Adult: Dose and rate of administration are dependent upon the patient’s ECG and serum K levels. Recommended administration rates: Peripheral or central line infusion: ≤10 mEq/hour. Central line infusion: >10 mEq/hour, guided by continuous ECG monitoring and frequent serum K determination. Administer doses as a dilute solution via slow IV infusion. Dosage and infusion rate recommendations may vary in the country of use (refer to specific local treatment guidelines).
Oral Hypokalaemia
Adult: Dosage is individualised and adjusted based on patient’s need and serum K levels. As extended-release tab/cap: Prophylaxis: Usual dose: 20 mEq daily. Treatment: Usual dose range: 40-100 mEq daily in divided doses. Max: 20 mEq/dose. As powder for oral solution: Prophylaxis: Usual dose: 20 mEq daily. Treatment: Usual dose range: 40-100 mEq daily in 2-5 divided doses. Max: 40 mEq/dose; 200 mEq daily. Child: Dosage is individualised and adjusted based on patient’s need and serum K levels. As powder for oral solution: Prophylaxis: Usual dose: 1 mEq/kg daily. Max: 3 mEq/kg daily. Treatment: Initially, 2-4 mEq/kg daily in divided doses. Max: 1 mEq/kg/dose or 40 mEq/dose (whichever is lower); 100 mEq daily.
Hepatic Impairment
Oral:
Cirrhosis: As powder for oral solution/extended-release tab: Initiate dose at the lower end of the dosing range.
Administration
Should be taken with food.
Reconstitution
Powder for oral solution: Dissolve the contents of 1 packet in at least 120 mL of cold water or other beverage before administration. IV infusion concentrate: Dilute with at least 50 times its volume of 0.9% NaCl infusion or other suitable diluent and mixed thoroughly prior to administration. Do not administer undiluted or via IV push or rapid IV infusion.
Contraindications
Hyperkalaemia, hyperchloraemia, predisposing conditions for hyperkalaemia (e.g. acute dehydration, systemic acidosis, extensive burns or tissue injury); adrenal insufficiency (e.g. Addison’s disease), heat cramps, renal failure, renal impairment with oliguria, anuria or azotaemia; plasma-K concentration >5 mEq/L. Tab/cap: Structural, pathological (e.g. diabetic gastroparesis), and/or pharmacologic (e.g. use of anticholinergics) cause for arrest or delay in gastrointestinal passage. Severe renal impairment. Concomitant use with K-sparing diuretics.
Special Precautions
Patient with acid-base alterations or correction; CV disease (e.g. heart failure, cardiac arrhythmias, atrioventricular block), cirrhosis. Avoid extravasation (IV). Hepatic and mild to moderate renal impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: IV infusion: Hypersensitivity/infusion reactions (e.g. anaphylaxis, chills), hyponatraemia. Oral: Gastrointestinal irritation (oral solution); ulcerative and/or stenotic lesions of the gastrointestinal tract (tab/cap). Gastrointestinal disorders: Nausea, vomiting, flatulence, abdominal pain or discomfort, diarrhoea; gastrointestinal haemorrhage, ulceration, perforation (tab/cap). Metabolism and nutrition disorders: Hypervolaemia. Injury, poisoning and procedural complications: Inj site reactions (e.g. pain, phlebitis, venous thrombosis). Potentially Fatal: Hyperkalaemia.
Closely monitor serum K concentrations and other electrolyte levels (e.g. serum Ca, chloride, Mg, phosphate, Na), acid-base balance, renal function, IV infusion rate, cardiac, clinical and fluid status prior to initiation and regularly during treatment. Perform ECG monitoring regularly.
Overdosage
Symptoms: Paraesthesia of the extremities, listlessness, mental confusion, cold skin, grey pallor, weakness or heaviness of the legs, flaccid paralysis, peripheral vascular collapse, fall in blood pressure, cardiac arrhythmias, heart block, and extremely high plasma K concentration (8-11 mEq/L) causing cardiac depression, arrhythmias or arrest. Management: Discontinue K chloride, other agents and foods with K or which increases serum K levels. Correct serum K levels and acid-base balance. May administer Ca gluconate (except in patients on digitalis) to reduce cardiac effects. May give IV infusion of 300-500 mL/hour 10% glucose solutions containing up to 10 units of insulin for each 20 g of glucose to reduce serum K levels. May administer IV Na bicarbonate to correct acidosis, if present. Continuously monitor ECG for arrhythmias and electrolyte changes especially serum K levels.
Drug Interactions
May increase the risk of hyperkalaemia with ACE inhibitors, angiotensin II receptor antagonists, ciclosporin, aliskiren. May enhance the antiarrhythmic effects of quinidine. May cause K retention with NSAIDs. May enhance the ulcerogenic effect of solid oral dosage forms of K chloride with anticholinergic agents. May cause further decrease in plasma K concentration with glucose infusion (IV). Potentially Fatal: Increased risk of severe hyperkalaemia with K-sparing diuretics (e.g. spironolactone, amiloride, triamterene).
Food Interaction
May increase the risk of hyperkalaemia with K-rich foods.
Action
Description: Mechanism of Action: Potassium chloride is a major cation of intracellular fluid. It is essential in physiological processes, including conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, carbohydrate metabolism, acid-base balance, and gastric secretion. Pharmacokinetics: Absorption: Well and readily absorbed from gastrointestinal tract. Distribution: Distributed into cells via active transport from extracellular fluid. Excretion: Mainly via urine; faeces and sweat (small amounts).
Chemical Structure
Potassium chloride Source: National Center for Biotechnology Information. PubChem Database. Potassium chloride, CID=4873, https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-chloride (accessed on Jan. 23, 2020)
Storage
Store between 20-25°C. Protect from light and moisture.
B05XA01 - potassium chloride ; Belongs to the class of electrolyte solutions used in I.V. solutions. A12BA01 - potassium chloride ; Belongs to the class of potassium-containing preparations. Used as dietary supplements.
References
Anon. Potassium Chloride. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/06/2020.Anon. Potassium Supplements. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 04/06/2020.Buckingham R (ed). Potassium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/06/2020.Joint Formulary Committee. Potassium Chloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/06/2020.K-Lyte 600 mg Tablet (Euro Generics International Philippines, Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 14/07/2020.K-Tab Tablet, Film Coated, Extended Release (AbbVie Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2020.Klor-Con Sprinkle Capsule, Extended Release (Upsher-Smith Laboratories, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2020.Potassium Chloride 15% w/v Concentrate for Solution for Infusion (Noridem Enterprises Ltd.). MHRA. https://products.mhra.gov.uk/. Accessed 04/06/2020.Potassium Chloride Concentrate 15% (Hameln Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk/. Accessed 04/06/2020.Potassium Chloride Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 14/07/2020.Potassium Chloride Powder, for Solution (Virtus Pharmaceuticals. DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2020.
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