(poe TASS ee um AS e tate)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL)
- Electrolyte Supplement, Parenteral
Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion
Enters cells via active transport from extracellular fluid
Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed
Use: Labeled Indications
Hypokalemia: Treatment and prevention of hypokalemia when it is necessary to avoid chloride or acid/base status requires an additional source of bicarbonate.
Severe renal impairment or adrenal insufficiency; hyperkalemia
Note: When maintaining normal daily requirements, IV doses should be incorporated into the patient's maintenance IV fluids. Intermittent IV potassium administration should be reserved for more severe depletion situations in patients undergoing ECG monitoring. Doses expressed as mEq of potassium.
Hypokalemia, treatment: IV intermittent infusion: Peripheral or central line: ≤10 mEq/hour; repeat as needed based on frequently obtained lab values; central line infusion and continuous ECG monitoring highly recommended for infusions >10 mEq/hour
Potassium dosage/rate of infusion general guidelines (per product labeling): Note: High variability exists in dosing/infusion rate recommendations; therapy guided by patient condition and specific institutional guidelines. As an estimate, 10 mEq of potassium will roughly increase serum levels by 0.1 mEq/L. Patients with more severe forms of hypokalemia (eg, serum potassium levels <3.5 mEq/L) may require increased amounts due to total body potassium deficit (Flurie 2017).
Serum potassium >2.5 to 3.5 mEq/L: Maximum infusion rate: 10 mEq/hour; maximum concentration: 40 mEq/L; maximum 24-hour dose: 200 mEq
Serum potassium <2.5 mEq/L or symptomatic hypokalemia (excluding emergency treatment of cardiac arrest): Maximum infusion rate (central line only): 40 mEq/hour in presence of continuous ECG monitoring and frequent lab monitoring; in selected situations, patients may require up to 400 mEq/24 hours.
Refer to adult dosing.
Maintenance potassium should be incorporated into the patient's maintenance IV fluids; intermittent IV potassium administration should be reserved for severe depletion situations; continuous ECG monitoring should be used for intermittent doses >0.5 mEq/kg/hour. Acid/base balance should be considered when selecting a potassium salt for maintenance therapy or treatment of hypokalemia; acetate is converted to bicarbonate in the body and may affect serum pH. High variability exists in dosing/infusion rate recommendations; therapy guided by patient condition and specific institutional guidelines. Doses expressed as mEq of potassium.
Note: Use caution in premature neonates; potassium acetate for injection contains aluminum.
Hypokalemia (severe) treatment: Infants, Children, and Adolescents: Intermittent IV infusion: 0.5 to 1 mEq/kg/dose; maximum dose: 40 mEq/dose, infuse at a rate ≤0.5 mEq/kg/hour (Corkins 2015; Fuhrman 2017; Kliegman 2016); serum concentrations should be evaluated 1 to 2 hours after completion of infusion; may repeat as needed based on lab values; severe depletion or ongoing losses may require >200% of normal daily maintenance.
Dosing: Renal Impairment
Reduce initial dose by at least 50% in patients with renal impairment (Kraft 2005). Potassium acetate administration may also increase serum aluminum and bicarbonate. Contraindicated in patients with renal failure.
Dosing: Hepatic Impairment
There are no dosage adjustment provided in the manufacturer's labeling. Use with caution due to impaired liver utilization of bicarbonate.
Parenteral: Potassium must be diluted prior to parenteral administration. The concentration of infusion may be dependent on patient condition and specific institution policy. Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and 20-40 mEq/100 mL for central infusions.
Parenteral: Potassium must be diluted prior to parenteral administration. For IV infusion; do not administer IV push. In general, the rate of administration may be dependent on patient condition and specific institution policy. Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and maximum rate of administration for peripheral infusion is 10 mEq/hour (Kraft 2005). ECG monitoring is recommended for peripheral or central infusions >10 mEq/hour in adults (Kraft 2005). With central line administration, higher concentrations and more rapid rates of infusion may be used; concentrations of 20 to 40 mEq/100 mL at a maximum rate of 40 mEq/hour via central line have been safely administered (Hamill 1991; Kruse 1990).
Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Hurst, 2004); elevate extremity.
Hyaluronidase: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 to 25 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara 1983; Reynolds 2014; Zenk 1981)
Store at room temperature; do not freeze.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Monitor therapy
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification
Heparin: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy
Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Consider therapy modification
Frequency not defined.
Cardiovascular: Cardiac arrhythmia, heart block, hypotension, paralysis, paresthesia
Central nervous system: Abnormal electroencephalogram, confusion, lethargy
Local: Local tissue necrosis (with extravasation)
Neuromuscular & skeletal: Weakness
Concerns related to adverse effects:
• Extravasation: Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.
• Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).
• Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely. In patients with metabolic or respiratory alkalosis, use with caution since use of potassium acetate may worsen alkalosis depending on the amount administered (Khanna 2006).
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.
• Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).
• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated with severe impairment.
Concurrent drug therapy issues:
• Digitalis: Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.
• Potassium-altering therapies: Use with caution in patients receiving concomitant medications or therapies that increase potassium (eg, ACEIs, potassium-sparing diuretics, potassium containing salt substitutes).
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.
• Parenteral administration: Use extreme caution with parenteral administration and monitor serum potassium concentrations closely. Evaluate renal function, cardiac and fluid status, and any factors contributing to altered potassium concentrations (eg, acidosis, alkalosis) prior to therapy. Do NOT administer undiluted or IV push; inappropriate parenteral administration may be fatal. Always administer potassium further diluted; refer to appropriate dilution and administration rate recommendations. Pain and phlebitis may occur during parenteral infusion requiring a decrease in infusion rate or potassium concentration.
Electrolytes (including serum potassium, bicarbonate, and magnesium), acid/base status; cardiac monitor (if intermittent infusion or potassium infusion rates 0.5 mEq/kg/hour in children or >10 mEq/hour in adults); to assess adequate replacement, repeat serum potassium level 2 to 4 hours after dose. Monitor IV infusion site for extravasation.
Pregnancy Risk Factor
Animal reproduction studies have not been conducted. Potassium requirements are the same in pregnant and nonpregnant women. Adverse events have not been observed following use of potassium supplements in healthy women with normal pregnancies. Use caution in pregnant women with other medical conditions (eg, pre-eclampsia; may be more likely to develop hyperkalemia) (IOM 2004).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Have patient report immediately to prescriber signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling) or difficulty moving (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.