
  - gemcitabine
  - granisetron
  - heparin
  - hydralazine
  - idarubicin
  - indomethacin
  - insulin
  - isoproterenol
  - labetalol
  - lidocaine
  - linezolid
  - lorazepam
  - magnesium sulfate
  - melphalan
  - menadiol
  - meperidine
  - methoxamine
  - methylergonovine
  - midazolam
  - milrinone
  - minocycline
  - morphine
  - neostigmine
  - norepinephrine
  - ondansetron
  - oxacillin
  - oxytocin
  - paclitaxel
  - penicillin G potassium
  - phytonadione
  - piperacillin/tazobactam
  - procainamide
  - prochlorperazine
  - propofol
  - propranolol
  - pyridostigmine
  - remifentanil
  - sargramostim
  - scopolamine
  - sodium bicarbonate
  - succinylcholine
  - tacrolimus
  - theophylline
  - thiotepa
  - tirofiban
  - trimethaphan
  - vinorelbine
  - warfarin
  - zidovudine
Y-Site Incompatibility:
- amphotericin B cholesteryl sulfate complex
- diazepam
- MORE...
  - ergotamine tartrate
  - phenytoin
Additive Compatibility:
- calcium gluconate
- cimetidine
- lidocaine
- sodium bicarbonate
- vitamin B complex with C

Patient/Family Teaching

Advise patient regarding sources of dietary potassium (see food sources for specific nutrients). Encourage compliance with recommended diet.
Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dosage may require adjustment.
Emphasize the importance of regular follow-up exams to monitor serum levels and progress.

Evaluation/Desired Outcomes

Prevention and correction of serum potassium depletion.
Cessation of arrhythmias caused by digoxin toxicity.

POTASSIUM SUPPLEMENTS (parenteral)is the Emergency Central Word of the day!