potassium salts Nursing Considerations & Management

 Drug Name

Generic Name :  potassium salts , potassium acetate , potassium chloride ,potassium gluconate

Brand Name:

  • Oral: Apo-K (CAN), Cena-K, Effer-K, Gen-K, Kaon-Cl, Kay Ciel, Kaylixir, K-Dur 10, K-Dur 20, K-Lor, K-Tab, Klor-Con, Klorvess, Klotrix, K-Lyte/Cl, Kolyum, K+ Care ET, K + 8, K + 10, Micro-K Extencaps, Potasalan, Rum-K, Ten K
  • Injection: Potassium Chloride , Kaon, K-G Elixir, Kolyum, Tri-K, Twin-K

Classification: Electrolyte

Pregnancy Category C 

Dosage & Route
Adult Dose for Hypokalemia

Parenteral:

  • 40 to 100 mEq potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 10 to 40 mEq/hour.

Oral:

  • 40 to 100 mEq orally once a day given in equally divided doses using formulations which include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution or powder for dissolution mixed with an appropriate volume of water or juice.
Adult Dose for Prevention of Hypokalemia

Parenteral:

  • 10 to 40 mEq potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 40 mEq/hour.

Oral:

  • 10 to 20 mEq orally once a day given in equally divided doses using formulations which include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution or powder for dissolution mixed with an appropriate volume of water or juice.
Pediatric Dose for Hypokalemia

Parenteral:

  • 0.5 to 1 mEq/kg/dose (maximum dose 30 mEq) potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 0.3 to 0.5 mEq/kg/hour.

Oral:

  • 2 to 5 mEq/kg/day orally in equally divided doses using age-appropriate oral dosage formulations.
Pediatric Dose for Prevention of Hypokalemia

Oral:

  • 1 to 2 mEq/kg/day orally in equally divided doses using age-appropriate oral dosage formulations.
Therapeutic actions
  • Principal intracellular cation of most body tissues, participates in a number of physiologic processes—maintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzymatic reactions.
Indications
  • Prevention and correction of potassium deficiency; when associated with alkalosis, use potassium chloride; when associated with acidosis, use potassium acetate, bicarbonate, citrate, or gluconate
  • IV: Treatment of cardiac arrhythmias due to cardiac glycosides
Adverse effects
  • Dermatologic: Rash
  • GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GI bleeding, GI ulceration or perforation
  • Hematologic: Hyperkalemia—increased serum K+, ECG changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of QTc interval)
  • Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm with injection
Contraindications
  • Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment with oliguria, anuria, azotemia; untreated Addison’s disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract.
  • Use cautiously with cardiac disorders, especially if treated with digitalis, pregnancy, lactation.
Nursing considerations
Assessment
  • History: Allergy to tartrazine, aspirin; severe renal impairment; untreated Addison’s disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps, GI disorders that cause delay in passage in the GI tract, cardiac disorders, lactation
  • Physical: Skin color, lesions, turgor; injection sites; P, baseline ECG; bowel sounds, abdominal examination; urinary output; serum electrolytes, serum bicarbonate
Interventions
  • Arrange for serial serum potassium levels before and during therapy.
  • Administer liquid form to any patient with delayed GI emptying.
  • Administer oral drug after meals or with food and a full glass of water to decrease GI upset.
  • Caution patient not to chew or crush tablets; have patient swallow tablet whole.
  • Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3–8 oz of cold water, juice, or other suitable beverage, and have patient drink it slowly.
  • Arrange for further dilution or dose reduction if GI effects are severe.
  • Agitate prepared IV solution to prevent “layering” of potassium; do not add potassium to an IV bottle in the hanging position.
  • Monitor IV injection sites regularly for necrosis, tissue sloughing, phlebitis.
  • Monitor cardiac rhythm carefully during IV administration.
  • Caution patient that expended wax matrix capsules will be found in the stool.
  • Caution patient not to use salt substitutes.
Teaching points
  • Take drug after meals or with food and a full glass of water to decrease GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3–8 ounces of cold water, juice, or other suitable beverage, and drink it slowly. Take the drug as prescribed; do not take more than prescribed.
  • Do not use salt substitutes.
  • You may find wax matrix capsules in the stool. The wax matrix is not absorbed in the GI tract.
  • Have periodic blood tests and medical evaluation.
  • You may experience these side effects: Nausea, vomiting, diarrhea (taking the drugs with meals, diluting them further may help).
  • Report tingling of the hands or feet, unusual tiredness or weakness, feeling of heaviness in the legs, severe nausea, vomiting, abdominal pain, black or tarry stools, pain at IV injection site.