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Chemistry – Potassium chloride occurs as either white, granular powder or as colorless, elongated, prismatic or cubical crystals. It is odorless and has a saline taste. One gram is soluble in about 3 ml of water and is insoluble in alcohol. The pH of the injection ranges from 4-8. One gram of potassium chloride contains 13.4 mEq of potassium. A 2 mEq/ml solution has an osmolarity of 4000 mOsm/L. Potassium chloride may also be known as KCl.
Potassium gluconate occurs as white to yellowish white, crystalline powder or granules. It is odorless and has a slightly bitter taste and is freely soluble in water. One gram of potassium gluconate contains 4.3 mEq of potassium.
Storage/Stability/Compatibility – Potassium gluconate oral products should be stored in tight, light resistant containers at room temperature (15-30°C), unless otherwise instructed by the manufacturer. Unless otherwise directed by the manufacturer, potassium chloride products should be stored in tight, containers at room temperature (15-30°C); protect from freezing.
Potassium chloride for injection is reportedly compatible with the following intravenous solutions and drugs (as an additive): All commonly used intravenous replacement fluids (not 10% fat emulsion), aminophylline, amiodarone HCl, bretylium tosylate, calcium gluconate, carbenicillin disodium, cephalothin sodium, cephapirin sodium, chloramphenicol sodium succinate, cimetidine HCl, clindamycin phosphate, corticotropin (ACTH), cytarabine, dimenhydrinate, dopamine HCl, erythromycin gluceptate/lactobionate, heparin sodium, hydrocortisone sodium succinate, isoproterenol HCl, lidocaine HCl, metaraminol bitartrate, methicillin sodium, methyldopate HCl, metoclopramide HCl, nafcillin sodium, norepinephrine bitartrate, oxacillin sodium, oxytetracycline HCl, penicillin G potassium, phenylephrine HCl, piperacillin sodium, sodium bicarbonate, tetracycline HCl, thiopental sodium, vancomycin HCl, verapamil HCl, and vitamin B-complex with C.
Potassium chloride for injection compatibility information conflicts or is dependent on diluent or concentration factors with the following drugs or solutions: fat emulsion 10%, amikacin sulfate, dobutamine HCl, methylprednisolone sodium succinate (at Y-site), penicillin G sodium, and promethazine HCl (at Y-site). Compatibility is dependent upon factors such as pH, concentration, temperature and diluents used. It is suggested to consult specialized references (e.g., Handbook on Injectable Drugs by Trissel; see bibliography) for more specific information.
Potassium chloride for injection is reportedly incompatible with the following solutions or drugs: amphotericin B, diazepam (at Y-site), and phenytoin sodium (at Y-site).
Pharmacology – Potassium is the principal intracellular cation in the body. It is essential in maintaining cellular tonicity; nerve impulse transmission; smooth, skeletal and cardiac muscle contraction; and maintenance of normal renal function. Potassium is also used in carbohydrate utilization and in protein synthesis.
Uses/Indications – Potassium supplementation is used to prevent or treat potassium deficits. When feasible and appropriate, oral or nutritional therapy is generally preferred over parenteral potassium administration, because it is generally safer.
Pharmacokinetics – Potassium is primarily (80-90%) excreted via the kidneys with the majority of the remainder excreted in the feces. Very small amounts may be excreted in perspiration (in animals with sweat glands).
Contraindications/Precautions – Potassium salts are contraindicated in patients with hyperkalemia, renal failure or severe renal impairment, severe hemolytic reactions, untreated Addison’s disease, and acute dehydration. Solid oral dosage forms should not be used in patients where GI motility is impaired. Use cautiously in digitalized patients (see Drug Interactions).
Because potassium is primarily an intracellular electrolyte, serum levels may not adequately reflect the total body stores of potassium. Acid-base balance may also mask the actual potassium picture. Patients with systemic acidosis conditions may appear to have hyperkalemia when in fact they may be significantly low in total body potassium. Conversely, alkalosis may cause a falsely low serum potassium value. Assess renal and cardiac function prior to therapy and closely monitor serum potassium levels. Supplementation should generally occur over 3-5 days to allow equilibration to occur between extracellular and intracellular fluids. Some clinicians feel that if acidosis is present, use potassium acetate, citrate or bicarbonate; and if alkalosis is present, use potassium chloride.
Adverse Effects/Warnings – The major problem associated with potassium supplementation is the development of hyperkalemia. Symptoms associated with hyperkalemia can range from muscular weakness and/or GI disturbances to cardiac conduction disturbances. Clinical symptoms can be exacerbated by concomitant hypocalcemia, hyponatremia, or acidosis. Intravenous potassium salts must be diluted before administering and given slowly (see Doses).
Oral therapy can cause GI distress and IV therapy may be irritating to veins.
Overdosage/Acute Toxicity – Fatal hyperkalemia may develop if potassium salts are administered too rapidly IV or if potassium renal excretory mechanisms are impaired. Symptoms associated with hyperkalemia are noted in the Adverse Effects section above. Treatment of hyperkalemia is dependent upon the cause and/or severity of the condition and can consist of: discontinuation of the drug with ECG, acid/base and electrolyte monitoring, glucose/insulin infusions, sodium bicarbonate, calcium therapy, and polystyrene sulfonate resin. It is suggested to refer to other references appropriate for the species being treated for specific protocols for treatment of hyperkalemia.
Drug Interactions – Potassium retention may occur when potassium is given with angiotensin converting enzyme inhibitors (e.g., captopril, enalapril) or with potassium-sparing diuretics (e.g., spironolactone). In patients with severe or complete heart block who are receiving digitalis therapy, potassium salts are not recommended to be used. Oral potassium given with non-steroidal antiinflammatory agents, or anticholinergic agents may increase the risk of gastrointestinal adverse effects occurring. Glucocorticoids, mineralocorticoids, or ACTH may cause increased renal losses of potassium.
Dogs & Cats:
a) Intravenous replacement: If animal has normal renal function, IV KCl not to exceed 0.5 mEq/kg/hr. Use IV replacement very cautiously in animals with impaired renal function or in those receiving potassium-sparing diuretics.
Subcutaneous replacement: If IV use is unfeasible or rapid correction is unnecessary, may add KCl to SQ fluids; do not exceed 30 mEq of potassium per liter.
Oral replacement: Potassium gluconate PO at a rate of 2.2 mEq per 100 calories of required energy intake or potassium gluconate elixir (20 mEq/ml) for dogs at 5 ml q8-12h PO. (Bell and Osborne 1986)
For hypokalemia in “downer” cows:
a) 80 g sodium chloride and 20 g potassium chloride in 10 liters of water PO via stomach tube. Provide a bucket containing similar solution for cow to drink and another containing fresh water. (Caple 1986)
a) 50 grams PO daily; 1 mEq/kg/hr IV drip. (Howard 1986)
Monitoring Parameters – Level and frequency of monitoring associated with potassium therapy is dependent upon the cause and/or severity of hypokalemia, acid/base abnormalities, renal function, and concomitant drugs administered or disease states and can include: 1) Serum potassium ; 2) Other electrolytes; 3) Acid/base status; 4) Glucose; 5) ECG; 6) CBC; 7) Urinalyses
Dosage Forms/Preparations/FDA Approval Status/Withholding Times –
There are several products for parenteral use that contain potassium; refer to the tables at the end of this section or individual proprietary veterinary products (e.g., Cal-Dextro® K— Fort Dodge) for additional information.
Potassium Gluconate Oral Powder Each 0.65 gram 4 oz (1/4 teaspoonful) contains 2 mEq of potassium; in 4 oz. containers Tumil-K ® (Daniels) (Rx)
Tumil-KCaplets® (Daniels); (Rx) Approved for use in dogs and cats.
Tumil-K Gel® (Daniels) (Rx) 5 oz/tube
Human-Approved Products: Not a complete list.
Potassium Chloride for Injection 2 mEq/ml in 250 & 500 ml; 10 mEq in 10 & 20 ml vials, syringes, & amps; 30 mEq in 14, 20, 30 & 100 ml vials and 20 ml syringes; 40 mEq in 20, 30, 50 & 100 ml vials, 20 ml amps and syringes; 60 mEq & 90 mEq in 30 ml vials. Must be diluted before administering. (Rx)
Potassium acetate for injection and potassium phosphate for injection (see previous monograph) are also available.
There are a multitude of human-labeled potassium salts for oral use available in several dosage forms; refer to human drug references for more information on these products.