Potassium acetate is the major intracellular cation that is responsible for the proper functioning of cardiac and skeletal muscles. It is also responsible for the maintenance of acid/base balance, nerve conduction, and renal functions.

Indications of potassium acetate:

• Treatment of Hypokalemia:

  • It is recommended for the treatment of hypokalemia when it's crucial to avoid chloride or when an additional supply of bicarbonate is needed due to an acid-base condition.

Potassium acetate dosage in adults:

Note:

• Intravenous doses should be incorporated into the intravenous fluids for maintenance.
• In more severe depletion situations in patients undergoing ECG monitoring, Intermittent intravenous potassium administration is recommended.
• The dose is expressed as mEq of potassium.

Potassium acetate dose for the treatment of Hypokalemia:

• Intermittent infusion intravenously via peripheral or central line:

  • 10 mEq per hour or less.
  • If infusions greater than 10 mEq/hour are administered, central line infusion and continuous ECG monitoring are strongly advised.
  • Repetition of the dose is based on regularly acquired lab findings.

• General recommendations for potassium dosage/rate of infusion (per product labelling):

Note: Dosing and infusion rate recommendations vary, and therapy is dependent on the patient's clinical condition and any applicable institutional policies.

• Generally speaking, 10 mEq of potassium will increase serum levels by roughly 0.1 mEq/L.
• Due to a whole body potassium deficiency, patients with severe hypokalemia (serum potassium values 3.5 mEq/L) may require higher doses.

  • Serum potassium <2.5 mEq/L or symptomatic hypokalemia (excluding emergency treatment of cardiac arrest):

    • Maximum infusion rate (central line only): 40 mEq/hour in the presence of ongoing lab testing and ECG monitoring.
    • Patients may need up to 400 mEq per 24 hrs in some circumstances.

  • Serum potassium >2.5 to 3.5 mEq/L:

    • The highest concentration: 40 mEq/L
    • The highest infusion rate: 10 mEq/hour
    • The highest 24-hour dose: 200 mEq

Dose in children:

Note:

• Electrocardiogram monitoring must be done continuously for intermittent doses of more than 0.5 mEq/kg/hour.
• The patient's IV fluids for maintenance should contain potassium.
• The body's conversion of acetate to bicarbonate can have an impact on the pH of the serum.
• Intermittent intravenous potassium administration is recommended in cases of severe depletion.
• When choosing a potassium salt for the maintenance or treatment of hypokalemia, acid/base balance should be considered.

Dose in the maintenance requirement of Parenteral nutrition:

• The following may be added to a parenteral feeding solution:

  • Children and infants weighing less than 50 kg:

    • 2 to 4 mEq per kg intravenous once daily

  • Children weighing more than 50 kg and Adolescents:

    • 1 to 2 mEq per kg intravenous once daily

Potassium acetate treatment dose of severe Hypokalemia in Infants, Children, and Adolescents:

• • Based on lab results, the dose repetition may require >200% of daily maintenance if there has been a significant depletion or continuous loss.
  • Intermittent intravenous infusion of 0.5 to 1 mEq per kg
  • At a pace of approximately 0.5 mEq per kg per hour, the maximum dose is 40 mEq per dose infusion.
  • After the infusion is finished, serum levels should be tested 60-120 minutes later.

Dose in pregnancy and lactation:

• Studies on animal reproduction have not been done. Both pregnant and unpregnant women need the same amount of potassium.
• The adverse effects of potassium supplements for healthy women during normal pregnancy were not observed.
• Pregnancy with pre-eclampsia or other medical conditions like pre-eclampsia should be done cautiously as hyperkalemia is a possibility.

Potassium acetate use during breastfeeding:

• Breast milk contains potassium.

Potassium acetate dose adjustment in renal disease:

• Serum bicarbonate and aluminium levels can both be increased by potassium acetate. Its use is not advised in people who have renal failure.
• In patients with renal impairment, the dose must be reduced by at least 50%.

Potassium acetate dose adjustment in liver disease:

There is no dosage adjustment provided in the manufacturer’s labeling.

Side effects of potassium acetate:

• Central nervous system:

  • Confusion
  • Abnormal electroencephalogram
  • Lethargy

• Cardiovascular:

  • Hypotension
  • Paralysis
  • Cardiac arrhythmia
  • Heart block
  • Paresthesia

• Neuromuscular & skeletal:

  • Weakness

• Local:

  • Local tissue necrosis (with extravasation)

Contraindication to Potassium acetate:

It is contraindicated for severe renal impairment, adrenal dysfunction or hyperkalemia

Warnings and precautions

• Extravasation:

  • Concentrations >0.1 mEq/mL: Vesicant/irritant
  • To avoid extravasation, it is important to ensure proper positioning of the catheter and needle before and during infusion.

• Hyperkalemia:

  • To prevent hyperkalemia, it is important to keep your serum potassium levels in check.
  • Severe hyperkalemia can cause cardiac conduction problems (such as heart block, ventricular arrhythmias, and asystole) as well as muscle weakness or paralysis.

• Acid/base disorders:

  • Patients with acid/base imbalances should take precautions since acid/base correction might cause changes in serum potassium levels. As a result, rigorous monitoring is suggested.
  • Use caution in the treatment of respiratory or metabolic alkalosis. The amount of potassium acetate prescribed can cause alkalosis to worsen.

• Cardiovascular disease

  • Patients with heart disease, arrhythmias or other cardiovascular conditions should be cautious about potassium levels.
  • They can become more vulnerable to dangerous cardiac effects from high or low potassium levels.

• Potassium-altering disorders and conditions:

  • Be careful with individuals who have abnormal serum potassium levels or hyperkalemia, as well as those who have conditions such as untreated Addison's disease, heat cramps, burns, or injuries that could cause tissue damage.

• Renal impairment

  • It is important to monitor serum potassium levels closely. It is not recommended for severe impairment.

Potassium acetate: Drug Interaction

Monitoring parameters:

• Monitoring of magnesium, bicarbonate, and potassium levels in the blood
• Two to four hours following the medication, the serum potassium level should be checked again. It's important to watch for extravasation at the intravenous infusion site.
• In order to ensure appropriate replacement, it is important to monitor acid/base status and perform an ECG (if intermittent infusion or potassium infusion rates are used of 0.5 mEq/kg/hour in children or >10 mEq/hour in adults).

How to administer Potassium acetate?

• Potassium must be diluted before being administered via the parenteral route. It shouldn't be given as a push intravenously.
• The pace of administration is based on the patient's health and the rules of the particular institution.
• Some medical professionals advise that the maximal dose and rate of administration for peripheral infusion be 10 mEq/hour and 10 mEq/100 mL, respectively.
• Electrocardiogram monitoring is necessary for peripheral or central infusions over 10 mEq/hour.
• A central line can be used to provide infusions at higher concentrations and faster rates.
• It is safe to provide 20 to 40 mEq/100 mL at a rate of no more than 40 mEq/hour through the central line.

Extravasation management:

• In the case of extravasation, the infusion should be stopped immediately and the cannula should be in place.
• Gentle aspiration of the extravasated solution without flushing the line should be done and a hyaluronidase antidote should be administered.
• Hyaluronidase is administered as an intradermal or subcutaneous injection of a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into the site of extravasation at the leading edge in a clockwise manner
• The cannula should be removed and dry cold compresses should be applied extremity should be elevated.

Mechanism of action of Potassium acetate:

• The heart, brain, and skeletal muscles all depend on potassium, the main cation in intracellular fluid, to conduct nerve impulses.
• It causes the cardiac, skeletal, and smooth muscles to contract, keeps the kidneys functioning normally, generates an acid-base imbalance, and regulates the metabolism of carbohydrates and gastric secretion.

Excretion

• Potassium: In urine, but also in small quantities in skin and feces. Most of the potassium in the intestine is absorbed.

Distribution:

• It is transported from the extracellular fluid to the cells by active transport