• Potassium chloride (KCl) is the major intracellular cation in the body. It is required for cellular functioning, neuronal conduction, and gut motility.
• Deficiency of Potassium in the body may occur as a result of excessive losses as in diarrhea, vomiting, or through urine (especially with potassium losing diuretics) or due to reduced intake.
• Hypokalemia, when severe, can result in respiratory muscles and limb paralysis.
• It can also result in reduced gut motility causing intestinal pseudoobstruction.
• Life-threatening cardiac arrhythmias can occur as a result of severe hypokalemia especially in patients with pre-existing cardiac disease.
• Potassium chloride is best administered via the oral route, however, in severe cases, slow intravenous administration is advised.

Potassium Chloride dose in adults:

Note:

Dose is expressed as mEq.Intermittent IV potassium administration should be reserved for severe depletion sin patients undergoing ECG monitoring.

Normal daily requirements of KCl:

• Oral, IV: 40 to 80 mEq/day

Potassium chloride Dose in the Prevention of hypokalemia:

• 20 to 40 mEq per oral per day in 1 to 2 divided doses

Potassium chloride  dose in the treatment of hypokalemia:

• Mild to moderate hypokalemia:

• Note:

  • If deficits are severe or ongoing losses are great, the IV route should be considered.

• Capsules, tablets, oral solution:

  • Usual dose: 40 to 100 mEq per oral daily in divided doses;
  • limit single doses to 20 to 25 mEq/dose to avoid GI discomfort.

• Powder for oral solution (Klor-Con):

  • Usual dose: 40 to 100 mEq daily in 2 to 5 divided doses, limit single doses to 40 mEq/dose
  • The maximum: 200 mEq/24 hours.

Note:

Total daily doses up to 120 mEq may be necessary depending on laboratory assessment, patient symptoms and/or ongoing losses.

• Potassium Chloride Dose in Severe hypokalemia:

  • Some clinicians initiate prescribe 40 mEq given 3 to 4 times per day;
  • 20 mEq every 2 to 3 hours in conjunction with IV potassium administration with careful monitoring may also be administered.
  • Administration of dose >40 mEq orally per dose frequently cause GI irritation and nausea.

  • IV intermittent infusion:

    • Peripheral or central line:

      • ≤10 mEq/hour; repeat as needed based on frequently obtained lab values;
      • central line infusion and continuous ECG monitoring is necessary for infusions >10 mEq/hour.

  • Potassium dosage/rate of infusion general guidelines (per product labeling):

  • Note:

    • High variability exists in dosing/infusion rate recommendations;
    • Therapy is guided by the patient's condition and specific institutional guidelines.

As an estimate, 10 mEq of potassium chloride will roughly increase serum levels by 0.1 mEq/L.

• Serum potassium levels <3.5 mEq/L may require increased amounts due to total body potassium deficit.

• Serum potassium >2.5 to 3.5 mEq/L:

  • Maximum infusion rate: 10 mEq/hour;
  • maximum concentration: 40 mEq/L
  • maximum 24-hour dose: 200 mEq

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

  • Maximum infusion rate (central line only): 40 mEq/hour with continuous ECG and level monitoring.
  • In selected situations, patients may require up to 400 mEq/24 hours.

Potassium chloride dose in children:

Note:

Oral solutions are available in two concentrations: 20 mEq/15 mL (1.33 mEq/mL) and 40 mEq/15 mL (2.67 mEq/mL); Use extra precaution; Verify product formulation for dosage calculation.

KCL Dose in the prevention of hypokalemia as in ongoing drug losses (eg, concurrent diuretic therapy of Hypokalemia):

• Infants, Children, and Adolescents:

  • 1 to 2 mEq/kg per oral in 1 to 2 divided doses;
  • The usual single dose should not exceed the usual adult single dose: 20 mEq/dose;
  • Although some patients may require a single dose up to 40 mEq/dose, some patients may require higher individual daily doses based on lab values and ongoing losses.

Potassium chloride dose to treat mild to moderate Hypokalemia:

• Infants, Children, and Adolescents:

  • 2 to 5 mEq/kg per oral in divided doses; not to exceed 1 to 2 mEq/kg as a single dose or 20 mEq (whichever is less);
  • Intravenous administration is necessary in cases of severe deficit.

Potassium chloride dose for the treatment of severe Hypokalemia:

• Infants, Children, and Adolescents:

  • Intermittent IV infusion: 0.5 to 1 mEq/kg/dose
  • maximum dose: 40 mEq/dose;
  • Infuse at a rate ≤0.5 mEq/kg/hour (see "How to administer" tab for more detail on rate)
  • Serum potassium levels should be checked 1 to 2 hours after infusion;
  • The dose may be repeated as needed based on lab values;
  • severe depletion or ongoing losses may require >200% of normal daily maintenance.

Potassium chloride Dose in the maintenance requirement of Parenteral nutrition:

• As an additive to parenteral nutrition solution:

  • Infants and Children weighing ≤50 kg:

    • 2 to 4 mEq/kg/day

  • Children weighing >50 kg and Adolescents:

    • 1 to 2 mEq/kg/day

Pregnancy Risk Category: C

• The requirements for potassium are the same for pregnant and unpregnant women.
• It has not been shown to have any adverse effects on pregnancy.
• It should not be used in patients suffering from preeclampsia.

Potassium chloride use during breastfeeding:

• Breast milk contains potassium secretion.
• Normal human milk potassium content is 13 mEq/L. Normal concentrations would not be affected by supplementation.

Dose adjustment in renal disease:

There are no specific dosage adjustments provided in the manufacturer's labeling. 50% dose reduction is required in patients with renal impairment . Its use is contraindicated in patients with renal failure.

Dose adjustment in liver disease:

There are no specific dosage adjustments provided in the manufacturer's labeling; use oral formulations with caution in patients with cirrhosis.

Side effects of Potassium Chloride:

• Cardiovascular:

  • Cardiac Arrhythmia
  • Cardiac Conduction Disturbance
  • Edema
  • Peripheral Edema

• Endocrine & Metabolic:

  • Fluid And Electrolyte Disturbance
  • Hypervolemia

• Gastrointestinal:

  • Abdominal Cramps
  • Abdominal Distress
  • Abdominal Pain
  • Diarrhea
  • Flatulence
  • Gastrointestinal Hemorrhage
  • Gastrointestinal Irritation
  • Gastrointestinal Obstruction
  • Gastrointestinal Perforation
  • Gastrointestinal Ulcer
  • Nausea
  • Vomiting

• Respiratory:

  • Pulmonary Edema

Contraindications to Potassium chloride:

• Hypersensitivity to potassium chloride and any other component of the formulation
• Failure of the renal system
• Hyperkalemia
• There are certain conditions that can lead to potassium retention.
• These include pharmacologic, structural or pathological causes for delay or arrest in passage through the GI tract.

Warnings and precautions

• Extravasation:

  • Potassium chloride is vesicant/irritant at concentrations greater than 0.01 mEq/mL.
  • To avoid extravasation, it is important to position the needle correctly before and during infusion.

• Hyperkalemia:

  • It can occur when IV or oral medication is used.
  • The risk factors include acute dehydration, heart failure, severe renal impairment, extensive burns or tissue injury, systemic acidosis, adrenal insufficiency, or the administration of potassium-sparing diuretics.
  • It is essential to monitor serum potassium closely.

• Hypersensitivity/ Infusion reactions

  • Injectable potassium can cause hypersensitivity, such as anaphylaxis or chills. This should be stopped immediately.

• Hyponatremia:

  • Hyponatremia can be a risk in children, elderly, psychogenic polydipsia, and combination with diuretics.
  • Monitor your levels of sodium and potassium.

• Acid/base disorders:

  • Hyperkalemia can be associated with hyperosmolality, acidosis, or correction of alkalosis. You should monitor your serum potassium carefully.

• Cardiovascular disease

  • It should not be used in cardiac arrhythmias, heart failure, and atrioventricular hyper/hypokalemia.

• Hepatic impairment

  • Patients with cirrhosis should be cautious; it is important to monitor the serum potassium more often.

• Renal impairment

  • It is best to avoid patients suffering from renal impairment.

Potassium chloride: Drug Interaction

Monitoring parameters:

• Renal function tests
• Serum electrolytes including serum potassium, calcium, chloride, magnesium, phosphate, sodium
• Acid/base balance
• Intravenous infusion site
• ECG/cardiac monitoring(if intermittent infusion or potassium infusion rates 0.5 mEq/kg/hour in children or >10 mEq/hour in adults).

How to administer Potassium chloride?

For Parenteral Use:

• Potassium must be diluted before parenteral administration and always given as a slow infusion.
• In general, the rate of administration may be dependent on patient condition and specific institution policy.
• Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and the maximum rate of administration for peripheral infusion is 10 mEq/hour.
• For peripheral or central infusions >10 mEq/hour in adults, ECG monitoring is necessary.
• Higher concentrations and more rapid rates of infusion may be used with a central line such as concentrations of 20 to 40 mEq/100 mL at a maximum rate of 40 mEq/hour can be safely infused.
• Potassium chloride is a vesicant/irritant (at concentrations >0.1 mEq/mL) therefore proper positioning of the needle before and during IV infusion is required to avoid extravasation.

Extravasation management:

• The infusion should be immediately stopped and disconnected leaving the cannula in place.
• The extravasated solution should be gently aspirated without flushing the line and hyaluronidase antidote should be started.
• The cannula should be removed and dry cold compresses should be applied in addition to elevating the extremity.

Hyaluronidase:

• Intradermal or SubQ:

  • 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) is injected into the area of extravasation at the leading edge in a clockwise manner.

Oral Tablets:

• It should be taken orally with meals (or immediately after eating) and a full glass of water or other liquid to prevent GI irritation.
• Oral preparations recommend more than 20 mEq to 40 mEq should not be given as a single dose.

Potassium chloride Capsule:

• MicroK: It should be swallowed as a whole without chewing.
• The capsules may also be opened and contents sprinkled on a spoonful of applesauce or pudding and should be swallowed immediately without chewing.

Potassium Chloride Powder for oral solution: Klor-Con:

• One packet is dissolved in at least 120 mL of cold water or other liquid before administration.
• Dilution can be increased in cases of gastrointestinal irritation.

Tablet: K-Tab, Kaon-Cl, Klor-Con:

• Tablets should be swallowed as a whole without crushing, chewing.

Klor-Con M:

• Tablets should be swallowed as a whole without crushing, chewing.
• The tablet may also be broken in half and each half is swallowed separately;
• The whole tablet may be dissolved in 4 ounces of water allowing 2 minutes to dissolve by stirring well and drinking immediately.

Mechanism of action of Potassium chloride:

• Potassium, the main intracellular fluid cation, is vital for nerve impulse conduction in the brain, heart, and skeletal muscles.
• It causes smooth, cardiac, and skeletal muscle contractions, as well as maintaining acid-base balance, carbohydrate metabolism and gastric secretion and normal renal function.

Absorption:

• Well absorbed from the upper GI tract

Distribution

• Active transport from extracellular fluid into cells to enter the cells

Excretion:

• Urine, skin and feces (small quantities); most of the intestinal potassium reabsorbed  

International Brands of Potassium chloride:

• K-Sol
• K-Tab
• Klor-Con
• Klor-Con 10
• Klor-Con M10
• Klor-Con M15
• Klor-Con M20
• Klor-Con Sprinkle
• Micro-K
• Potassium Chloride PROAMP
• APO-K
• Micro-K
• Slo-Pot 600
• Addi-K
• Alkay ER
• Apo-K
• Beacon K
• Budaxiu
• Chloropotassuril
• Clor-K-Zat
• Clotassio
• Co-Salt
• Control K
• Corpotasin
• Crysta K
• Di Jia
• Diffu-K
• Duro-K
• Dyna-K
• Electro K
• Enpott
• Flexivial
• Geo
• Gluco-K
• Ionclor
• K-Card
• K-Chlor
• K-Contin
• K-Contin Continus
• K-Dur
• K-Norm
• K-Retard
• K-Supply
• K-Tab
• Kadalex
• Kaion Retard
• Kaldyum
• Kaleorid
• KaliSterop
• Kaligen
• Kalinor-Retard P
• Kalinorm
• Kaliolite
• Kalipoz
• Kalitabs
• Kalium
• Kalium-R
• Kalnormin
• Kalytes
• Katelin
• Kation
• Kay-Cee-L
• Kay-Ciel
• Kaylyte
• KCL Retard
• Kelefusin
• Keylyte
• KSR
• Lejia
• Lento-Kalium
• MicroKalium Retard
• Orakit
• Perennum
• Plenisk-K
• Plus Kalium Retard
• Pota-K
• Potasion
• Potassin
• Potassride
• Potazek
• Potklor
• Potrelease TR
• Rekawan
• Sando-K
• Sandoz K
• Slow-K
• Slow-K MR
• Span-K
• Susta-K
• Sylvite
• Tascit
• Xian Jia
• Xin Jian Ju
• Zerosodio

Potassium Chloride Brands in Pakistan: