Drugs List

Therapeutic Indications

Uses

Source of phosphate ions in electrolyte replacement therapy
Source of potassium ions in electrolyte replacement therapy

Administration

For slow intravenous infusion following dilution in infusion fluid.

Contraindications

Hyperphosphatemia
Severe renal impairment
Urolithiasis

Precautions and Warnings

Acute pancreatitis
Adrenal insufficiency
Breastfeeding
Cardiac disorder
Dehydration
Diabetes mellitus
Hypoparathyroidism
Myotonia congenita
Osteomalacia
Pregnancy
Renal impairment
Rickets
Severe burn

Administer infusion slowly
Administer using controlled infusion device
Do not use if dispersion is not uniform after adequate mixing
Follow storage and handling guidelines
Must be diluted before use
Precipitate may form when phosphates added to calcium or magnesium solution
Rapid injection may be cardiotoxic
Evaluate renal function before and during treatment
Monitor ECG
Monitor serum electrolytes

National Patient Safety Agency (NPSA) Patient Safety Alert:

Potassium overdose can be rapidly fatal. The National Patient Safety Agency have recommended the withdrawal of concentrated potassium solutions from ward stock and the use of ready-made diluted infusion solutions. Arrangements for control and supply have also been suggested where the use of concentrated solutions is unavoidable, for example, in critical care areas (consult NPSA website www.npsa.nhs.uk)

Pregnancy and Lactation

Pregnancy

Potassium acid phosphate is contraindicated during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Potassium acid phosphate is contraindicated in breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anxiety
Bradycardia
Confusion
Convulsions
Dizziness
Fluid retention
Headache
Hyperkalaemia
Hypernatraemia
Hyperphosphataemia
Hypocalcaemia
Muscle cramps
Muscle weakness
Numbness
Oedema
Shortness of breath
Tetany
Thirst
Tingling sensation
Tiredness

Presentation

Sterile concentrate solution of potassium acid phosphate.

Drugs List

Therapeutic Indications

Uses

Source of phosphate ions in electrolyte replacement therapy
Source of potassium ions in electrolyte replacement therapy

Dosage

Consult latest NHS National Patient Safety Agency (NPSA) advice on strong potassium solutions for injection and local policies prior to use.

The concentrated injection must be diluted and thoroughly mixed with a larger volume of fluid prior to use.

Adults

Children

Adolescents

Neonates

Patients with Renal Impairment

Administration

For slow intravenous infusion following dilution in infusion fluid.

Contraindications

Hyperphosphatemia
Severe renal impairment
Urolithiasis

Precautions and Warnings

Acute pancreatitis
Adrenal insufficiency
Breastfeeding
Cardiac disorder
Dehydration
Diabetes mellitus
Hypoparathyroidism
Myotonia congenita
Osteomalacia
Pregnancy
Renal impairment
Rickets
Severe burn

Administer infusion slowly
Administer using controlled infusion device
Do not use if dispersion is not uniform after adequate mixing
Follow storage and handling guidelines
Must be diluted before use
Precipitate may form when phosphates added to calcium or magnesium solution
Rapid injection may be cardiotoxic
Evaluate renal function before and during treatment
Monitor ECG
Monitor serum electrolytes

National Patient Safety Agency (NPSA) Patient Safety Alert:

Potassium overdose can be rapidly fatal. The National Patient Safety Agency have recommended the withdrawal of concentrated potassium solutions from ward stock and the use of ready-made diluted infusion solutions. Arrangements for control and supply have also been suggested where the use of concentrated solutions is unavoidable, for example, in critical care areas (consult NPSA website www.npsa.nhs.uk)

Pregnancy and Lactation

Pregnancy

Potassium acid phosphate is contraindicated during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Potassium acid phosphate is contraindicated in breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anxiety
Bradycardia
Confusion
Convulsions
Dizziness
Fluid retention
Headache
Hyperkalaemia
Hypernatraemia
Hyperphosphataemia
Hypocalcaemia
Muscle cramps
Muscle weakness
Numbness
Oedema
Shortness of breath
Tetany
Thirst
Tingling sensation
Tiredness

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: November 2013

Reference Sources

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

National Patient Safety Agency - Patient Safety Alert Potassium Chloride Concentrate and Other Strong Potassium Solutions, July 2002. https://www.npsa.nhs.uk/site/media/documents/486_riskalertpsa01.pdf

Summary of Product Characteristics: Sterile Potassium Acid Phosphate Solution 13.6% w/v. Martindale pharmaceuticals. November 1999.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 24 August 2017