POTASSIUM CHLORIDE, POTASSIUM GLUCONATE

Chemistry - Potassium chloride occurs as either white, granular powder or as colorless, elongated, prismatic or cubical crystals. It is odorless and has a saline taste. One gram is soluble in about 3 mlof water and is insoluble in alcohol. The pH of the injection ranges from 4-8. One gram ofpotassium chloride contains 13.4 mEq of potassium. A 2 mEq/ml solution has an osmolarity of4000 mOsm/L. Potassium chloride may also be known as KCl.
Potassium gluconate occurs as white to yellowish white, crystalline powder or granules. It isodorless and has a slightly bitter taste and is freely soluble in water. One gram of potassium gluconate contains 4.3 mEq of potassium.

Storage, Stability, Compatibility

Potassium gluconate oral products should be stored in tight, light resistant containers at room temperature (15-30°C), unless otherwise instructed by the manufacturer.
Unless otherwise directed by the manufacturer, potassium chloride products should be stored intight, containers at room temperature (15-30°C); protect from freezing.
Potassium chloride for injection is reportedly compatible with the following intravenous solutions and drugs (as an additive): All commonly used intravenous replacement fluids (not 10% fatemulsion), aminophylline, amiodarone HCl, bretylium tosylate, calcium gluconate, carbenicillindisodium, cephalothin sodium, cephapirin sodium, chloramphenicol sodium succinate, cimetidine
HCl, clindamycin phosphate, corticotropin (ACTH), cytarabine, dimenhydrinate, dopamine HCl, erythromycin gluceptate/lactobionate, heparin sodium, hydrocortisone sodium succinate, isoproterenol
HCl, lidocaine HCl, metaraminol bitartrate, methicillin sodium, methyldopate HCl, metoclopramide HCl, nafcillin sodium, norepinephrine bitartrate, oxacillin sodium, oxytetracycline
HCl, penicillin G potassium, phenylephrine HCl, piperacillin sodium, sodium bicarbonate, tetracycline HCl, thiopental sodium, vancomycin HCl, verapamil HCl, and vitamin B-complex with
C.Potassium chloride for injection compatibility information conflicts or is dependent on diluentor concentration factors with the following drugs or solutions: fat emulsion 10%, amikacin sulfate, dobutamine HCl, methylprednisolone sodium succinate (at Y-site), penicillin G sodium, andpromethazine HCl (at Y-site). Compatibility is dependent upon factors such as pH, concentration, temperature and diluents used. It is suggested to consult specialized references (e.g., Handbook on
Injectable Drugs by Trissel; see bibliography) for more specific information.
Potassium chloride for injection is reportedly incompatible with the following solutions ordrugs: amphotericin B, diazepam (at Y-site), and phenytoin sodium (at Y-site).

Pharmacology - POTASSIUM CHLORIDE, POTASSIUM GLUCONATE

Potassium is the principal intracellular cation in the body. It is essential inmaintaining cellular tonicity; nerve impulse transmission; smooth, skeletal and cardiac musclecontraction; and maintenance of normal renal function. Potassium is also used in carbohydrateutilization and in protein synthesis.

Uses, Indications

Potassium supplementation is used to prevent or treat potassium deficits.
When feasible and appropriate, oral or nutritional therapy is generally preferred over parenteralpotassium administration, because it is generally safer.

Pharmacokinetics - POTASSIUM CHLORIDE, POTASSIUM GLUCONATE

Potassium is primarily (80-90%) excreted via the kidneys with the majority ofthe remainder excreted in the feces. Very small amounts may be excreted in perspiration (in animalswith sweat glands).
Contraindications/Precautions - Potassium salts are contraindicated in patients with hyperkalemia, renal failure or severe renal impairment, severe hemolytic reactions, untreated Addison'sdisease, and acute dehydration. Solid oral dosage forms should not be used in patients where GImotility is impaired. Use cautiously in digitalized patients (see Drug Interactions).
Because potassium is primarily an intracellular electrolyte, serum levels may not adequately reflectthe total body stores of potassium. Acid-base balance may also mask the actual potassium picture.
Patients with systemic acidosis conditions may appear to have hyperkalemia when in fact they maybe significantly low in total body potassium. Conversely, alkalosis may cause a falsely low serumpotassium value. Assess renal and cardiac function prior to therapy and closely monitor serumpotassium levels. Supplementation should generally occur over 3-5 days to allow equilibration tooccur between extracellular and intracellular fluids. Some clinicians feel that if acidosis is present, use potassium acetate, citrate or bicarbonate; and if alkalosis is present, use potassium chloride.

Adverse Effects, Warnings

The major problem associated with potassium supplementation is thedevelopment of hyperkalemia. Symptoms associated with hyperkalemia can range from muscularweakness and/or GI disturbances to cardiac conduction disturbances. Clinical symptoms can beexacerbated by concomitant hypocalcemia, hyponatremia, or acidosis. Intravenous potassium saltsmust be diluted before administering and given slowly (see Doses).
Oral therapy can cause GI distress and IV therapy may be irritating to veins.

Overdosage, Acute Toxicity

Fatal hyperkalemia may develop if potassium salts are administeredtoo rapidly IV or if potassium renal excretory mechanisms are impaired. Symptoms associated withhyperkalemia are noted in the Adverse Effects section above. Treatment of hyperkalemia isdependent upon the cause and/or severity of the condition and can consist of: discontinuation of thedrug with ECG, acid/base and electrolyte monitoring, glucose/insulin infusions, sodium bicarbonate, calcium therapy, and polystyrene sulfonate resin. It is suggested to refer to other referencesappropriate for the species being treated for specific protocols for treatment of hyperkalemia.

Drug Interactions

Potassium retention may occur when potassium is given with angiotensinconverting enzyme inhibitors (e.g., captopril, enalapril) or with potassium-sparingdiuretics (e.g., spironolactone).
In patients with severe or complete heart block who are receiving digitalis therapy, potassiumsalts are not recommended to be used.
Oral potassium given with non-steroidal antiinflammatory agents, or anticholinergicagents may increase the risk of gastrointestinal adverse effects occurring.
Glucocorticoids, mineralocorticoids, or ACTH may cause increased renal losses of potassium.