Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance
Hypokalaemia - severe

Administration

For slow intravenous infusion only.

Ready-mixed infusion solutions containing potassium should be used.

Exceptionally, if potassium chloride concentrate is used for preparing an infusion, the infusion solution should be thoroughly mixed.

Refer to specific manufacturer information for suitable vehicle solutions, dilution and infusion rates.

Contraindications

Heat cramp
Addison's disease
Anuria
Cardiac failure
Hyperchloraemia
Hyperkalaemia
Oliguria
Severe dehydration
Severe renal impairment
Sickle cell disease

Precautions and Warnings

Adrenal insufficiency
Cardiac disorder
Gastrointestinal stenosis
History of peptic ulcer
Renal impairment
Severe burn

Avoid rapid infusion rates
Ensure adequate hydration prior to infusion
Monitor acid-base balance
Monitor creatinine, blood urea nitrogen (BUN) and urinary output
Monitor ECG
Monitor fluid and electrolyte status
Monitor renal function
Monitor serum potassium regularly
Discontinue if renal function deteriorates

Initial potassium replacement therapy should not involve glucose infusions, because glucose may cause a further decrease in the plasma-potassium concentration.

Potassium overdose can be rapidly fatal. Ready-mixed infusion solutions containing potassium should be used. Exceptionally, if potassium chloride concentrate is used for preparing an infusion, the infusion solution should be thoroughly mixed. Local policies on avoiding inadvertent use of potassium chloride concentrate should be followed.

Pregnancy and Lactation

Pregnancy

The use of potassium containing products during pregnancy is not considered to pose a hazard.

Because high or low potassium levels are detrimental to maternal and foetal cardiac function, serum potassium levels should be closely monitored.

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

The use of potassium containing products during breastfeeding is not considered to pose a hazard.

Breast milk is naturally high in potassium with levels that are 3 to 4 times those in plasma. Because potassium passes freely in and out of milk, the use of potassium chloride by a lactating woman with normal plasma potassium levels would have no adverse effect on a nursing infant (Briggs, 2015)

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

Acidosis
Cardiac arrhythmias
Cardiotoxicity (from rapid infusion)
Hyperchloraemia
Hyperkalaemia
Local pain (injection site)
Nausea
Oesophageal ulceration
Small bowel ulceration
Thrombophlebitis (localised)
Vomiting

Presentation

Infusions of potassium chloride.

Drugs List

Therapeutic Indications

Uses

Electrolyte imbalance
Hypokalaemia - severe

Dosage

Dosage is dependent on the individual potassium deficit or daily maintenance requirements.

Adults

Children

Neonates

Administration

For slow intravenous infusion only.

Ready-mixed infusion solutions containing potassium should be used.

Exceptionally, if potassium chloride concentrate is used for preparing an infusion, the infusion solution should be thoroughly mixed.

Refer to specific manufacturer information for suitable vehicle solutions, dilution and infusion rates.

Contraindications

Heat cramp
Addison's disease
Anuria
Cardiac failure
Hyperchloraemia
Hyperkalaemia
Oliguria
Severe dehydration
Severe renal impairment
Sickle cell disease

Precautions and Warnings

Adrenal insufficiency
Cardiac disorder
Gastrointestinal stenosis
History of peptic ulcer
Renal impairment
Severe burn

Avoid rapid infusion rates
Ensure adequate hydration prior to infusion
Monitor acid-base balance
Monitor creatinine, blood urea nitrogen (BUN) and urinary output
Monitor ECG
Monitor fluid and electrolyte status
Monitor renal function
Monitor serum potassium regularly
Discontinue if renal function deteriorates

Initial potassium replacement therapy should not involve glucose infusions, because glucose may cause a further decrease in the plasma-potassium concentration.

Potassium overdose can be rapidly fatal. Ready-mixed infusion solutions containing potassium should be used. Exceptionally, if potassium chloride concentrate is used for preparing an infusion, the infusion solution should be thoroughly mixed. Local policies on avoiding inadvertent use of potassium chloride concentrate should be followed.

Pregnancy and Lactation

Pregnancy

The use of potassium containing products during pregnancy is not considered to pose a hazard.

Because high or low potassium levels are detrimental to maternal and foetal cardiac function, serum potassium levels should be closely monitored.

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

The use of potassium containing products during breastfeeding is not considered to pose a hazard.

Breast milk is naturally high in potassium with levels that are 3 to 4 times those in plasma. Because potassium passes freely in and out of milk, the use of potassium chloride by a lactating woman with normal plasma potassium levels would have no adverse effect on a nursing infant (Briggs, 2015)

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

Acidosis
Cardiac arrhythmias
Cardiotoxicity (from rapid infusion)
Hyperchloraemia
Hyperkalaemia
Local pain (injection site)
Nausea
Oesophageal ulceration
Small bowel ulceration
Thrombophlebitis (localised)
Vomiting

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: January 2019

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Potassium Chloride 0.4mmol/mL Solution for Infusion. Ennogen Healthcare Limited. Revised November 2017.

Summary of Product Characteristics: Potassium Chloride Concentrate 15%. Hameln Pharmaceuticals Ltd. Revised August 2012.

Summary of Product Characteristics: Potassium Chloride Concentrate 20%. Hameln Pharmaceuticals Ltd. Revised August 2012.

Summary of Product Characteristics: Sterile Potassium Chloride Concentrate (15% w/v) BP. B. Braun Medical Ltd. Revised October 2012.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 7 December 2018