Potassium Chloride

ADMINISTRATION ROUTES:

IV, PO, NG

ALTERNATIVE NAMES:

Chlorvescent, Slow K, Span K

ICU INDICATIONS:

1. Hypokalaemia

PRESENTATION AND ADMINISTRATION:

IV:

750 mg/10 mL (1 mmol/mL) vial

Add 10 - 20 mmol KCl to 100 mL compatible IV fluid and infuse over 1 hour via a central line. If fluid restriction is required, the same amount can be concentrated into 50 mL for administration by a central line only. Rates of up to 40 mmol/hr have been used via a central line for severe hypokalaemia (< 2 mmol/L) when cardiac arrhythmias were present.

When infused via a peripheral line, the maximum concentration is 40 mmol/L. The exception is 10 mmol in 100 mL sodium chloride 0.29% pre-mixed bags (isotonic solution). Consider whether oral or NG replacement is possible. For loop diuretic-induced hypokalaemia during treatment for hypervolaemia, consider addition of potassium-sparing diuretic (spironolactone).

When KCl has been added to IV fluids or when commercial preparations are opened, discard any solution not used within 24 hours. Do not use cloudy solutions.

Compatible with the following IV fluids: 0.9% sodium chloride, Hartmanns, 5%/10%/20% glucose, Glucose and sodium chloride

Store at room temperature

PO/NG:

• Chlorvescent effervescent tablets (each contains 14 mmol of potassium)
• Span K sustained release tablets (each contains 8 mmol of potassium)
• Oral liquid for children (containing 2 mmol/mL of potassium). Store in refrigerator. Discard one month after opening. Administer with feeds.

DOSAGE:

IV:

After cardiac surgery or in presence of arrhythmias:

For K < 4.0 mmol/L, give 20 mmol KCl

For K < 4.5 mmol/L, give 10 mmol KCl

For other hypokalaemic patients:

For K < 3.5 mmol/L, give 20 mmol KCl

For K < 4.0 mmol/L, give 10 mmol KCl

PO:

Dose 1 - 3 tablets according to requirements and response

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

Dose in renal replacement therapy

DOSAGE IN PAEDIATRICS:

See Starship Guidelines

*For maintenance treament of hypokalaemia:

Oral administration is the preferred route

PO:

2 mmol/kg/day given 4 - 6 hrly in divided doses with feeds

*Acute treament of symptomatic hypokalaemia:

IV:

0.5 mmol/kg over 1 hour & reassess

For central line administration:

Dilute to 1 mmol in 12.5 mL (80 mmol/L = 0.08 mmol/mL) with 0.9% sodium chloride, 5% glucose, or 10% glucose. Mix well.

For peripheral line administration:

Dilute 1 mmol in 25 mL (40 mmol/L = 0.04 mmol/mL) with 0.9% sodium chloride, 5% glucose, or 10% glucose. Mix well. Administer by slow IV infusion via Y injection port. Keep IV fluids running to ensure further dilution of potassium. Do NOT mix with other medicines, bloods or blood products.

CLINICAL PHARMACOLOGY:

Potassium is the major intracellular cation. Potassium ions participate in a number of essential physiological processes including the maintenance of intracellular tonicity, the transmission of nerve impulses, the contraction of cardiac, skeletal and smooth muscle and the maintenance of normal renal function. Serum potassium levels are a poor marker of total body stores of potassium with a low serum potassium more often reflecting redistribution rather than total body deficit. Both alkalosis and insulin will lower serum potassium by pushing the ion into cells.

CONTRAINDICATIONS:

1. Hyperkalaemia

WARNINGS:

In patients with impaired mechanisms for excreting potassium, the administration of potassium salts can produce hyperkalaemia and cardiac arrest.

PRECAUTIONS:

General:

Solid oral dosage forms of potassium chloride can produce ulcerative and/or stenotic lesions of the gastrointestinal tract.

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

None known

IMPORTANT DRUG INTERACTIONS IN ICU:

Simultaneous administration of ACE inhibitors or potassium sparing diuretics (spironolactone) with KCl may lead to hyperkalaemia.

ADVERSE REACTIONS:

Body as a Whole:

Hyperkalaemia

Gastrointestinal system (with oral preparations):

GI upset, ulcer, perforation, bleeding

Local:

Injection site pain