Precautions
The treatment of potassium depletion, particularly in the presence of cardiac disease, renal disease or acidosis, requires careful attention to acid base balance and appropriate monitoring of serum electrolytes, the ECG and the patient's clinical status.
Use potassium with caution in diseases associated with heart block since increased serum potassium may increase the degree of block.
Supplied
Each dose of 7.8 g powder contains: potassium chloride 1.86 g [25 mmol (mEq) of potassium and 25 mmol (mEq) of chloride]. Energy: 88.7 kJ (21.2 kcal)/7.8 g dose. Fruit flavored powder available in boxes of 30 “unit dose” pouches (7.8 g each).
Each effervescent, orange flavored and colored tablet, when dissolved in water, contains: potassium citrate 2.5 g or elemental potassium 25 mmol (mEq). Boxes of 30 individually foil wrapped tablets.
Warnings
In patients with impaired mechanisms for excreting potassium, e.g. chronic renal disease, administration of potassium salts can produce hyperkalemia and cardiac arrest. This occurs most commonly in patients given i.v. potassium but may also occur in patients given oral potassium. Potentially fatal hyperkalemia can develop rapidly and be asymptomatic. Careful monitoring of the serum potassium concentration and appropriate dosage adjustment is recommended.
Caution is advised with concomitant administration of potassium and potassium sparing diuretics e.g., spironolactone or triamterene, since hyperkalemia may develop. Hypokalemia in patients with metabolic acidosis should be treated with an alkalinizing potassium salt such as the acetate, bicarbonate, gluconate or citrate.
In patients on a low salt diet particularly, hypokalemic hypochloremic alkalosis is a possibility that may require chloride as well as potassium supplementation.
Contraindications
In ventricular fibrillation, hyperkalemia of any etiology, in association with Addison's disease, salt losing adrenal hyperplasia, in extensive tissue breakdown as in severe burns, acute dehydration and heat cramps. Renal impairment with oliguria or azotemia. Increased sensitivity to potassium administration, e.g., in congenital paramyotonia or adynamia episodica hereditaria.
Adverse Effects
Nausea, vomiting and diarrhea have been reported. These symptoms are due to irritation of the gastrointestinal tract and are best avoided by dissolving each dose completely in the stated amount of water, increasing fluid intake when possible, taking the dose with meals or reducing dose.
Indications
Oral potassium supplement for the therapy or prophylaxis of potassium deficiency. Especially useful for routine use with thiazide diuretics or corticosteroid hormones to replace excessive potassium losses.
Dosage
Completely dissolve 1 K-Lyte tablet in 85 to 115 mL of cold or ice water, or 1 dose (7.8 g pouch) of K-Lyte/Cl powder in 180 mL of cold or ice water and administer 2 to 4 times daily, depending upon the patient's requirements.
Note: K-Lyte or K-Lyte/Cl should be taken with meals and sipped slowly over a 5 to 10 minute period.
The usual dietary intake of potassium is 40 to 80 mmol (mEq)/day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mmol (mEq) of potassium from the total body store.
If given concomitantly in chronic diuretic therapy, administer on alternating days.
Prevention of hypokalemia: supplementally, approximately 20 to 40 mmol (mEq)/day.
Treatment of depletion: 40 to a maximum of 100 mmol (mEq) daily.
Overdose
In patients under normal conditions of exertion, concentrations of potassium in the blood of greater than 4 mmol (mEq)/L, and in the urine of greater than 2.0 g/24 hours, may indicate hyperkalemia.
Paresthesia of the extremities, listlessness, mental confusion, weakness, paralysis, hypotension, cardiac arrhythmias, heart block and cardiac arrest may occur. ECG changes include increased amplitude and peaking of the T waves, depression of the ST segment, reduction in the amplitude of the R wave, widening of the QRS complex, prolongation of the PR interval and a decrease in the amplitude and ultimately disappearance of the P wave. Widening of the QRS complex is one of the most ominous signs and indicates the need for aggressive treatment.
Frequently hyperkalemia is asymptomatic and may be manifested only by increased serum potassium concentration and characteristic electrocardiographic changes as above.
Eliminate foods and medications containing potassium, and discontinue potassium sparing diuretics.
I.V. administration of 300 to 500 mL/hour of 10% dextrose solution containing 10 to 20 units of crystalline insulin/1000 mL.
Correct acidosis, if present, with i.v. sodium bicarbonate.
Use exchange resins, hemodialysis or peritoneal dialysis.
In the presence of life threatening cardiac arrhythmias, to antagonize the cardiac toxicity, administer i.v. 10 to 50 mL calcium gluconate 10% over 1 to 5 mins. Continuous ECG monitoring is mandatory.
In treating hyperkalemia in digitalized patients, too rapid a lowering of the serum potassium concentration can produce digitalis toxicity.
