Potassium

B05B - I.V. solutions ATC A06AD65 Small molecule Natural product

JFDA label: Movicol Sachets

Mechanism of Action

Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion

Indications

Approved

Hypokalemia

Contraindications

Source: Lexicomp

Severe renal impairment or adrenal insufficiency Absolute
hyperkalemia Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (5)

Not Known Cardiac arrhythmia · heart block · hypotension · paralysis · paresthesia

Nervous system disorders (3)

Not Known Abnormal electroencephalogram · confusion · lethargy

Musculoskeletal and connective tissue disorders (1)

Not Known Weakness

General disorders and administration site conditions (1)

Not Known Local tissue necrosis (with extravasation)

Dosing

Source: Lexicomp

Note: When maintaining normal daily requirements, IV doses should be incorporated into the patient's maintenance IV fluids. Intermittent IV potassium administration should be reserved for more severe depletion situations in patients undergoing ECG monitoring. Doses expressed as mEq of potassium. Hypokalemia, treatment: 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 highly recommended 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 guided by patient condition and specific institutional guidelines. As an estimate, 10 mEq of potassium will roughly increase serum levels by 0.1 mEq/L. Patients with more severe forms of hypokalemia (eg, serum potassium levels 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

(For additional information see "Potassium acetate: Pediatric drug information") Maintenance potassium should be incorporated into the patient's maintenance IV fluids; intermittent IV potassium administration should be reserved for severe depletion situations; continuous ECG monitoring should be used for intermittent doses >0.5 mEq/kg/hour. Acid/base balance should be considered when selecting a potassium salt for maintenance therapy or treatment of hypokalemia; acetate is converted to bicarbonate in the body and may affect serum pH. High variability exists in dosing/infusion rate recommendations; therapy guided by patient condition and specific institutional guidelines. Doses expressed as mEq of potassium. Note: Use caution in premature neonates; potassium acetate for injection contains aluminum. Hypokalemia (severe) treatment: 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 (Corkins 2015; Fuhrman 2017; Kliegman 2016); serum concentrations should be evaluated 1 to 2 hours after completion of infusion; may repeat as needed based on lab values; severe depletion or ongoing losses may require >200% of normal daily maintenance.

Refer to adult dosing.

Reduce initial dose by at least 50% in patients with renal impairment (Kraft 2005). Potassium acetate administration may also increase serum aluminum and bicarbonate. Contraindicated in patients with renal failure.

There are no dosage adjustment provided in the manufacturer's labeling. Use with caution due to impaired liver utilization of bicarbonate.

Warnings & Precautions

Source: Lexicomp

Extravasation

Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.

Hyperkalemia

Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole). Disease-related concerns:

Acid/base disorders

Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely. In patients with metabolic or respiratory alkalosis, use with caution since use of potassium acetate may worsen alkalosis depending on the amount administered (Khanna 2006).

Cardiovascular disease

Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.

Potassium-altering conditions/disorders

Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).

Renal impairment

Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated with severe impairment. Concurrent drug therapy issues:

Digitalis

Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.

Potassium-altering therapies

Use with caution in patients receiving concomitant medications or therapies that increase potassium (eg, ACEIs, potassium-sparing diuretics, potassium containing salt substitutes). Dosage form specific issues:

Aluminum

The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling. Other warnings/precautions:

Parenteral administration

Use extreme caution with parenteral administration and monitor serum potassium concentrations closely. Evaluate renal function, cardiac and fluid status, and any factors contributing to altered potassium concentrations (eg, acidosis, alkalosis) prior to therapy. Do NOT administer undiluted or IV push; inappropriate parenteral administration may be fatal. Always administer potassium further diluted; refer to appropriate dilution and administration rate recommendations. Pain and phlebitis may occur during parenteral infusion requiring a decrease in infusion rate or potassium concentration.

Pregnancy & Lactation

Pregnancy

FDA category C

Animal reproduction studies have not been conducted. Potassium requirements are the same in pregnant and nonpregnant women. Adverse events have not been observed following use of potassium supplements in healthy women with normal pregnancies. Use caution in pregnant women with other medical conditions (eg, pre-eclampsia; may be more likely to develop hyperkalemia) (IOM 2004).

Lactation

Potassium is excreted into breast milk (IOM 2004).

Monitoring

Clinical pearl	Electrolytes (including serum potassium, bicarbonate, and magnesium), acid/base status; cardiac monitor (if intermittent infusion or potassium infusion rates 0.5 mEq/kg/hour in children or >10 mEq/hour in adults); to assess adequate replacement, repeat serum potassium level 2 to 4 hours after dose. Monitor IV infusion site for extravasation.

Chemistry & Properties

Formula	K
Molecular weight	39.1 g/mol
IUPAC name	potassium
CAS	7440-09-7
PubChem CID	5462222
InChIKey	`ZLMJMSJWJFRBEC-UHFFFAOYSA-N`

SMILES

[K]

Biology & Pharmacokinetics

Pharmacokinetics

Registered Products (16)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
Apectrolyte	Cream 1.5 g, 3.5 g, 2.9 g, 20 g	28.2gm	Sahar Drug Store	0.150
Babylyte	Solution 2.045 g, 0.98 g, 2.1620 g, 25 g	240 ml	Sabbagh Drug Store	1.020
Potassium Chloride Oral Sol.	Solution 4 mg/ml	100 ml	The Arab Pharmaceutical Manufactruing Co.	1.250
ORS New	Tablet 0.30 g, 0.52 g, 2.7 g, 0.58 g	10 tab	Reda Jardaneh Drug Store	1.540
Oral Rehydration salts(ORS) Powder	Powder 1.5 g, 3.5 g, 20 g, 2.9 g	1 sachet	Reda Jardaneh Drug Store	3.930
Sopa-K Syrup	Syrup 312 mg/ml	200 ml	AL Rahma Drug Store	4.450
Movicol Sachets	Sachet 0.047 g, 0.178 g, 0.351 g, 13.125 g	20 sachet	Khoury Drug Store	5.500
Pharmaton Capsules	Capsule 20 mg, 15 mg, 10 mg, 60 mg, 400 IU, 2 mg, 4000 IU, 1 mcg, 90.3 mg, 1 mg, 10 mg, 1 mg, 10 mg, 40 mg, 10 mg, 1 mg, 2 mg, 8 mg, 66 mg, 1 mg, 26 mg, 70 mg, 0.2 mg	30 cap	THE ARAB DRUG STORE P.S.C	6.700
Fortrans	Sachet 0.75 g, 1.680 g, 1.460 g, 64 g, 5.700 g	4 sachet	Abu Sharef Medical Stores	8.190
Moviprep	Sachet 1.015 g, 2.691 g, 4.7 g, 100 g, 5.9 g, 7.5 g	2 sachet	Khoury Drug Store	9.240
Uralyt (U) granules	Granules 2.4 g/2.5 g	280 g	Khoury Drug Store	10.870
Cardioplegia INF	Ampoule 5.965 %, Hexahydrate 16.265 %, 1.364 %	10 amp	AL Razi Drug Store	—
Olimel N12E	Solution Alanine 10.99 g/1000 ml, Arginine 7.44 g/1000 ml, L-Aspartic acid 2.20 g/1000 ml, Glutamic acid 3.79 g/1000 ml, Glycine 5.26 g/1000 ml, HISTIDINE 4.53 g/1000 ml, isoleucine 3.79 g/1000 ml, Leucine 5.26 g/1000 ml, Lysine acetate 8.43 g/1000 ml, methionine 3.79 g/1000 ml, phenylalanine 5.26 g/1000 ml, proline 4.53 g/1000 ml, Serine 3 g/1000 ml, threonine 3.79 g/1000 ml, Tryptophan 1.26 g/1000 ml, Tyrosine 0.2 g/1000 ml, valine 4.86 g/1000 ml, Sodium Acetate Trihydrate 1.5 g/1000 ml, Sodium Glycerophosphate (Liq 50 %) 3.67 g/1000 ml, Potassium Chloride 2.24 g/1000 ml, Magnesium Chloride Hexahydrate 0.81 g/1000 ml, Calcium Chloride Dihydrated 0.52 g/1000 ml, Glucose Monohydrate 80.67 g/1000 ml, Olive Oil 28 g/1000 ml, Soyabean Oil 7 g/1000 ml	1000 ml	Khoury Drug Store	—
Olimel N12E	Solution Alanine 7.14 g/650 ml, Arginine 4.84 g/650 ml, L-Aspartic acid 1.43 g/650 ml, Glutamic acid 2.46 g/650 ml, Glycine 3.42 g/650 ml, HISTIDINE 2.94 g/650 ml, isoleucine 2.46 g/650 ml, Leucine 3.42 g/650 ml, Lysine acetate 5.48 g/650 ml, methionine 2.46 g/650 ml, phenylalanine 3.42 g/650 ml, proline 2.94 g/650 ml, Serine 1.95 g/650 ml, threonine 2.46 g/650 ml, Tryptophan 0.82 g/650 ml, Tyrosine 0.13 g/650 ml, valine 3.16 g/650 ml, Sodium Acetate Trihydrate 0.97 g/650 ml, Sodium Glycerophosphate (Liq 50 %) 2.39 g/650 ml, Potassium Chloride 1.45 g/650 ml, Magnesium Chloride Hexahydrate 0.53 g/650 ml, Calcium Chloride Dihydrated 0.34 g/650 ml, Glucose Monohydrate 52.43 g/650 ml, Olive Oil 18.2 g/650 ml, Soyabean Oil 4.55 g/650 ml	650 ml	Khoury Drug Store	—
Olimel N9E	Solution Alanine 16, 48 g/2000 ml, Arginine 11, 16 g/2000 ml, L-Aspartic acid 3, 30 g g/2000 ml, Glutamic acid 5, 69 g/2000 ml, Glycine 7, 90 g/2000 ml, HISTIDINE 6, 79 g/2000 ml, isoleucine 5, 69 g/2000 ml, Leucine 7, 90 g/2000 ml, Lysine acetate 12, 64 g g/2000 ml, methionine 5, 69 g/2000 ml, phenylalanine 7, 90 g/2000 ml, proline 6, 79 g/2000 ml, Serine 4, 50 g/2000 ml, threonine 5, 69 g/2000 ml, Tryptophan 1, 90 g/2000 ml, Tyrosine 0, 30 g/2000 ml, valine 7, 29 g/2000 ml, Sodium Acetate Trihydrate 2, 99 g g/2000 ml, Sodium Glycerophosphate (Liq 50 %) 7, 34 g/2000 ml, Potassium Chloride 4, 47 g/2000 ml, Magnesium Chloride Hexahydrate 1, 62 g/2000 ml, Calcium Chloride Dihydrated 1, 03 g/2000 ml, Glucose Monohydrate 242, 00 g/2000 ml, Olive Oil 64 g/2000 ml, Soyabean Oil 16 g/2000 ml	2000 ml	Khoury Drug Store	—
PeriOlimel N4E	Solution Arginine 3.72 g/1500 ml, L-Aspartic acid 1.1 g/1500 ml, Glutamic acid 1.90 g/1500 ml, Glycine 2.63 g/1500 ml, HISTIDINE 2.26 g/1500 ml, isoleucine 1.90 g/1500 ml, Leucine 2.63 g/1500 ml, Lysine acetate 4.21 g/1500 ml, methionine 1.90 g/1500 ml, phenylalanine 2.63 g/1500 ml, proline 2.26 g/1500 ml, Serine 1.5 g/1500 ml, threonine 1.9 g/1500 ml, Tryptophan 0.64 g/1500 ml, Tyrosine 0.1 g/1500 ml, valine 2.43 g/1500 ml, Sodium Acetate Trihydrate 1.73 g/1500 ml, Sodium Glycerophosphate (Liq 50 %) 2.87 g/1500 ml, Potassium Chloride 1.79 g/1500 ml, Magnesium Chloride Hexahydrate 0.67 g/1500 ml, Calcium Chloride Dihydrated 0.440 g/1500 ml, Glucose Monohydrate 123.75 g/1500 ml, Olive Oil 45 g/1500 ml, Soyabean Oil 45 g/1500 ml, Alanine 5.5 g/1500 ml	1500 ml	Khoury Drug Store	—