Potassium Chloride - Uses, Mechanism of Action, Precautions, and Side Effects

Overview:

Potassium chloride is a potassium salt used in the management and treatment of hypokalemia with or without metabolic alkalosis in patients who cannot be managed with potassium-rich foods or a reduction in the diuretic dose. It belongs to the electrolyte supplement class of medicines.

How Does Potassium Chloride Work?

Potassium chloride is administered to increase the potassium level in the body. Around 98 % of the potassium in the body is found within the cells (intracellular). Mostly the skeletal muscle cells harbor potassium in the body. The potassium ions carry out several functions, such as maintenance of tonicity, nerve impulse transmission, proper contraction of the various muscles, normal kidney function, and electrolyte balance in the body. The potassium concentration is around 150 to 160 mEq per liter. Hypokalemia (less potassium level in the body) interferes with normal cardiac function leading to life-threatening arrhythmias or an increase in heart rate.

Uses of Potassium Chloride:

Potassium chloride is indicated in the following:

• Diabetic Ketoacidosis - Diabetic ketoacidosis usually presents with hyperkalemia because of associated hyperosmolality and insulin deficiency.

• Kidney Disease - Kidney potassium is vital in determining the serum potassium level.

• Hyperaldosteronism - Aldosterone is a mineral corticosteroid that helps the kidney collecting duct cells to retain sodium and water and remove potassium and hydrogen ions. Hyperaldosteronism results from conditions producing excessive aldosterone or aberrantly stimulating the renin-angiotensin-aldosterone system.

• Medications - Medication-induced hypokalemia takes place through renal potassium loss or intracellular drift. Drugs such as beta 2-receptor agonists and xanthines cause hypokalemia.

• Gastrointestinal Disease - Gastrointestinal-related potassium loss occurs due to vomiting and diarrhea.

• Others - Potassium chloride is needed during cardiac surgeries to produce cardioplegia by interfering with phase zero of the cardiac action potential.

Limitations:

People allergic to potassium should not take the medication.

Dosage Restrictions:

• Routes of Administration - Oral and intravenous.

• Dosage Strength

• Each medicine pouch contains 1.5 grams of Potassium chloride, supplying 20 mEq of potassium and 20 mEq of chloride.

• Dosage Forms

• The medication is available as extended-release tablets, capsules, injectables, oral solutions, and powder for oral answers.

Recommended Dosage

For Administration and Monitoring Purposes:

In case serum potassium is less than 2.5 mEq/L, intravenous potassium is used. The Potassium chloride used for intravenous administration should be diluted and taken with meals or immediately after food.

1. Adult Dose:

The daily dose ranges from forty to one hundred mEq which is given in two to five divided doses (limiting quantities to 40 mEq per dose). The daily dose should not exceed two hundred mEq in twenty hours.

2. Pediatric Dose:

From birth to 16 years old - The initial dose is 2 to 4 mEq/kg/day in divided doses. The amount should not exceed a single dose of 1 mEq/kg or 40 mEq, whichever is lower. The maximum dose should not be more than 100 mEq per day.

Special Considerations:

• Pregnancy: It is not likely that potassium supplementation that does not cause hyperkalemia would have a side effect on the fetus or affect reproductive capacity.

• Breastfeeding: The potassium ion concentration of human milk is around 13 mEq/L. The orally taken potassium becomes a part of the body's potassium pool; as long as the potassium concentration is not in excess, it does not cause much/any effect on human milk.

• Pediatric: Potassium chloride is safe and effective in children with diarrhea and malnutrition from birth to 18 years of age.

• Geriatric Patients: Dose selection in the elderly should be made carefully. The kidneys excrete potassium chloride, so the risk of toxic reaction to it is more significant in people with decreased kidney function. Since older adults are likely to have reduced kidney function, careful dose selection is recommended.

• Cirrhosis: The treatment of Individuals with cirrhosis should begin with a lower dosage with regular monitoring of the serum potassium level.

• Renal Impairment: Individuals with renal impairment have decreased removal of potassium and are at an increased risk of hyperkalemia. They should be started at the lower end of the dose.

Warnings:

• Gastrointestinal Irritation: Potassium chloride might irritate the gastric mucosa. The irritation could be reduced by increasing the dilution of the solution and by taking medicine with meals.

Contraindications:

• Potassium chloride is contraindicated in patients on potassium-sparing diuretics.

For Patients:

What Is Hypokalemia?

Hypokalemia is low potassium concentration in the body. Potassium is a mineral that the body needs to work correctly. It helps muscle movement and the nerves send signals, maintain normal blood pressure levels, and maintain an average electrolyte balance. The normal blood potassium level is 3.6 to 5.2 millimole per liter (mmol/L). A deficient potassium level is life-threatening and requires medical attention. Various factors can cause it. The most common cause is medicines causing an increase in urine. Vomiting and diarrhea can also cause hypokalemia.

Why Is Potassium Chloride Prescribed for Hypokalemia?

Potassium is one of the primary ions in the cells (intracellular fluid). Hypokalemia is a life-threatening condition that could lead to cardiac arrhythmias or increased heart rate. Potassium chloride is indicated in the treatment and prevention of hypokalemia to replenish the amount of lost potassium, thus maintaining the blood potassium level.

Facts One Should Know About Potassium Chloride

• Potassium chloride can be administered orally or intravenously.

• Potassium chloride effectively increases potassium levels in the body, thus treating hypokalemia.

How Should One Take Potassium Chloride?

• Potassium chloride is available as an extended-release tablet. It is also available as an injectable, ready-made solution or in powder form.

• The medicine should be taken under the guidance of the doctor.

• In severe cases, the medicine is administered intravenously.

• For adults, the daily dose ranges from 40 to 100 mEq, given in two to five divided doses (limiting to 40 mEq per dose).

• The daily dose should not exceed 200 mEq in 20 hours.

• The initial dose is 2 to 4 mEq/kg/day in divided doses from birth to 16. The amount should not exceed a single dose of 1 mEq/kg or 40 mEq, whichever is lower. The maximum daily dose should not be more than 100 mEq.

• The medicine should be taken diluted with water.

• It should be taken right after food.

• Do not stop the medication without the doctor's consent.

• The extended-release tablet should not be crushed, chewed, broken, or sucked. Instead, it should be swallowed whole.

What Should One Discuss With the Doctor Before Starting Potassium Chloride?

One should inform the doctor in case of:

• High potassium levels in the blood.

• Is taking a 'potassium-sparing' diuretic pill (water pill).

• Kidney disease.

• Cirrhosis or other liver diseases.

• Adrenal gland disorder.

• Tissue injury resulting from a burn.

• Severe dehydration.

• Diabetes.

• Heart disease or high blood pressure.

• Stomach or intestinal bleeding.

• Blockage in the stomach or intestines.

• Chronic diarrhea.

• Inform the doctor if one is pregnant or breastfeeding.

Is Potassium Chloride Safe?

Potassium chloride is a safe medication for treating hypokalemia. However, it should be avoided if one is allergic to it, has high potassium levels in the body, or takes a "potassium-sparing" diuretic (water pill). The administration of potassium to people with normal excretory mechanisms is fine, but if kidney function is impaired, then potassium administration may cause hyperkalemia.

Is Potassium Chloride Effective?

Both intravenous and orally administered Potassium chloride are effective in treating hypokalemia.

What Are the Side Effects of Potassium Chloride?

The side effects of potassium chloride are related to the route of administration.

The oral route of administration might cause -

• Vomiting.

• Diarrhea.

• Gastrointestinal irritation.

• Ulcers of the gastrointestinal tract due to prolonged exposure.

Intravenous administration might cause -

• Phlebitis - Swelling of the vein.

• Erythema - Redness of the skin caused by injury.

• Mild Hyperkalemia - An increased potassium concentration in the body due to rapid injection of potassium chloride.

Can One Stop Taking Potassium Chloride Without a Doctor's Approval?

Potassium chloride should not be stopped abruptly without the doctor's consent.

How Should One Store Potassium Chloride?

Potassium chloride should be stored at room temperature, away from direct sunlight. It should not be stored in the bathroom. In addition, the medication should be kept away from children and pets.

How Should One Dispose of Potassium Chloride?

• The medication should not be flushed down the toilet or drain.

• Once expired, the medicine should be disposed of at a local waste disposal company.

What To Do in Case of Overdose?

An overdose of the drug can cause irregular heartbeat, chest pain, or muscle fatigue.

In such cases, the individual should seek medical attention immediately.

For Doctors:

Indications

Potassium chloride is indicated in the following:

• Diabetic Ketoacidosis - Diabetic ketoacidosis usually presents with hyperkalemia because of associated hyperosmolality and insulin deficiency.

• Kidney Disease - Kidney potassium is essential in determining the serum potassium level.

• Hyperaldosteronism - Aldosterone is a mineral corticosteroid that helps the kidney collecting duct cells to retain sodium and water and remove potassium and hydrogen ions. Hyperaldosteronism results from conditions producing excessive aldosterone or aberrantly stimulating the renin-angiotensin-aldosterone system.

• Medications - Medication-induced hypokalemia takes place through renal potassium loss or intracellular drift. Drugs such as beta 2-receptor agonists and xanthines cause hypokalemia.

• Gastrointestinal Disease - Gastrointestinal-related potassium loss occurs due to vomiting and diarrhea.

• Others - Potassium chloride is needed during cardiac surgeries to produce cardioplegia by interfering with phase zero of the cardiac action potential.

What Is the Pharmacology of Potassium Chloride?

Description

Potassium chloride is a whitish solid substance soluble in water and very sparingly soluble in alcohol. Chemically potassium chloride has a molecular mass of 74.55.

Components:

1. Active Components

Each pouch of light pink to orange powder contains 1.5 grams of potassium chloride, equal to around 20 mEq of potassium and 20 mEq of chloride.

2. Inactive Components

• Citric acid is anhydrous.

• Colloidal silicon dioxide.

• F D and C Yellow Number. 6.

• Natural and artificial orange flavor.

• Sucralose.

Clinical Pharmacology:

Mechanism of Action

The potassium ion is the most critical intracellular ion of the body. They participate in several essential physiological functions, such as the maintenance of intracellular tonicity, the transmission of nerve impulses, the contraction of cardiac, skeletal, and smooth muscles, and the maintenance of normal kidney function. The intracellular potassium concentration is around 150 to 160 mEq per liter. The normal potassium in an adult is about 3.5 to 5 mEq per liter. An active ion transport system maintains this concentration across the plasma membrane. As a result, potassium is readily available in the diet. Under steady-state conditions, the amount of potassium absorbed from the gastrointestinal tract is the same as the amount removed from urine.

Pharmacodynamics

• Potassium-sparing Diuretics: The person taking these medicines should monitor potassium levels frequently.

• Loop and Thiazide Diuretics: These drugs cause potassium excretion from the body, causing hypokalemia.

Pharmacokinetics

The absorption and excretion of potassium from Potassium chloride oral solution are higher in the first few hours after dosing relative to the modified release of Potassium chloride. However, the bioavailability of potassium, measured by the cumulative excretion of potassium ions over twenty-four hours after administration, is similar to Potassium chloride solution and modified release products.

Elimination

The secretion from the tubules occurs in the distal convoluted tubule and collecting duct and account for the potassium excretion in urine, around ten percent of the filtered amount. Therefore, the elimination of potassium in feces is less and plays no role in potassium homeostasis.

Special Considerations

• Pregnancy: It is not likely that potassium supplementation that does not cause hyperkalemia would have a side effect on the fetus or affect reproductive capacity.

• Breastfeeding: The potassium ion concentration of human milk is around 13 mEq/L. The orally taken potassium becomes a part of the body's potassium pool; as the potassium concentration is not in excess, it does not cause much/any effect on human milk.

• Pediatric: Potassium chloride is safe and effective in children with diarrhea and malnutrition from birth to eighteen years of age.

• Geriatric Patients: Dose selection in the elderly should be made carefully. The kidneys excrete potassium chloride, so the risk of a toxic reaction to it is more significant in people with decreased kidney function. Since older adults are likely to have reduced kidney function, careful dose selection is recommended.

• Cirrhosis: The treatment of Individuals with cirrhosis should begin with a lower dosage with regular monitoring of the serum potassium level.

• Renal Impairment: Individuals with renal impairment have decreased removal of potassium and are at an increased risk of hyperkalemia. They should be started at the lower end of the dose.

Drug Interactions

• Amiloride: Amiloride and potassium chloride increase serum potassium. They should not be used together.

• Baloxavir Marboxil: Potassium chloride decreases the concentration of Baloxavir marboxil by cation binding in the gastrointestinal tract. Avoid using them together or use them alternately.

• Drospirenone: Potassium chloride and Drospirenone increase potassium concentration in the blood, so they should not be used together.

What Have Clinical Trials Shown Concerning Potassium Chloride?

Not many clinical studies have been conducted to test the efficacy of potassium chloride in treating hypokalemia.

One such study is

Comparison of Enteral Versus Intravenous Potassium Supplementation in Hypokalemia in Post Cardiac Surgery Pediatric Cardiac Intensive Care Patients - Prospective Open.

• Objective:This clinical trial aimed to compare the efficiency of enteral potassium replacement (EPR) and Intravenous potassium replacement (IVPR) for the treatment of hypokalemia.

• Result: EPR or enteral potassium replacement is equally effective in treating hypokalemia as IVPR or intravenous potassium replacement.

Patient Counseling Information:

Administration Instructions

• Take Potassium chloride as prescribed by the doctor.

• This drug should be taken immediately after food to avoid gastric irritation.

• Do not crush, split, or chew the medicine; swallow these tablets whole.

• Take this medication with enough water.

Complications or Side Effects

Most of the side effects result from the way Potassium chloride is taken.

Oral administration of the drug might cause:

• Vomiting and diarrhea.

• Stomach upset.

• Stomach pain.

Intravenous administration might lead to:

• Phlebitis.

• Erythema.

• Thrombosis.

• Mild hyperkalemia.