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Potassium Phosphate

Medically reviewed by Drugs.com. Last updated on Jul 9, 2020.

Pronunciation

(poe TASS ee um FOS fate)

Index Terms

  • Phosphate, Potassium
  • Potassium Acid Phosphate
  • Potassium Phosphate Monobasic

Dosage Forms

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

Injection, solution:

Generic: Potassium 4.4 mEq and phosphorus 3 mmol per mL (5 mL) [equivalent to potassium 170 mg and elemental phosphorus 93 mg per mL]; potassium 4.7 mEq and phosphorus 3 mmol per mL (15 mL) [equivalent to potassium 184 mg and phosphorous 93 mg per mL]

Tablet, Oral:

K-Phos: 500 mg [scored]

Brand Names: U.S.

  • K-Phos

Pharmacologic Category

  • Electrolyte Supplement, Parenteral
  • Urinary Acidifying Agent

Pharmacology

Phosphorus in the form of organic and inorganic phosphate has a variety of important biochemical functions in all organs and tissues, including critical roles in nucleic acid structure, energy storage and transfer, cell signaling, cell membrane composition and structure, acid-base balance, mineral homeostasis, and bone mineralization.

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

Oral: Well absorbed from upper GI tract

Distribution

Enters cells via active transport from extracellular fluid; ~85% of serum phosphates is free and ultra-filterable.

Excretion

Primarily urine (>80% to 90% of dose reabsorbed by the kidney); skin and feces (small amounts)

Protein Binding

15%.

Use: Labeled Indications

Injection: Treatment and prevention of hypophosphatemia in adult and pediatric patients ≥12 years of age; nutritional supplementation to prevent hypophosphatemia in patients receiving parenteral nutrition in adults weighing ≥45 kg and pediatric patients ≥12 years of age weighing ≥40 kg. Note: The concomitant amount of potassium must be calculated into the total electrolyte content. In general, for each 1 mmol of phosphate, ~1.5 mEq of potassium will be administered. Therefore, if ordering 30 mmol of potassium phosphate, the patient will receive ~45 mEq of potassium.

Oral: To acidify the urine to lower urinary calcium concentrations; reduce odor and rash caused by ammonia in urine; to increase the antibacterial activity of methenamine.

Contraindications

Hyperphosphatemia and hyperkalemia. In general, severe renal impairment (eGFR <30 mL/minute/1.73 m2) and end-stage renal disease; if used in this population, use with caution and at lower doses and more frequent monitoring.

Injection: Hypercalcemia or significant hypocalcemia.

Oral: Infected phosphate stones.

Dosing: Adult

Acute treatment of hypophosphatemia:

Note: If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Concentration and dosing are different from FDA-approved products; use caution when switching between products. Refer to Sodium Glycerophosphate Pentahydrate monograph.

Caution: The concomitant amount of potassium must be calculated into the total electrolyte content. For each 1 mmol of phosphate, ~1.5 mEq of potassium will be administered. Therefore, if ordering 30 mmol of potassium phosphate, the patient will receive ~45 mEq of potassium. With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Doses listed as mmol of phosphate.

Repletion of severe hypophosphatemia should be treated with IV phosphate as large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Reserve intermittent IV infusion for severe depletion situations; may require continuous cardiac monitoring depending on potassium administration rate. Guidelines differ based on degree of illness, need/use of parenteral nutrition, and severity of hypophosphatemia. If potassium >4.0 mEq/L consider phosphate replacement strategy without potassium (eg, sodium phosphates). Patients with severe renal impairment were excluded from phosphate supplement trials. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate.

General replacement guidelines (Kraft 2005): Note: For initial or single doses in symptomatic patients; some patients may require lower or higher dose based on clinical presentation and renal function. Additional phosphate repletion can be given until the patient is asymptomatic or the phosphate level is >2 mg/dL. High variability exists in dosing/infusion rate recommendations; therapy guided by patient condition and specific institutional guidelines.

IV:

Low dose, serum phosphate level 2.3 to 2.7 mg/dL: Initial: 0.08 to 0.16 mmol/kg over 4 to 6 hours.

Intermediate dose, serum phosphate level 1.5 to 2.2 mg/dL: Initial: 0.16 to 0.32 mmol/kg over 4 to 6 hours.

High dose, serum phosphate level <1.5 mg/dL: Initial: 0.32 to 0.64 mmol/kg over 4 to 6 hours.

Obesity: May use adjusted body weight for patients weighing >130% of IBW (and BMI <40 kg/m2) by using (IBW + 0.25 [actual body weight − IBW]) (Brown 2006).

Critically ill adult patients receiving concurrent enteral/parenteral nutrition (Brown 2006; Clark 1995): Note: Round doses to the nearest 7.5 mmol for ease of preparation. If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition.

IV:

Low dose, serum phosphate level 2.3 to 3 mg/dL: Initial: 0.16 to 0.32 mmol/kg over 4 to 6 hours.

Intermediate dose, serum phosphate level 1.6 to 2.2 mg/dL: Initial: 0.32 to 0.64 mmol/kg over 4 to 6 hours.

High dose, serum phosphate <1.5 mg/dL: Initial: 0.64 to 1 mmol/kg over 8 to 12 hours.

Obesity: May use adjusted body weight for patients weighing >130% of IBW (and BMI <40 kg/m2) by using (IBW + 0.25 [actual body weight − IBW]) (Brown 2006).

Parenteral nutrition: IV: 10 to 15 mmol/1,000 kcal (Hicks 2001) or 20 to 40 mmol/24 hours (Mirtallo 2004 [ASPEN guidelines]).

Urine acidification: Oral: 1,000 mg 4 times daily.

Dosing: Geriatric

Use with caution due to increased risk of renal impairment in the elderly. Refer to adult dosing.

Dosing: Pediatric

Note: If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Concentration and dosing are different from FDA approved products; use caution when switching between products. Refer to Sodium Glycerophosphate Pentahydrate monograph.

Caution: The concomitant amount of potassium must be calculated into the total electrolyte content. Each 1 mmol of phosphate provides ~1.5 mEq of potassium. With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate.

Hypophosphatemia, acute treatment: Repletion of severe hypophosphatemia should be treated with IV phosphate since large doses of oral phosphate may cause diarrhea and intestinal absorption may be unreliable. Reserve intermittent IV infusion for severe depletion situations; may require continuous cardiac monitoring depending on potassium administration rate. Guidelines differ based on degree of illness, need/use of TPN, and severity of hypophosphatemia. If hyperkalemia exists, consider phosphate replacement strategy without potassium (eg, sodium phosphates).

IV doses may be incorporated into the patient's maintenance IV fluids; intermittent IV infusion should be reserved for severe depletion situations; requires continuous cardiac monitoring. Note: Doses listed as mmol of phosphate.

Children and Adolescents: Note: Dose based on actual body weight; if patient is significantly above ideal body weight, consider using an adjusted body weight for dosing. The regimens below have only been studied in adult patients; however, many institutions have used them in children safely and successfully (ASPEN [Corkins 2015]). Patients with severe renal impairment were excluded from adult phosphate supplement trials.

General replacement guidelines (including ICU patients) (Kraft 2005): Note: The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia and lowered by 25% to 50% if the patient is hypercalcemic (Lentz 1978).

Low dose: 0.08 to 0.16 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 2.7 mg/dL.

Intermediate dose: 0.16 to 0.32 mmol/kg over 4 to 6 hours; use if serum phosphorus level 1.5 to 2.2 mg/dL.

High dose: 0.32 to 0.64 mmol/kg over 4 to 6 hours; use if serum phosphorus <1.5 mg/dL.

Patients receiving TPN (Clark 1995):

Low dose: 0.16 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 3 mg/dL (0.73 to 0.96 mmol/L).

Intermediate dose: 0.32 mmol/kg over 4 to 6 hours; use if serum phosphorus level 1.6 to 2.2 mg/dL (0.51 to 0.72 mmol/L).

High dose: 0.64 mmol/kg over 8 to 12 hours; use if serum phosphorus <1.5 mg/dL (<0.5 mmol/L).

Critically ill adult trauma patients receiving TPN (Brown 2006):

Low dose: 0.32 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 3 mg/dL (0.73 to 0.96 mmol/L).

Intermediate dose: 0.64 mmol/kg over 4 to 6 hours; use if serum phosphorus level 1.6 to 2.2 mg/dL (0.51 to 0.72 mmol/L).

High dose: 1 mmol/kg over 8 to 12 hours; use if serum phosphorus <1.5 mg/dL (<0.5 mmol/L).

Parenteral nutrition, maintenance phosphorus requirement (ASPEN [Mirtallo 2004]):

Infants and Children ≤50 kg: IV: 0.5 to 2 mmol/kg/day of phosphorus as an additive to parenteral nutrition solution.

Children >50 kg and Adolescents: IV: 10 to 40 mmol/day of phosphorus as an additive to parenteral nutrition solution.

Dosing: Obesity

Refer to indication-specific dosing for obesity-related information (may not be available for all indications).

Reconstitution

Injection solution must be diluted in appropriate IV solution and volume prior to administration. In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition and specific institution policy. Intermittent infusion doses of potassium phosphate are typically prepared in 100 to 250 mL of NS or D5W (usual phosphate concentration range: 0.15 to 0.6 mmol/mL) (Charron 2003; Rosen 1995). Preparation for administration may vary; refer to individual product labeling and institutional protocols for details.

Suggested maximum concentrations:

Central line administration: 18 mmoL potassium phosphate/100 mL (28.2 mEq potassium/100 mL).

Peripheral line administration: 6.4 mmoL potassium phosphate/100 mL (10 mEq potassium/100 mL).

Observe the vial for the presence of translucent visible particles. Do not use vial if particles are present.

Administration

IV: Injection must be diluted in appropriate IV solution and volume prior to administration; do not administer IV push. In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition/indication and specific institution policy. Must consider administration precautions for phosphate and potassium when prescribing.

For patients with severe symptomatic hypophosphatemia (ie, <1.5 mg/dL), may administer at rates up to 15 mmol phosphate/hour (this rate will deliver potassium at 22.5 mEq/hour) (Charron 2003). The maximum rate of administration for peripheral infusion is ~6.4 mmol phosphate per hour (potassium 10 mEq/hour). The maximum rate for central administration is ~15 mmol phosphate per hour (potassium 23.5 mEq/hour). In patients with renal dysfunction and/or less severe hypophosphatemia, slower administration rates (eg, over 4 to 6 hours) or oral repletion is recommended. Potassium infusion rates >10 mEq/hour should be administered via central line (minimizes burning and phlebitis). ECG monitoring is recommended for potassium infusions >10 mEq/hour.

Vesicant/irritant (may depend on concentration); 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; Reynolds 2014); elevate extremity.

Hyaluronidase: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 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).

Oral: Administer at mealtime and at bedtime. Dissolve tablets in 6 to 8 oz of water prior to administration to avoid GI injury. For best results, soak tablets in water for at least 2 to 5 minutes and stir. If any tablet particles remain undissolved, crush and stir vigorously to speed dissolution.

Dietary Considerations

Phosphorous:

Dietary adequate intake (AI) (IOM 1997):

1 to 6 months: 3.2 mmol/day (100 mg/day).

7 to 12 months: 8.9 mmol/day (275 mg/day).

Dietary recommended daily allowance (RDA) (IOM 1997):

1 to 3 years: 14.8 mmol/day (460 mg/day).

4 to 8 years: 16.1 mmol/day (500 mg/day).

9 to 18 years: 40.3 mmol/day (1,250 mg/day).

Storage

Injection:

Store intact vials at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F).

CMP Pharma (manufacturer): Store at 2°C to 8°C (36°F to 46°F). Do not freeze. After dilution, solution is stable for 48 hours under refrigeration at 2°C to 8°C (36°F to 46°F) or at room temperature from 20°C to 25°C (68°F to 77°F).

Use parenteral nutrition solution promptly after mixing; may store admixture under refrigeration from 2°C to 8°C (36°F to 46°F) no longer than 24 hours. After removal from refrigeration, bring to room temperature and use promptly and complete the infusion within 24 hours. Discard any remaining admixture. Protect from light.

Oral: Store at 20°C to 25°C (68°F to 77°F).

Drug Interactions

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

Alpha-/Beta-Agonists (Indirect-Acting): Urinary Acidifying Agents may decrease the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Amantadine: Urinary Acidifying Agents may decrease the serum concentration of Amantadine. Monitor therapy

Amphetamines: Urinary Acidifying Agents may decrease the serum concentration of Amphetamines. 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

Antacids: May decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Consider therapy modification

Burosumab: Phosphate Supplements may enhance the adverse/toxic effect of Burosumab. Avoid combination

Calcium Salts: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Consider therapy modification

ChlorproPAMIDE: Urinary Acidifying Agents may increase the serum concentration of ChlorproPAMIDE. Monitor therapy

Drospirenone: Potassium Salts may enhance the hyperkalemic effect of Drospirenone. 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

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). 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

Iron Preparations: May decrease the absorption of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral iron preparation as possible to minimize the significance of this interaction. Exceptions: Ferric Carboxymaltose; Ferric Derisomaltose; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Consider therapy modification

Magnesium Salts: May decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Consider therapy modification

Mecamylamine: Urinary Acidifying Agents may decrease the serum concentration of Mecamylamine. Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an iron-containing oral multivitamin as possible to minimize the significance of this interaction. Consider therapy modification

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. Management: Avoid coadministration of a potassium-sparing diuretic and a potassium salt. This combination should only be used in cases of significant hypokalemia, and only if serum potassium can be closely monitored. Consider therapy modification

Salicylates: Potassium Phosphate may increase the serum concentration of Salicylates. Monitor therapy

Sucralfate: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Administering oral phosphate supplements at least 2 hours before sucralfate may reduce the significance of the interaction. Consider therapy modification

Adverse Reactions

Frequency not defined:

Cardiovascular: Bradycardia, cardiac arrhythmia, chest pain, ECG changes, edema, heart block, hypotension, localized phlebitis (IV), prolonged QT interval on ECG

Endocrine & metabolic: Decreased serum magnesium, hyperkalemia, hyperphosphatemia, hypocalcemia

Gastrointestinal: Diarrhea, nausea, stomach pain, vomiting

Genitourinary: Decreased urine output

Nervous system: Confusion, lethargy, paralysis, paresthesia, seizures

Neuromuscular & skeletal: Asthenia, tetany (with large doses of phosphate)

Renal: Acute renal failure

Respiratory: Dyspnea

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Vesicant/irritant (may depend on concentration); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.

• Hyperkalemia: Severe hyperkalemia may occur and may cause life-threatening cardiac events, especially when administered in excessive doses, undiluted, or by rapid IV infusion. This risk is increased in patients with severe renal impairment and end-stage renal disease (ESRD), severe adrenal insufficiency or cardiac disease, and in patients who are receiving other drugs that increase the risk of hyperkalemia. Do not exceed the maximum daily amount of potassium or the recommended infusion rate; continuous ECG monitoring may be needed during infusion. 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).

• Hyperphosphatemia: May occur with administration, especially in patients with renal impairment or higher doses; may lead to hypocalcemia and associated symptoms (eg, neurological irritability with tetany), nephrocalcinosis with acute kidney injury and more rarely, cardiac irritability with arrhythmias.

• Hypomagnesemia: May cause a decrease in serum magnesium (and calcium) concentrations when administered to patients with hypercalcemia and diabetic ketoacidosis.

• Laxative effect: A mild laxative effect may occur with oral use within the first few days of therapy; if the laxative effect persists to a self-limiting degree, consider reducing the dose or discontinue use until diarrhea improves.

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.

• Adrenal insufficiency: Use with caution in patients with severe adrenal insufficiency (eg, Addison disease); adrenal insufficiency requires close monitoring of serum potassium and phosphorus concentrations to avoid hyperkalemia and/or hyperphosphatemia.

• 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.

• Dehydration: Use with caution in patients with acute dehydration.

• Myotonia congenita: Use with caution in patients with myotonia congenita.

• Pancreatitis: Use with caution in patients with acute pancreatitis.

• Parathyroid disease: Use with caution in patients with hypoparathyroidism.

• Renal calculi: Patients with renal calculi may pass preformed stones when phosphate therapy is initiated.

• Renal impairment: Use with caution in patients with renal impairment; renal impairment requires close monitoring of serum potassium and phosphorus concentrations to avoid hyperkalemia and/or hyperphosphatemia. In general, use is contraindicated in patients with severe renal impairment and ESRD; if used in this population, use with caution and at lower doses and more frequent monitoring. In patients with moderate renal insufficiency (eGFR ≥30 to <60 mL/minute/1.73 m2), start at lower end of dosing range and monitor potassium and other electrolytes more frequently.

• Rickets: Use with caution in patients with rickets; may increase the risk of extraskeletal calcification.

• Tissue breakdown: Use with caution in patients with extensive tissue breakdown (eg, severe burns).

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

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). Exposure to aluminum from injection is not more than 4.9 mcg/kg/day for parenteral nutrition when adults ≥45 kg are administered the recommended maximum dose (45 mmol/day) or pediatric patients ≥12 years of age and ≥40 kg are administered the recommended maximum dose (40 mmol/day) according to the CMP Pharma product labeling.

• Oral administration: Tablets should be dissolved completely in water prior to administration to avoid GI injury due to administration of a concentrated potassium salt preparation.

• Parenteral administration: Use extreme caution when administering potassium phosphate parenterally; evaluate patient's renal function, cardiac and fluid status, and any factors contributing to altered potassium concentrations (eg, acid-base disorders) prior to therapy. Parenteral potassium must be diluted and administered in IV fluids or used as an admixture in parenteral nutrition; not for direct IV infusion which may cause vein irritation, damage, and/or thrombosis. Avoid undiluted, bolus or rapid IV administration; single doses of IV phosphate ≥50 mmol (adults) and/or rapid infusion rates (over 1 to 3 hours) have resulted in death, cardiac arrest, cardiac arrhythmia (including QT prolongation), hyperkalemia, hyperphosphatemia, hypotension, and seizures. Administration of undiluted or insufficiently diluted potassium phosphate (ie, IV push) has resulted in cardiac arrest, cardiac arrhythmias, hypotension, and death.

• Precipitates: Periodically inspect solution, infusion set, and catheter for precipitates. Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported in admixed products containing calcium and phosphates, or parenteral nutrition. If signs of pulmonary distress occur, stop the infusion.

Monitoring Parameters

IV: Serum potassium, calcium, phosphorus, 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 and phosphorus levels 2 to 4 hours after dose; renal function

Oral: Serum potassium, phosphorus, and calcium; renal function; serum salicylate concentration (in patients taking concomitant salicylates)

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted. Phosphorus requirements are the same in pregnant and nonpregnant women (IOM 1997). Although this product is not used for potassium supplementation, 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, preeclampsia; may be more likely to develop hyperkalemia) (IOM 2004).

Patient Education

What is this drug used for?

Injection:

• It is used to treat or prevent low phosphate levels.

Tablets:

• It is used to lower the urine's pH.

• It may be given to you for other reasons. Talk with the doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Abdominal pain

• Diarrhea

• Nausea

• Vomiting

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• High potassium like abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, or numbness or tingling feeling

• Low calcium like muscle cramps or spasms, numbness and tingling, or seizures

• Low magnesium like mood changes; muscle pain or weakness; muscle cramps or spasms; seizures; tremors; lack of appetite; severe nausea or vomiting; or an abnormal heartbeat

• Kidney stone like back pain, abdominal pain, or blood in your urine

• Injection site redness, burning, pain, swelling, or leaking of fluid

• Bone pain

• Joint pain

• Feeling of heaviness in arms or legs

• Not able to move

• Chest pain

• Trouble urinating

• Change in amount of urine passed

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

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