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Potassium Acetate

Pronunciation

(poe TASS ee um AS e tate)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL)

Pharmacologic Category

  • Electrolyte Supplement, Parenteral

Pharmacology

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

Distribution

Enters cells via active transport from extracellular fluid

Excretion

Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed

Use: Labeled Indications

Potassium deficiency; to avoid chloride when high concentration of potassium is needed, source of bicarbonate

Contraindications

Severe renal impairment or adrenal insufficiency; hyperkalemia

Dosing: Adult

IV doses should be incorporated into the patient's maintenance IV fluids, intermittent IV potassium administration should be reserved for severe depletion situations and requires ECG monitoring; doses listed as mEq of potassium

Treatment of hypokalemia: IV: 40-100 mEq/day

IV intermittent infusion (must be diluted prior to administration):

5-10 mEq/dose (maximum: 40 mEq/dose) to infuse over 2-3 hours (maximum: 40 mEq over 1 hour)

Note: Continuous cardiac monitor recommended for rates >0.5 mEq/kg/hour

Potassium dosage/rate of infusion guidelines:

Serum potassium >2.5 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: Maximum infusion rate: 40 mEq/hour; maximum concentration: 80 mEq/L; maximum 24-hour dose: 400 mEq

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

IV doses should be incorporated into the patient's maintenance IV fluids, intermittent IV potassium administration should be reserved for severe depletion situations and requires ECG monitoring; doses listed as mEq of potassium.

Note: Use caution in premature neonates; potassium acetate for injection contains aluminum.

Treatment of hypokalemia: IV: 2-5 mEq/kg/day

IV intermittent infusion (must be diluted prior to administration): 0.5-1 mEq/kg/dose (maximum: 30 mEq/dose) to infuse at 0.3-0.5 mEq/kg/hour (maximum: 1 mEq/kg/hour)

Note: Continuous cardiac monitor recommended for rates >0.5 mEq/kg/hour

Potassium dosage/rate of infusion guidelines:

Serum potassium >2.5 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: Maximum infusion rate: 40 mEq/hour; maximum concentration: 80 mEq/L; maximum 24-hour dose: 400 mEq

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling. Use caution; potassium acetate injection may increase serum aluminum and/or potassium.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling. Use with caution.

Reconstitution

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.

Administration

Potassium must be diluted prior to parenteral administration; maximum recommended concentration (peripheral line): 80-100 mEq/L; maximum recommended concentration (central line): 150 mEq/L or 15 mEq/100 mL; in severely fluid-restricted patients (with central lines): 200 mEq/L or 20 mEq/100 mL has been used; maximum rate of infusion, see Dosage, IV intermittent infusion

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 mL (15 units/mL) as five separate 0.2 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara, 1983; Zenk, 1981).

Storage

Store at room temperature; do not freeze.

Drug Interactions

ACE Inhibitors: Potassium Salts may enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

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

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

Heparin (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

Adverse Reactions

Frequency not defined.

Cardiovascular: Arrhythmias, EEG abnormalities, heart block, hypotension

Central nervous system: Confusion, listlessness

Neuromuscular & skeletal: Paralysis, paresthesia, weakness

Local: Local tissue necrosis with extravasation

Warnings/Precautions

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).

Disease-related concerns:

• 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.

• 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.

Other warnings/precautions:

• 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.

Monitoring Parameters

Serum potassium, magnesium (to facilitate potassium repletion), and bicarbonate; 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 2-4 hours after dose

Pregnancy Risk Factor

C

Pregnancy Considerations

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).

Patient Education

• 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.

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