Potassium chlorideNursing considerations

Side effects by what to assess

Sources: [1][2][3][4]

ECG (rhythm and QT interval)

Why

Hyperkalemia changes and guidance of IV therapy

When

Serial ECGs during IV therapy, especially with digitalis or cardiac or renal disease; continuous for urgent high-rate infusions

Act on

Peaked T waves, lost P waves, or ST depression suggest hyperkalemia

Sources: [1][2][3]

Magnesium

Why

Other electrolyte deficits during potassium repletion

When

During treatment of potassium depletion

Act on

Correct electrolyte deficits as appropriate

Normal

1.7 to 2.2 mg/dL.

Sources: [1][2]

Potassium

Why

Dose adjustment and hyperkalemia

When

Before and during therapy; periodically during maintenance; often in renal impairment or cirrhosis

Act on

Below 2.5 mEq/L: use IV potassium instead of oral

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2][3][4]

Serum creatinine

Why

Renal function and potassium excretion

When

Periodically, especially in older adults and renal impairment

Act on

IV potassium is contraindicated in renal failure

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2][3][4]

High-alert status

High-alert medication (IV only). Potassium chloride for injection concentrate is named on the ISMP acute care high-alert list. Oral tablets are not listed.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1][2]

Boxed warning

None on the current ER tablet or injection labels. Fatal arrhythmias from undiluted IV potassium are a labeled warning.

Sources: [1][2]

Antidote or reversal

No specific antidote; treat hyperkalemia. Stop all potassium sources, including potassium-sparing drugs. Give IV calcium gluconate if digitalis toxicity risk is low, IV dextrose with insulin, and sodium bicarbonate for acidosis; remove potassium with exchange resins or dialysis. Monitor the ECG closely. ER tablets can delay absorption and toxicity for hours.

Sources: [1][2]

Patient teaching

• Take each dose with a meal and a full glass of water
• Swallow tablets whole; do not crush, chew, or suck them
• An empty wax tablet shell may appear in the stool; this does not mean the drug did not work
• Report black, tarry stools or other signs of GI bleeding
• Tell the prescriber if you use a salt substitute; many contain potassium
• Keep appointments for potassium blood tests

Sources: [1][2][3]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Hypokalemia treatment, oral

Typically 40 to 100 mEq per day in divided doses, no more than 20 mEq per dose.

Hypokalemia prevention, oral

Typically 20 mEq per day.

IV, potassium above 2.5 mEq/L

Up to 10 mEq/hour at a concentration up to 40 mEq/L; maximum 200 mEq per 24 hours.

IV, urgent (below 2.0 mEq/L with ECG changes or paralysis)

Up to 40 mEq/hour with continuous cardiac monitoring; up to 400 mEq per 24 hours.

Sources: [1][2]

Renal adjustment

Start at the low end of the oral range, especially with RAAS inhibitors or NSAIDs, because reduced excretion sharply raises hyperkalemia risk. Monitor potassium often and renal function periodically. IV potassium is contraindicated in renal failure.

Sources: [1][2]

Hepatic adjustment

Cirrhosis: start at the low end of the dosing range and check potassium often. Serum potassium rose to about twice the normal response after an oral load.

Sources: [1]

Mechanism

Replaces potassium, the main cation inside cells. Potassium maintains cell tonicity, nerve impulse transmission, and contraction of cardiac, skeletal, and smooth muscle, and supports normal kidney function. Normal plasma potassium is 3.5 to 5 mEq per liter. Chloride replacement also helps correct metabolic alkalosis.

Sources: [1][2][3]