Potassium Supplements

Class: Replacement Preparations
CAS Number: 127-08-2
Brands: Effer-K, Kaon-Cl, Kay Ciel, K-Lor, Klor-Con, Klor-Con/EF, Klotrix, K-Tab, Micro-K

Introduction

A source of potassium, an essential nutrient cation.a

Uses for Potassium Supplements

Hypokalemia

Treatment or prevention of hypokalemia (potassium deficiency) in patients in whom dietary measures are inadequate.a

Conditions that may indicate or result in potassium deficiency include vomiting, diarrhea, drainage of GI fluids, hyperadrenalism, malnutrition, debilitation, prolonged negative nitrogen balance, prolonged parenteral alimentation without addition of potassium, dialysis, metabolic alkalosis, metabolic or diabetic acidosis, GI tract abnormalities that result in poor absorption, certain renal diseases, and familial periodic paralysis characterized by hypokalemia.a

Potassium should be included in long-term electrolyte replacement regimens and has been recommended for routine prophylactic administration following surgery after adequate urine flow has been established.a

Potassium replacement may be indicated in patients receiving certain drugs that may sometimes cause potassium depletion (e.g., thiazide diuretics, carbonic anhydrase inhibitors, loop diuretics, some corticosteroids, corticotropin, aminosalicylic acid, amphotericin B).a Although ingestion of potassium-rich foods and/or use of potassium-containing salt substitutes may prevent potassium depletion in patients receiving potassium-depleting drugs, judicious prophylactic administration of potassium may be advisable in selected patients during prolonged diuretic or corticosteroid therapy, especially if they are digitalized.a

Potassium chloride usually is the salt of choice in the treatment of potassium depletion, since the chloride ion is required to correct hypochloremia which frequently accompanies potassium deficiency and since the citrate, bicarbonate, gluconate, or another alkalinizing salt of potassium may cause hypochloremia, particularly when used in conjunction with chloride-restricted diets.a

Alkalinizing potassium salts (acetate, bicarbonate, citrate, gluconate) should be used for treatment of hypokalemia in patients with metabolic acidosis (e.g., renal tubular acidosis).a c g

Potassium also is available as the potassium phosphate salt; however, potassium phosphate usually is used to replace phosphate losses or to correct coexisting hypokalemia and hypophosphatemia.q r s t

Hypertension

Inadequate dietary intake of potassium plays an important role in the development of hypertension,101 102 103 and high dietary intake of potassium (including use of potassium supplements) may protect against the development of high blood pressure and improve blood pressure control in patients with hypertension.101 103

Most experts recommend that an adequate intake of potassium101 103 (about 50–90 mEq daily)101 be maintained in hypertensive patients as part of lifestyle modifications,101 103 particularly in those unable to adequately reduce their sodium intake.a 103

Adequate intake of potassium should be considered as a means of preventing the development of hypertension.101 103 Food sources high in potassium such as fruits and vegetables101 104 are preferred.101 Alternatively, potassium supplements or salt-substitutes or potassium-sparing diuretics can be used, particularly in patients receiving kaliuretic diuretics.101

AMI

Potassium supplementation, combined with magnesium supplementation if necessary, has been used to reduce risk of ventricular arrhythmias in patients with AMI.105

Clinical experience as well as observational data from coronary care unit populations indicate that hypokalemia is a risk factor for development of ventricular fibrillation.105 110 111 Although benefits of potassium supplementation as a strategy in preventing ventricular fibrillation following AMI have not been confirmed, maintaining serum potassium and magnesium concentrations at levels >4 and >2 mEq/L, respectively, is considered sound clinical practice.105

IV potassium chloride has been used early in the course of suspected AMI in conjunction with IV insulin injection (regular insulin) and dextrose (d-glucose) (referred to as glucose-insulin-potassium or GIK therapy) for metabolic modulation and potential beneficial effects on morbidity and mortality.105 106 107 108 109

Initial experience (from the pre-thrombolytic reperfusion era) with early post-MI GIK therapy indicate substantial potential reductions in mortality associated with AMI.107 108 109 Pooled analysis of early studies indicate an overall mortality reduction benefit of 28–48%, which depended on the dosage and timing of GIK therapy relative to symptom onset.107 108 109

GIK therapy appears to be a feasible strategy in the early hours after an AMI.105 106 107 109

Arrhythmias

Potassium salts may be used cautiously to abolish arrhythmias of cardiac glycoside toxicity precipitated by a loss of potassium.a

Elevation of plasma potassium concentrations by 0.5–1.5 mEq/L or to the ULN may be useful in the management of tachyarrhythmias following cardiac surgery,a but this strategy should not be used in patients with atrioventricular block since potassium may further impair nodal conduction.a

Thallium Toxicity

IV potassium supplements, usually potassium chloride,34 35 h i j have been used in the management of thallium poisoning to enhance diuresis and mobilize thallium from tissues;a h such treatment is limited by the amount of thallium that can be released into the blood without worsening cerebral symptoms.a

Potassium Supplements Dosage and Administration

Administration

Administer orally or by slow IV infusion.a c d Potassium-containing injections (usually potassium chloride),k m n have been administered by hypodermoclysis (into subcutaneous tissues).25 a k l m n o

Potassium acetate, bicarbonate, chloride, citrate, and gluconate can be administered orally.a Potassium acetate and chloride can be administered IV.a

Whenever possible, potassium supplements should be given orally since the relatively slow absorption from the GI tract prevents sudden, large increases in plasma potassium concentrations.a Replace IV potassium therapy with oral supplements and/or ingestion of potassium-rich foods as soon as possible.a

Oral Administration

Oral potassium supplements should preferably be administered with or after meals with a full glass of water or fruit juice to minimize the possibility of GI irritation and a saline cathartic effect.a

Usually administered orally in 1–4 doses daily.a c Daily dosage >20 mEq should be divided into several doses and should not be given as a single dose.c g

Powders or tablets for oral solution should be dissolved and/or diluted and administered according to the manufacturers’ directions.a g

Extended-release potassium chloride preparations should be reserved for use in patients who cannot tolerate or refuse to take liquid or effervescent potassium preparations or for those in whom there is a problem of compliance with these latter dosage forms.c

IV Infusion

Close monitoring of ECG and plasma potassium concentrations is essential during IV administration of potassium, especially when the rate of administration is >20 mEq/hour.a (See Hyperkalemia under Cautions.)

Potassium IV solutions should generally be administered only in patients with adequate urine flow (e.g., administer to postoperative patients only after adequate urine flow established).a

In dehydrated patients, 1 liter of potassium-free fluid should be administered prior to initiating potassium therapy.a

Local vascular intolerance may limit the ability to administer concentrated solutions; administer via large, high-flow vein (e.g., femoral vein) or administer less concentrated solutions in divided doses via 2 veins simultaneously.a Avoid administration of concentrated potassium solutions via subclavian, jugular, or right atrial catheter; local potassium concentrations achieved in the heart may be high and potentially cardiotoxic.a

Potassium chloride injection in plastic containers should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.a

Hyperkalemia has been reported when concentrated potassium chloride solutions were added to IV infusions from a hanging flexible plastic container, apparently as a result of pooling of the concentrated potassium solution at the base of the container and infusion of undiluted solution.a Squeezing the container does not facilitate mixing but tends to pump the concentrated solution into the infusion chamber.a Such solutions must be carefully mixed by inverting the plastic container during the addition of potassium solutions with subsequent agitation and/or kneading to prevent pooling.a

Dilution

For solution and drug compatibility information, see Compatibility under Stability.

Potassium acetate and potassium chloride are available as concentrates that must be diluted prior to IV administration.a

Generally, potassium concentrations in IV fluids should not exceed 40 mEq/L.a However, higher potassium concentrations (e.g., 60–80 mEq/L) occasionally may be needed initially for management of severe hypokalemia and associated cardiac arrhythmias, diabetic ketoacidosis or diuretic phase of acute renal failure.a

Rate of Administration

Must be administered by slow IV infusion.a Generally, rate of administration should not exceed 20 mEq/hour.a

More rapid administration occasionally may be necessary for management of severe hypokalemia and associated cardiac arrhythmias or diabetic ketoacidosis or diuretic phase of acute renal failure.a

Hypodermoclysis

If administered by hypodermoclysis, potassium concentrations should not exceed 10 mEq/L to avoid local pain.a

Dosage

Dosage of potassium supplements usually expressed as mEq of potassium.a

Normal adult daily potassium requirement and usual dietary intake of potassium is 40–80 mEq; infants may require 2–3 mEq/kg or 40 mEq/m2 daily.a

Dosage must be carefully individualized according to the patient’s requirements and response.a c

To avoid serious hyperkalemia, replacement of potassium deficits must be undertaken gradually, usually over a 3- to 7-day period depending on the severity of the deficit.a

Potassium replacement requirements can be estimated only by clinical condition and response, ECG monitoring, and/or plasma potassium determinations.a

Dosage Equivalents of Oral Potassium Salts

40 mEq of potassium is provided by approximately:

3.9 g of potassium acetate

4.0 g of potassium bicarbonate

3.0 g of potassium chloride

4.3 g of potassium citrate

9.4 g of potassium gluconate

Pediatric Patients

Hypokalemia
Prevention or Treatment
Oral

If used in pediatric patients, do not exceed 3 mEq/kg daily in young children.a

Adults

Hypokalemia
Prevention
Oral

Average dosage approximately 20 mEq daily.a c Usually should not exceed 200 mEq daily.a p

Treatment
Oral

Usual dosage is 40–100 mEq or more daily.a c Usually should not exceed 200 mEq daily.a p

AMI
Glucose-Insulin-Potassium (GIK) Therapy
IV

GIK therapy in AMI patients involves use of IV potassium chloride in conjunction with IV insulin injection (regular insulin) and IV dextrose (d-glucose).105 106 Goal is to maintain serum potassium concentrations >4 mEq/L and serum magnesium concentrations >2 mEq/L.105 a

Low-dose regimen: IV solution containing potassium chloride 40 mEq/L, 10% dextrose, and 20 units insulin [regular]/L given at a rate of 1 mL/kg per hour per 24 hours.105 106

High-dose regimen: IV solution containing potassium chloride 80 mEq/L, 25% dextrose, and 50 units insulin [regular]/L given at a rate of 1.5 mL/kg per hour for 24 hours.105 106

Usually initiated in AMI patients within approximately 10–11 hours of symptom onset.105 106 Both low-dose and high-dose regimens appear beneficial; some evidence suggests that the high-dose regimen may be more effective.106 107

Prescribing Limits

Pediatric Patients

Hypokalemia
Prevention or Treatment
Oral

3 mEq/kg daily for young children.a

Adults

Hypokalemia
Prevention or Treatment
Oral

Usually should not exceed 200 mEq daily.a p

Special Populations

Renal Impairment

Cautious dosage selection and careful monitoring recommended in patients with renal impairment.c

Geriatric Patients

Select dosage with caution, starting at low end of dosage range, because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.c

Cautions for Potassium Supplements

Contraindications

  • Hyperkalemia, including that complicating chronic renal failure, systemic acidosis (e.g., diabetic acidosis), acute dehydration, extensive tissue breakdown (e.g., in severe burns), adrenal insufficiency, or concomitant use of potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene).c e g

  • Severe renal impairment with oliguria, anuria, or azotemia.a e

  • Use of solid oral dosage preparations in patients with structural, pathologic (e.g., diabetic gastroparesis), and/or pharmacologic (e.g., induced by anticholinergic agents) causes for arrest or delay in GI transit.a

  • Use of extended-release preparations in patients with esophageal compression caused by an enlarged left atrium.a c

Warnings/Precautions

Warnings

Hyperkalemia

Hyperkalemia and cardiac arrest can occur following use of potassium supplements in patients with impaired mechanisms for excreting potassium.c d Most common and serious adverse effect of potassium therapy.a

Potentially fatal; can develop rapidly and patients may be asymptomatic.c Occurs most frequently with IV potassium (especially if administered too rapidly),a but may occur with oral potassium.c

Use IV solutions containing potassium with extreme caution, if at all, in patients with hyperkalemia, severe renal failure, or other conditions with potassium retention.d

Evaluate renal function before therapy; monitor clinical status with periodic ECGs and/or determinations of plasma potassium concentrations.a

Clinical signs and symptoms of hyperkalemia include paresthesia of the extremities, listlessness, mental confusion, weakness or heaviness of the legs, flaccid paralysis, cold skin, gray pallor, peripheral vascular collapse with fall in blood pressure, cardiac arrhythmias, and heart block.a

Metabolic Acidosis

In patients who have both hypokalemia and metabolic acidosis, an alkalinizing potassium salt (acetate, bicarbonate, citrate, gluconate) should be used for treatment of hypokalemia.a c g

Fluid Overload and Edematous States

Use of IV solutions containing potassium may cause fluid and/or solute overload, leading to decreased electrolyte concentrations, overhydration, congestion, and pulmonary edema.d

Use IV solutions containing potassium with extreme caution, if at all, in patients with CHF, severe renal insufficiency, or other conditions with sodium retention and edema.d

GI Lesions

Solid oral dosage forms of potassium have resulted in ulcerative and/or stenotic GI lesion; perforation has occurred.a c Possibly more frequent with enteric-coated tablets (no longer commercially available in the US).a

Administer wax matrix and extended-release preparations with caution; discontinue immediately if abdominal pain, distention, severe vomiting, or GI bleeding occurs.a

Reserve use of extended-release potassium chloride preparations for patients who cannot tolerate or refuse to take liquid or effervescent potassium preparations or for those in whom there is a problem of compliance with these latter dosage forms.c

Some experts question the use of any solid potassium preparation, since use of dilute liquid preparations minimizes the risk of GI complications.a

Local Reactions

Pain and phlebitis may occur at IV administration site, especially with potassium solutions containing ≥30 mEq/L.a

General Precautions

Laboratory Monitoring

Monitor fluid balance, electrolyte concentrations, and acid-base balance periodically during therapy.d Regular serum potassium determinations are recommended, especially in patients with renal impairment or diabetic nephropathy.c

Use of Parenteral Solutions

When potassium is administered IV in parenteral solutions, consider the cautions, precautions, and contraindications associated with fluid volume and electrolytes contained in the IV infusion fluid.d

Specific Populations

Pregnancy

Category C.c d

Lactation

Not known whether potassium is distributed into milk.d Use with caution.d

Pediatric Use

Safety and efficacy not established.c d

Geriatric Use

Response in patients ≥65 years of age does not appear to differ from that in younger adults; however, use with caution due to greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.c

Monitor renal function.c

Renal Impairment

Parenteral solutions containing potassium may cause sodium and/or potassium retention.d

Use cautiously; monitor plasma potassium concentrations frequently.a

Common Adverse Effects

Hyperkalemia; GI effects (nausea, vomiting, diarrhea, flatulence, abdominal pain or discomfort); infusion site reactions.a c e

Interactions for Potassium Supplements

Specific Drugs

Drug

Interaction

Comments

ACE inhibitors (e.g., captopril, enalapril)

Increased risk of hyperkalemiac

Use concomitantly only if monitored closely; monitor serum potassium frequently c

Corticosteroids

Use caution when used concomitantly with parenteral solutions containing potassium d

Corticotropin (ACTH)

Use caution when used concomitantly with parenteral solutions containing potassium d

Diuretics, potassium-sparing (e.g. amiloride, spironolactone, triamterene)

Increased risk of severe hyperkalemiac

Concomitant use contraindicatedc

Potassium Supplements Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration.a

Following oral administration of extended-release formulations, potassium is released slowly; risk of high, localized concentrations is minimized.a

Plasma Concentrations

Normal plasma potassium concentrations generally range from 3.5–5 mEq/L in healthy adults.a

Plasma concentrations up to 7.7 mEq/L may be normal in neonates.a

Plasma potassium concentrations are not necessarily indicative of cellular potassium concentrations; cellular deficits may occur without concomitant decreases in plasma potassium concentrations.a Hypokalemia may occur without substantial depletion of cellular potassium.a

Extracellular fluid pH changes produce reciprocal effects on plasma potassium concentrations; 0.1 unit increase in plasma pH produces a decrease of 0.6 mEq/L in plasma potassium concentration.a

Distribution

Extent

Enters extracellular fluid and actively transported into cells; intracellular concentration is up to 40 times extracellular concentration.a

Intracellular movement augmented by dextrose, insulin, and oxygen.a

Potassium concentrations in gastric and intestinal secretions are higher than plasma concentrations; diarrheal fluid may contain up to 60 mEq/L.a

Elimination

Elimination Route

Excreted principally in urine; small amounts may be excreted via the skin and intestinal tract.a

Filtered by the glomeruli, reabsorbed in the proximal tubule, and secreted in the distal tubule, the site of sodium-potassium exchange.a

Tubular secretion influenced by chloride ion concentration, hydrogen ion exchange, acid-base equilibrium, and adrenal hormones.a

Healthy adults on potassium-free diets usually excrete 40–50 mEq of potassium daily.a

Special Populations

Potassium excretion decreased in patients with renal impairment.c

Surgery and/or tissue injury result in increased urinary excretion of potassium which may continue for several days.a

Postoperative patients or patients under stress of disease with normal kidneys may excrete up to 80–90 mEq of potassium daily, even though they are not receiving any potassium.a

Stability

Storage

Oral

Capsules and Tablets

Tight, light resistant containers at 15–30°C.c

Powder for Solution

15–30°C.f

Solution

15–30°C.f

Parenteral

Injection for IV Infusion

25°C (may be exposed to 15–30°C).c

Concentrate For IV Infusion

25°C (may be exposed to up to 40°C).e

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Drug Compatibility (Potassium Acetate)
Admixture CompatibilityHID

Compatible

Metoclopramide HCl

Y-site CompatibilityHID

Compatible

Ciprofloxacin

Solution Compatibility (Potassium Chloride)HID

Compatible

Dextrose–Ringer’s injection combinations

Dextrose–Ringer’s injection, lactated, combinations

Dextrose 5% in Ringer’s injection, lactated

Dextrose–saline combinations

Dextrose 5% in sodium chloride 0.9%

Dextrose 2.5, 5, 10, or 20% in water

Ionosol products

Ringer’s injection

Ringer’s injection, lactated

Sodium chloride 0.45 or 0.9%

Sodium lactate (1/6) M

Variable

Fat emulsion 10%, IV

Drug Compatibility (Potassium Chloride)
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Aminophylline

Amiodarone HCl

Atracurium besylate

Calcium gluconate

Cefepime HCl

Ceftazidime

Chloramphenicol sodium succinate

Ciprofloxacin

Clindamycin phosphate

Cytarabine

Dimenhydrinate

Dopamine HCl

Enalaprilat

Erythromycin lactobionate

Fluconazole

Foscarnet sodium

Fosphenytoin sodium

Furosemide

Heparin sodium

Hydrocortisone sodium succinate

Hydromorphone HCl

Isoproterenol HCl

Lidocaine HCl

Magnesium sulfate

Methyldopate HCl

Metoclopramide HCl

Mitoxantrone HCl

Nafcillin sodium

Nicardipine HCl

Norepinephrine bitartrate

Oxacillin sodium

Penicillin G potassium

Phenylephrine HCl

Ranitidine HCl

Sodium bicarbonate

Vancomycin HCl

Verapamil HCl

Incompatible

Amphotericin B

Variable

Dobutamine HCl

Penicillin G sodium

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Allopurinol sodium

Amifostine

Aminophylline

Amiodarone HCl

Ampicillin sodium

Anidulafungin

Atropine sulfate

Aztreonam

Bivalirudin

Calcium gluconate

Caspofungin acetate

Ceftaroline fosamil

Chlorpromazine HCl

Ciprofloxacin

Cisatracurium besylate

Cladribine

Clonidine HCl

Cyanocobalamin

Dexamethasone sodium phosphate

Dexmedetomidine HCl

Digoxin

Diltiazem HCl

Diphenhydramine HCl

Dobutamine HCl

Docetaxel

Dopamine HCl

Doripenem

Doxorubicin HCl liposome injection

Droperidol

Edrophonium chloride

Enalaprilat

Epinephrine HCl

Ertapenem sodium

Esmolol HCl

Estrogens, conjugated

Ethacrynate sodium

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Fentanyl citrate

Filgrastim

Fludarabine phosphate

Fluorouracil

Furosemide

Gallium nitrate

Gemcitabine HCl

Gentamicin sulfate

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydralazine HCl

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Idarubicin HCl

Indomethacin sodium trihydrate

Isoproterenol HCl

Labetalol HCl

Levofloxacin

Lidocaine HCl

Linezolid

Lorazepam

Magnesium sulfate

Melphalan HCl

Meperidine HCl

Meropenem

Micafungin sodium

Midazolam HCl

Milrinone lactate

Morphine sulfate

Neostigmine methylsulfate

Nicardipine HCl

Norepinephrine bitartrate

Ondansetron HCl

Oxacillin sodium

Oxaliplatin

Oxytocin

Paclitaxel

Palonosetron HCl

Pantoprazole sodium

Pemetrexed disodium

Penicillin G potassium

Pentazocine lactate

Phytonadione

Piperacillin sodium–tazobactam sodium

Procainamide HCl

Prochlorperazine edisylate

Propofol

Propranolol HCl

Quinupristin-dalfopristin

Remifentanil HCl

Sargramostim

Scopolamine HBr

Sodium bicarbonate

Sodium nitroprusside

Succinylcholine chloride

Tacrolimus

Telavancin HCl

Teniposide

Theophylline

Thiotepa

Tigecycline

Tirofiban HCl

Trimethobenzamide HCl

Vinorelbine tartrate

Warfarin sodium

Zidovudine

Incompatible

Amphotericin B cholesteryl sulfate complex

Azithromycin

Diazepam

Ergotamine tartrate

Phenytoin sodium

Variable

Aldesleukin

Methylprednisolone sodium succinate

Promethazine HCl

Actions

  • The major cation of intracellular fluid; essential for maintenance of acid-base balance, isotonicity, and electrodynamic cellular function.a

  • Important activator in many enzymatic reactions; essential for transmission of nerve impulses; contraction of cardiac, smooth, and skeletal muscles; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.a

  • Reduces mean SBP and DBP.103

  • Mechanism of beneficial effect of metabolic modulation with potassium in combination with dextrose (d-glucose) and insulin (glucose-insulin-potassium or GIK therapy) following an AMI has not been completely determined.a 107 109

  • Current evidence suggests that several metabolic mechanisms may be involved in the protective effects of GIK on ischemic myocardium.a 107 109

  • GIK decreases both circulating concentrations of free fatty acids (FFAs) and myocardial uptake of FFAs shown to be toxic to ischemic myocardium.a 107

  • Stimulates myocardial potassium uptake by insulin via Na+-K+-ATPase and provision of glucose (substrate) for glycolic ATP production.a 107 109

Advice to Patients

  • Importance of advising patient to take oral supplement with meal and full glass of water.c

  • Importance of taking only as prescribed; do not increase dosage or duration of therapy unless otherwise instructed by a clinician.c

  • Importance of informing clinician of tarry stools or other GI symptoms.c

  • Importance of informing clinician of difficulty swallowing capsules or if capsules seem to become stuck in throat.c

  • Advise patient to swallow capsules and not crush, chew, or suck capsules.c

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.c

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.c

  • Importance of informing patients of other important precautionary information.c (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Acetate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection concentrate

2 mEq of K+/mL and CH3COO-/mL*

Potassium Acetate Injection

2 mEq of K+/mL and CH3COO-/mL pharmacy bulk package*

Potassium Acetate Injection

Potassium Acetate Injection MaxiVial

Abraxis

4 mEq of K+/mL and CH3COO-/mL*

Potassium Acetate Injection

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Bicarbonate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, for solution

10 mEq of K+

Effer-K

Nomax

20 mEq of K+

Effer-K

Nomax

25 mEq of K+*

Klor-Con/EF

Upsher-Smith

Potassium Bicarbonate Effervescent Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules, extended-release

8 mEq of K+ and Cl-

Micro-K

Ther-Rx

10 mEq of K+ and Cl-*

Micro-K

Ther-Rx

Potassium Chloride Extended-Release Capsules

For solution

20 mEq of K+ and Cl- per packet*

K-Lor

Abbott

Kay Ciel

Forest

Klor-Con Powder

Upsher-Smith

25 mEq of K+ and Cl- per packet

Klor-Con/25 Powder

Upsher-Smith

Solution

6.7 mEq of K+/5 mL and Cl-/5 mL*

Kay Ciel

Forest

Potassium Chloride Oral Solution

Potassium Chloride Oral Solution

Potassium Chloride Oral Solution ()

Potassium Chloride Oral Solution ()

13.3 mEq of K+/5 mL and Cl-/5 mL*

Potassium Chloride Oral Solution ()

Tablets, extended-release

10 mEq of K+ and Cl-

Kaon-Cl-10

Savage

Tablets, extended-release (containing coated potassium chloride crystals)

10 mEq of K+ and Cl-*

Klor-Con M10

Upsher-Smith

Potassium Chloride Extended-Release Tablets

15 mEq of K+ and Cl-

Klor-Con M15 (scored)

Upsher-Smith

20 mEq of K+ and Cl-*

Klor-Con M20 (scored)

Upsher-Smith

Potassium Chloride Extended-Release Tablets (scored)

Potassium Chloride Extended-Release Tablets (scored)

Tablets, extended-release, film-coated

8 mEq of K+ and Cl-*

Klor-Con 8

Upsher-Smith

Potassium Chloride Extended-Release Tablets

10 mEq of K+ and Cl-*

Klor-Con 10

Upsher-Smith

Klotrix

Bristol-Myers Squibb

K-Tab Filmtab

Abbott

Potassium Chloride Extended-Release Tablets

Parenteral

For injection concentrate

1.5 mEq of K+ and Cl- per mL*

Potassium Chloride for Injection Concentrate

2 mEq of K+ and Cl- per mL*

2 mEq of K+ and Cl- per mL pharmacy bulk package*

Potassium Chloride for Injection Concentrate

Hospira

For injection concentrate, for IV infusion

0.1 mEq of K+ and Cl- per mL (10 mEq)*

Potassium Chloride for Injection Concentrate

Potassium Chloride Injection Highly Concentrated (Viaflex)

Baxter

0.2 mEq of K+ and Cl- per mL (10 and 20 mEq)*

Potassium Chloride Injection Highly Concentrated (Viaflex)

Baxter

0.3 mEq of K+ and Cl- per mL (30 mEq)*

Potassium Chloride Injection Highly Concentrated (Viaflex)

Baxter

0.4 mEq of K+ and Cl- per mL (20 and 40 mEq)*

Potassium Chloride Injection Highly Concentrated (Viaflex)

Baxter

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride in Dextrose Injection

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

10 mEq of K+ per L in 5% Dextrose*

10 mEq/L Potassium Chloride in 5% Dextrose Injection (Viaflex)

Baxter

20 mEq of K+ per L in 5% Dextrose*

20 mEq/L Potassium Chloride in 5% Dextrose Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 5% Dextrose Injection

Braun, Hospira

30 mEq of K+ per L in 5% Dextrose*

30 mEq/L Potassium Chloride in 5% Dextrose Injection (Viaflex)

Baxter

30 mEq/L (0.224%) Potassium Chloride in 5% Dextrose Injection

Hospira

40 mEq of K+ per L in 5% Dextrose*

40 mEq/L Potassium Chloride in 5% Dextrose Injection (Viaflex)

Baxter

40 mEq (0.3%) Potassium Chloride in 5% Dextrose Injection

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride in Sodium Chloride Injection

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

20 mEq of K+ per L in 0.9% Sodium Chloride*

20 mEq/L Potassium Chloride in 0.9% Sodium Chloride Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 0.9% Sodium Chloride Injection

40 mEq of K+ per L in 0.9% Sodium Chloride*

40 mEq/L Potassium Chloride in 0.9% Sodium Chloride Injection (Viaflex)

Baxter

40 mEq/L (0.3%) Potassium Chloride in 0.9% Sodium Chloride Injection

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride in Dextrose and Lactated Ringer’s Injection

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

20 mEq of K+ per L in 5% Dextrose and Lactated Ringer’s*

20 mEq/L Potassium Chloride in 5% Dextrose and Lactated Ringer’s Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 5% Dextrose and Lactated Ringer’s Injection

40 mEq of K+ per L in 5% Dextrose and Lactated Ringer’s*

40 mEq/L Potassium Chloride in 5% Dextrose and Lactated Ringer’s Injection (Viaflex)

Baxter

40 mEq/L (0.3%) Potassium Chloride in 5% Dextrose and Lactated Ringer’s Injection

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride in Dextrose and Sodium Chloride Injection

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

10 mEq of K+ per L in 5% Dextrose and 0.2–0.225% Sodium Chloride*

10 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection (Viaflex)

Baxter

(0.075%) 10 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection

10 mEq/L (0.075%) Potassium Chloride in 5% Dextrose and 0.225% Sodium Chloride Injection

10 mEq of K+ per L in 5% Dextrose and 0.3–0.33% Sodium Chloride*

10 mEq/L (0.075%) Potassium Chloride in 5% Dextrose and 3% Sodium Chloride Injection

10 mEq/L Potassium Chloride in 5% Dextrose and 0.33% Sodium Chloride Injection (Viaflex)

Baxter

10 mEq of K+ per L in 5% Dextrose and 0.45% Sodium Chloride*

10 mEq/L Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection (Viaflex)

Baxter

10 mEq/L (0.075%) Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection

20 mEq of K+ per L in 5% Dextrose and 0.2–0.225% Sodium Chloride*

20 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 5% Dextrose and 0.225% Sodium Chloride Injection

(0.15%) 20 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection

20 mEq K+ per L in 5% Dextrose and 0.3–0.33% Sodium Chloride*

20 mEq/L Potassium Chloride in 5% Dextrose and 0.33% Sodium Chloride Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 5% Dextrose and 0.3% Sodium Chloride Injection

20 mEq of K+ per L in 5% Dextrose and 0.45% Sodium Chloride*

20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection (Viaflex)

Baxter

20 mEq/L (0.15%) Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection

20 mEq of K+ per L in 5% Dextrose and 0.9% Sodium Chloride*

20 mEq/L Potassium Chloride in 5% Dextrose and 0.9% Sodium Chloride Injection (Viaflex)

Baxter

20 mEq (0.15%) Potassium Chloride in 5% Dextrose and 0.9% Sodium Chloride Injection

20 mEq of K+ per L in 10% Dextrose and 0.2% Sodium Chloride*

(0.15%) 20 mEq/L Potassium Chloride in 10% Dextrose and 0.2% Sodium Chloride Injection

30 mEq of K+ per L in 5% Dextrose and 0.2–0.225% Sodium Chloride*

30 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection (Viaflex)

Baxter

30 mEq/L (0.224%) Potassium Chloride in 5% Dextrose and 0.225% Sodium Chloride Injection

(0.22%) 30 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection

30 mEq of K+ per L in 5% Dextrose and 0.3–0.33% Sodium Chloride*

30 mEq/L Potassium Chloride in 5% Dextrose and 0.33% Sodium Chloride Injection (Viaflex)

Baxter

30 mEq/L (0.224%) Potassium Chloride in 5% Dextrose and 0.3% Sodium Chloride Injection

30 mEq of K+ per L in 5% Dextrose and 0.45% Sodium Chloride*

30 mEq/L Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection (Viaflex)

Baxter

30 mEq/L (0.224%) Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection

(0.22%) 30 mEq/L Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection

40 mEq of K+ per L in 5% Dextrose and 0.2–0.225% Sodium Chloride*

40 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection (Viaflex)

Baxter

40 mEq/L (0.3%) Potassium Chloride in 5% Dextrose and 0.225% Sodium Chloride Injection

(0.3%) 40 mEq/L Potassium Chloride in 5% Dextrose and 0.2% Sodium Chloride Injection

40 mEq of K+ per L in 5% Dextrose and 0.3–0.33% Sodium Chloride*

40 mEq/L Potassium Chloride in 5% Dextrose and 0.33% Sodium Chloride Injection

40 mEq/L (0.3%) Potassium Chloride in 5% Dextrose and 0.3% Sodium Chloride Injection

40 mEq of K+ per L in 5% Dextrose and 0.45% Sodium Chloride*

40 mEq/L Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection (Viaflex)

Baxter

40 mEq/L (0.3%) Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection

40 mEq of K+ per L in 5% Dextrose and 0.9% Sodium Chloride*

40 mEq/L Potassium Chloride in 5% Dextrose and 0.9% Sodium Chloride Injection (Viaflex)

Baxter

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Chloride in Water

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

0.1 mEq per mL (10 mEq)*

Potassium Chloride in Water for Injection (Premixed) (LifeCare)

Hospira

0.2 mEq per mL (10 and 20 mEq)*

Potassium Chloride in Water for Injection (Premixed) (LifeCare)

Hospira

0.3 mEq per mL (30 mEq)*

Potassium Chloride in Water for Injection (Premixed) (LifeCare)

Hospira

0.4 mEq per mL (20 and 40 mEq)*

Potassium Chloride in Water for Injection (Premixed) (LifeCare)

Hospira

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Potassium Bicarbonate and Potassium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, for solution

25 mEq of K+ and Cl- (provided by potassium bicarbonate 0.5 g and potassium chloride 1.5 g)*

Potassium Effervescent Tablets

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Effervescent Pot Chloride 25MEQ Effervescent Tablets (QUALITEST): 30/$30.99 or 90/$85.97

K-Tabs 10MEQ Controlled-release Tablets (ABBOTT): 100/$71.99 or 300/$209.97

Klor-Con 20MEQ Packet (UPSHER-SMITH): 100/$84.99 or 300/$229.97

Klor-Con 25MEQ Packet (UPSHER-SMITH): 30/$36.99 or 60/$64.98

Klor-Con 8MEQ Controlled-release Tablets (UPSHER-SMITH): 30/$25.99 or 60/$35.98

Klor-Con 10 10MEQ Controlled-release Tablets (UPSHER-SMITH): 100/$49.99 or 300/$119.97

Klor-Con M15 15MEQ Controlled-release Tablets (UPSHER-SMITH): 100/$59.99 or 300/$165.97

Klor-Con M20 20MEQ Controlled-release Tablets (UPSHER-SMITH): 100/$45.99 or 300/$125.97

Potassium Chloride 20 MEQ/15ML(10%) Liquid (QUALITEST): 473/$13.99 or 1419/$23.63

Potassium Chloride CR 10MEQ Controlled-release Capsules (WATSON LABS): 30/$35.99 or 60/$59.98

Potassium Chloride CR 10MEQ Controlled-release Tablets (SANDOZ): 100/$45.99 or 300/$115.97

Potassium Chloride CR 8MEQ Controlled-release Capsules (WATSON LABS): 30/$35.99 or 90/$85.97

Potassium Chloride CR 8MEQ Controlled-release Tablets (SANDOZ): 100/$45.99 or 200/$80.98

Potassium Chloride Crys CR 10MEQ Controlled-release Tablets (SANDOZ): 100/$57.99 or 300/$150.98

Potassium Chloride Crys CR 20MEQ Controlled-release Tablets (SANDOZ): 30/$21.99 or 60/$32.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions September 4, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

25. Travenol Laboratories, Inc. Travenol Guide to Fluid Therapy. 1973 May.

34. Bank WJ, Pleasure DE, Suzuki K et al. Thallium poisoning. Arch Neurol. 1972; 26:456-64. [PubMed 4337304]

35. Cavanagh JB, Fuller NH, Johnson HRM et al. The effects of thallium salts, with particular reference to the nervous system changes: a report of three cases. Q J Med. 1974; 43:293-319. [PubMed 4369306]

101. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health. (NIH publication No. 98-4080.)

102. Stamler R, Stamler J, Grandits GA. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr. 1997; 65(Suppl):338-65S.

103. Whelton PK, He J, Cutler JA et al. Effects of oral potassium on blood pressure: meta-analysis of randomized controlled clinical trials. JAMA. 1997; 277:1624-32. [IDIS 385547] [PubMed 9168293]

104. Appel LJ, Moore TJ, Obarzanek E et al for the DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997; 336:1117-24. [PubMed 9099655]

105. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). From ACC website.

106. Diaz R, Paolasso EA, Piegas LS et al for the ECLA (Estudios Cardiologicos Latinoamerica) Collaborative Group. Metabolic modulation of acute myocardial infarction: The ECLA Glucose-Insulin-Potassium Pilot Trial. Circulation. 1998; 98:2227-34. [IDIS 419032] [PubMed 9867443]

107. Apstein CS. Glucose-insulin-potassium for acute myocardial infarction: remarkable results from a new prospective, randomized trial. Circulation. 1998; 98:2223-6. [IDIS 419031] [PubMed 9826307]

108. Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation. 1997; 96:1152-6. [IDIS 392642] [PubMed 9286943]

109. Apstein CS. Glucose-insulin-potassium in acute nyocardial infarction: the time has come for a large, prospective trial. Circulation. 1997; 96:1074-7. [IDIS 392638] [PubMed 9286931]

110. Nordrehaug JE, von der Lippe G. Hypokalemia and ventricular fibrillation in acute myocardial infarction. Br Heart J. 1983; 50:525-9. [IDIS 180150] [PubMed 6651995]

111. Higham PD, Adams PC, Murray A et al. Plasma potassium, serum magnesium and ventricular fibrillation: a prospective study. Q J Med. 1993; 86:609-17. [PubMed 8255976]

a. AHFS Drug Information 2004. McEvoy, GK, ed. Potassium Supplements. Bethesda, MD: American Society of Health-System Pharmacists; 2004:2517-23.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:956-67.

c. Ethex. Potassium chloride extended-release capsules, USP 10 mEq (750 mg) prescribing information. St Louis, MO; 2003 Sept.

d. Baxter. Potassium chloride in sodium chloride injection, USP prescribing information. Deerfield, IL; 2003 May.

e. Baxter. Highly concentrated potassium chloride injection prescribing information. Deerfield, IL; 2003 Feb.

f. Forest. Kay Ciel (potassium chloride) oral solution 10% and powder prescribing information. St Louis, MO; 1999 April.

g. Abbott. L-Lor (potassium chloride) powder packets prescribing information. St Louis, MO; 1994 Jun.

h. Malbrain ML, Lambrecht GL, Zandijk E et al. Treatment of severe thallium intoxication. J Toxicol Clin Toxicol. 1997; 35:97-100. [PubMed 9022660]

i. Moore D, House I, Dixon A. Thallium poisoning: diagnosis may be elusive but alopecia is the clue. BMJ. 1993; 306:1527-9. [PubMed 8518684]

j. Galván-Arzate S, Santamaría A. Thallium toxicity. Toxicol Lett. 1998; 99:1-13. [PubMed 9801025]

k. Sasson M, Shvartzman P. Hypodermoclysis: an alternative infusion technique. Am Fam Physician. 2001; 64:1575-8. [PubMed 11730312]

l. Pirrello RD, Ting Chen C, Thomas SH. Initial experiences with subcutaneous recombinant human hyaluronidase. J Palliat Med. 2007; 10:861-4. [PubMed 17803404]

m. Rochon PA, Gill SS, Litner J et al. A systematic review of the evidence for hypodermoclysis to treat dehydration in older people. J Gerontol A Biol Sci Med Sci. 1997; 52:M169-76. [PubMed 9158559]

n. Ferry M, Dardaine V, Constans T. Subcutaneous infusion or hypodermoclysis: a practical approach. J Am Geriatr Soc. 1999; 47:93-5. [PubMed 9920236]

o. Berger EY. Nutrition by hypodermoclysis. J Am Geriatr Soc. 1984; 32:199-203. [PubMed 6421919]

p. Kokko JP. Fluids and Electrolytes. In: Goldman L, Ausiello D, eds. Cecil textbook of medicine. 22nd ed. Philadelphia: Saunders; 2004:669-87.

q. Sedlacek M, Schoolwerth AC, Remillard BD. Electrolyte disturbances in the intensive care unit. Semin Dial. 2006; 19:496-501. [PubMed 17150050]

r. Gennari FJ. Hypokalemia. N Engl J Med. 1998; 339:451-8. [PubMed 9700180]

s. Kraft MD, Btaiche IF, Sacks GS et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005; 62:1663-82. [PubMed 16085929]

t. Rastegar A, Soleimani M, Rastergar A. Hypokalaemia and hyperkalaemia. Postgrad Med J. 2001; 77:759-64. [PubMed 11723313]

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