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Potassium Chloride

Pronunciation

Pronunciation

(poe TASS ee um KLOR ide)

Index Terms

  • KCl
  • Kdur

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule Extended Release, Oral:

Klor-Con Sprinkle: 8 mEq [contains brilliant blue fcf (fd&c blue #1)]

Klor-Con Sprinkle: 10 mEq [contains fd&c red #40, fd&c yellow #10 (quinoline yellow)]

Micro-K: 8 mEq, 10 mEq

Generic: 8 mEq, 10 mEq

Liquid, Oral:

Generic: 20 mEq/15 mL (10%) (473 mL); 40 mEq/15 mL (20%) (473 mL)

Packet, Oral:

K-Vescent: 20 mEq (100 ea [DSC])

Klor-Con: 20 mEq (1 ea, 30 ea, 100 ea); 25 mEq (30 ea, 100 ea) [sugar free; contains fd&c yellow #6 (sunset yellow); fruit flavor]

Generic: 20 mEq (1 ea, 30 ea, 100 ea)

Solution, Intravenous:

Generic: 5 mEq (250 mL); 10 mEq (500 mL, 1000 mL); 20 mEq (1000 mL); 30 mEq (1000 mL); 40 mEq (1000 mL); 0.4 mEq/mL (50 mL); 10 mEq/100 mL (100 mL); 10 mEq/50 mL (50 mL); 20 mEq/100 mL (100 mL); 20 mEq/50 mL (50 mL); 30 mEq/100 mL (100 mL [DSC]); 40 mEq/100 mL (100 mL); 2 mEq/mL (5 mL, 10 mL, 15 mL [DSC], 20 mL, 30 mL, 250 mL); 20 mEq/L (1000 mL); 40 mEq/L (1000 mL)

Solution, Oral:

K-Sol: 20 mEq/15 mL (10%) (473 mL) [alcohol free, dye free, sugar free; contains methylparaben, propylene glycol, propylparaben, saccharin sodium]

K-Sol: 40 mEq/15 mL (20%) (473 mL) [alcohol free, sugar free; contains fd&c red #40, saccharin sodium, sodium benzoate]

Generic: 20 MEQ/15ML (10%) (30 mL); 20 mEq/15 mL (10%) (15 mL, 30 mL, 473 mL, 3800 mL); 40 mEq/15 mL (20%) (473 mL)

Tablet Extended Release, Oral:

K-Tab: 8 mEq, 10 mEq [contains fd&c yellow #10 (quinoline yellow)]

K-Tab: 20 mEq

Klor-Con: 8 mEq [contains fd&c blue #1 aluminum lake, fd&c blue #2 aluminum lake]

Klor-Con 10: 10 mEq [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Klor-Con M10: 10 mEq

Klor-Con M15: 15 mEq [scored]

Klor-Con M20: 20 mEq [scored]

Generic: 8 mEq, 10 mEq, 20 mEq

Brand Names: U.S.

  • K-Sol
  • K-Tab
  • K-Vescent [DSC]
  • Klor-Con
  • Klor-Con 10
  • Klor-Con M10
  • Klor-Con M15
  • Klor-Con M20
  • Klor-Con Sprinkle
  • Micro-K

Pharmacologic Category

  • Electrolyte Supplement, Oral
  • 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

Absorption

Well absorbed from upper GI tract

Distribution

Enters cells via active transport from extracellular fluid

Excretion

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

Use: Labeled Indications

Treatment or prevention of hypokalemia

Contraindications

Hypersensitivity to any component of the formulation; hyperkalemia, renal failure, and conditions in which potassium retention is present. In addition, solid oral dosage forms are contraindicated in patients in whom there is a structural, pathological, and/or pharmacologic cause for delay or arrest in passage through the GI tract.

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 in patients undergoing ECG monitoring. Doses expressed as mEq of potassium.

Normal daily requirements: Oral, IV: 40-80 mEq/day

Prevention of hypokalemia: Oral: 20-40 mEq/day in 1-2 divided doses

Treatment of hypokalemia:

Oral:

Mild to moderate hypokalemia: Note: If deficits are severe or ongoing losses are great, IV route should be considered.

Manufacturer’s labeling: Usual dose: 40 to 100 mEq daily in divided doses; limit single doses to 20 to 25 mEq/dose to avoid GI discomfort.

Alternate dosing: Some clinicians initiate treatment with 10 to 20 mEq given 2 to 4 times per day (20 to 80 mEq/day), depending upon the severity of the hypokalemia. Total daily doses up to 120 mEq may be necessary as determined by laboratory assessment, patient symptoms and/or ongoing losses (Brophy, 2014).

Severe hypokalemia: Some clinicians initiate treatment with 40 mEq given 3 to 4 times per day; may also administer 20 mEq every 2 to 3 hours in conjunction with IV potassium administration with careful monitoring.

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.

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.

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 in patients undergoing ECG monitoring. Doses expressed as mEq of potassium.

Normal daily requirements: Oral, IV: 1-2 mEq/kg/day

Prevention of hypokalemia: Oral: 1-2 mEq/kg/day in 1-2 divided doses

Treatment of hypokalemia:

Oral: 1-2 mEq/kg initially, then as needed based on frequently obtained lab values. If deficits are severe or ongoing losses are great, IV route should be considered.

IV intermittent infusion: 0.5-1 mEq/kg/dose (maximum dose: 40 mEq). If infusion exceeds 0.5 mEq/kg/hour, physician should be at bedside and patient should have continuous ECG monitoring; repeat as needed based on frequently obtained lab values.

Dosing: Renal Impairment

There are no specific dosage adjustments provided in the manufacturer’s labeling. Reduce initial dose by at least 50% in patients with renal impairment (Kraft 2005).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

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

Parenteral: Potassium must be diluted prior to parenteral administration. Do not administer IV push. In general, the dose, concentration of infusion and 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). Concentrations and rates of infusion may be greater with central line administration. 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 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).

Oral: Oral dosage forms should be taken with meals and a full glass of water or other liquid to minimize the risk of GI irritation. Prescribing information for the various oral preparations recommend that no more than 20 mEq or 25 mEq should be given as single dose.

Capsule: MicroK: Swallow whole, do not chew. Capsules may also be opened and contents sprinkled on a spoonful of applesauce or pudding and should be swallowed immediately without chewing.

Powder: Klor-Con: Dissolve one packet in 4-5 ounces of water or other beverage prior to administration.

Tablet:

K-Tab, Kaon-Cl, Klor-Con: Swallow tablets whole; do not crush, chew, or suck on tablet.

Klor-Con M: Swallow tablets whole; do not crush, chew, or suck on tablet. Tablet may also be broken in half and each half swallowed separately; the whole tablet may be dissolved in ~4 ounces of water (allow ~2 minutes to dissolve, stir well and drink immediately)

Dietary Considerations

Administer with plenty of fluid to decrease stomach irritation and discomfort. Some dietary sources of potassium include leafy green vegetables (eg, spinach, cabbage), tomatoes, cucumbers, zucchini, fruits (eg, apples, oranges, and bananas), root vegetables (eg, carrots, radishes), beans, and peas.

Compatibility

Stable in D5LR, D51/4NS, D51/2NS, D5NS, D5W, D10W, D20W, LR, 1/2NS, NS.

Y-site administration: Incompatible with amphotericin B cholesteryl sulfate complex, azithromycin, diazepam, ergotamine, phenytoin.

Compatibility in syringe: Incompatible with dimenhydrinate.

Storage

Capsule: MicroK: Store between 20°C to 25°C (68°F to 77°F).

Powder for oral solution: Klor-Con: Store at room temperature of 15°C to 30°C (59°F to 86°F).

Solution for injection: Store at 25°C (77°F); do not freeze; avoid excessive heat. Use only clear solutions. When admixed in most common infusion solutions (D5LR, D51/4NS, D51/2NS, D5NS, D5W, D10W, D20W, LR, 1/2NS, NS), potassium chloride is stable indefinitely (ie, until the labeled expiration date of the infusion solution).

Tablet: K-Tab: Store below 30°C (86°F).

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

Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

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

Glycopyrrolate (Systemic): May enhance the adverse/toxic effect of Potassium Chloride. This is specific to solid oral dosage forms of potassium chloride. Avoid combination

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.

Dermatologic: Rash

Endocrine & metabolic: Hyperkalemia

Gastrointestinal: Abdominal pain/discomfort, diarrhea, flatulence, GI bleeding (oral), GI obstruction (oral), GI perforation (oral), nausea, vomiting

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, ACEI, potassium-sparing diuretics, potassium containing salt substitutes).

Dosage form specific issues:

• Oral formulations: May cause GI upset (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation, and/or obstruction. Oral liquid preparations (not solid) should be used in patients with esophageal compression or delayed gastric emptying.

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. Avoid administering potassium diluted in dextrose solutions during initial therapy; potential for transient decreases in serum potassium due to intracellular shift of potassium from dextrose-stimulated insulin release.

Monitoring Parameters

Serum potassium, chloride, magnesium (to facilitate potassium repletion), 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

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). Potassium supplementation (that does not cause maternal hyperkalemia) would not be expected to cause adverse fetal events.

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?)

• Patient may experience diarrhea, flatulence, or tablet wax in stool. Have patient report immediately to prescriber signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling), severe constipation, severe nausea, severe vomiting, abdominal edema, black, tarry, or bloody stools, vomiting blood, severe abdominal pain, or injection site irritation (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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