Names and pronunciation
Klor-Con, K-Tab
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Drug reference
Klor-Con, K-Tab
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Func. class.: Electrolyte, mineral replacement
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Chem. class.: Potassium
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ACTION: Needed for the adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance
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USES: Prevention and treatment of hypokalemia
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CONTRAINDICATIONS: Renal disease (severe), severe hemolytic disease, Addison’s disease, hyperkalemia, acute dehydration, extensive tissue breakdown Precautions: Pregnancy, cardiac dis- ease, potassium-sparing diuretic therapy, systemic acidosis
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SIDE EFFECTS CNS: Confusion CV: Bradycardia, cardiac depression, dys- rhythmias, arrest; peaking T waves, low- ered R, depressed RST, prolonged P-R interval, widened QRS complex GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel GU: Oliguria INTEG: Cold extremities, rash
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INTERACTIONS Increase: hyperkalemia—potassium phosphate IV; products containing cal- cium or magnesium; potassium-sparing diuretic or other potassium products; ACE inhibitors
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DOSAGE AND ROUTES Hypokalemia (prevention) (bicarbonate, chloride) • Adult: PO 20 mEq/day in 1-2 divided doses • Child: PO 1-2 mEq/kg/day in 1-2 di- vided doses Hypokalemia (treatment) • Adult: PO initial 40 mmol/day, titrate to 60 mmol/day, max: 100 mmol/day Hypokalemia, digoxin toxicity (acetate, chloride) • Adult: serum potassium concentra- tion >2.5 mEq/L: IV max 10 mEq/1 hr with 24-hr max dose 200 mEq, initial dose of 20-40 mEq has been recom- mended; PO 40-100 mEq/day in 2-4 divided doses • Child: IV 0.25-0.5 mEq/kg/dose at 0.25-0.5 mEq/kg/hr; PO 2-5 mEq/day in divided doses
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Available forms: acetate: Solution for injection 4 mEq/ mL; chloride: oral capsule, extended release 8 mEq, 10 mEq, oral solution 10%, 20%, 40%, extended-release tablet 10 mEq, 20 mEq; citrate: tablet, extended release 5, 10, 15 mE
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Administer: PO route • Do not break, crush, or chew ext rel tabs, caps, or enteric products • With or after meals; dissolve efferves- cent tabs, powder in 8 oz cold water or juice; do not give IM, SUBCUT • Caps with full glass of liquid IV route • Through large-bore needle to de- crease vein inflammation; check for extravasation; in large vein, avoid scalp vein in child (IV); never give IV bolus Potassium acetate Y-site compatibilities: Ciprofloxacin Potassium chloride • Must be diluted; concentrated potas- sium injections fatal Continuous IV INFUSION route • Concentration max 100 mcg/L for pe- ripheral line; 200 mEq/L for central line • Dehydrated patients should receive 1 L of potassium-free hydrating solution, then infuse 10 mEq/hr; in severe hypo- kalemia, rate may be 40 mEq/hr with infusion pump and ECG monitoring, draw potassium levels frequently • Do not ever use IV push or bolus, cardiac arrest may occur • Monitor I&O, urine should be >0.5 mL kg/hr to prevent hyperkalemia Y-site compatibilities: Acyclovir, aldes- leukin, allopurinol, amifostine, amino- phylline, amiodarone, ampicillin, amri- none, atropine, aztreonam, betamethasone, calcium gluconate, cephalothin, cephapirin, chlordiazePOX- IDE, chlorproMAZINE, ciprofloxacin, cladribine, cyanocobalamin, dexametha- sone, digoxin, diltiaZEM, diphenhydr- AMINE, DOBUTamine, DOPamine, dro- peridol, edrophonium, enalaprilat, EPINEPHrine, esmolol, estrogens, ethac- rynate, famotidine, fentaNYL, filgrastim, fludarabine, fluorouracil, furosemide, gallium, granisetron, heparin, hydrALA- ZINE, IDArubicin, indomethacin, insulin (regular), isoproterenol, kanamycin, labetalol, lidocaine, LORazepam, magne- sium sulfate, melphalan, meperidine, methicillin, methoxamine, methylergo- novine, midazolam, minocycline, mor- phine, neostigmine, norepinephrine, ondansetron, oxacillin, oxytocin, PACLi- taxel, penicillin G potassium, pentazo- cine, phytonadione, piperacillin/tazobac- tam, prednisoLONE, procainamide, prochlorperazine, propofol, proprano- lol, pyridostigmine, remifentanil, sar- gramostim, scopolamine, sodium bicar- bonate, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, tri- methaphan, trimethobenzamide, vinorel- bine, warfarin, zidovudine
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Assess: • Hyperkalemia: indicates toxicity; fatigue, muscle weakness, confusion, dyspnea, palpitation; ECG for peaking T waves, lowered R, depressed RST, pro- longed P-R interval, widening QRS complex, hyperkalemia; product should be reduced or discontinued, ad- minister sodium bicarbonate (meta- bolic acidosis); potassium level during treatment (3.5-5 mg/dL is normal level) • Determine hydration status, I&O ratio; watch for decreased urinary output; no- tify prescriber immediately • Cardiac status: rate, rhythm, CVP, PWP, PAWP if being monitored directly, if in- fused rate is higher, use cardiac monitor- ing • IV site for irritation; decrease rate if irritation occurs • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breastfeeding
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Evaluate: • Therapeutic response: absence of fa- tigue, muscle weakness; decreased thirst, urinary output; cardiac changes
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To add potassium-rich foods to diet: bananas, orange juice, avocados, whole grains, broccoli, carrots, prunes, cocoa after product is discontinued • To avoid OTC products: antacids, salt substitutes, analgesics, vitamin prepara- tions unless specifically directed by pre- scriber; to avoid licorice in large amounts because it may cause hypokale- mia, sodium retention • To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea, vomiting, fainting, decreased output) or continued hypokalemia symptoms (fa- tigue, weakness, polyuria, polydipsia, cardiac changes) • To dissolve powder or tablet com- pletely in ≥120 mL water or juice • About the importance of regular fol- low-up visits • That potassium levels will need to be monitored periodically
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PHARMACOKINETICS PO: Excreted by kidneys and in feces; onset of action ≈30 min IV: Immediate onset of action
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• Child: PO 1-2 mEq/kg/day in 1-2 di- vided doses Hypokalemia (treatment)
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• Child: IV 0.25-0.5 mEq/kg/dose at 0.25-0.5 mEq/kg/hr; PO 2-5 mEq/day in divided doses
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