Potassium Chloride: a clinical overview

Potassium Chloride: a clinical overview

GlobalRPh medical writer

Potassium chloride is vital for every cell in the human body. This essential mineral keeps the heart pumping, regulates fluids, moves the muscles smoothly, prompts the nervous system to transmit signals, ups the energy levels, and so much more.

How much potassium chloride does an adult need? About 90 mmol or 3,510 mg per day. Most people, though, fall short, which is unfortunate. Because low potassium, medically known as hypokalemia, can cause mood changes, mental and physical fatigue, cramps, and muscle aches. A severe deficiency can be life-threatening.

Supplemental potassium chloride in the form of potassium-rich foods or potassium chloride medication can help restore normal potassium levels.

Potassium – Pharmacodynamics

• • Potassium is the major cation in the intracellular fluid, constituting about 150 mEq/L. Extracellular space also contains a small amount of potassium. Under steady-state conditions, the amount of potassium absorbed from the small intestine is equivalent to the amount excreted in the urine (about 180 – 190 mg/day). An imbalance occurs when the rate of potassium loss exceeds the rate of intake.

 

• • Since most of the potassium absorption occurs in the small intestine, inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis can cause potassium deficiency. IBD reduces electrolyte absorption in the body and increases potassium loss through diarrhea.

 

• • Some medications like diuretics, corticosteroids, laxatives, and enemas contribute to potassium depletion in the body. Certain medical conditions like vomiting and diarrhea can cause the body to lose potassium. Low on potassium over an extended period of time makes one hypokalemic.

 

• Sometimes it doesn’t matter if the body has enough potassium, one may still be at risk of hypokalemia. This can happen in patients with Fanconi Syndrome, a rare kidney disorder that impairs absorption and reabsorption of potassium. Potassium salts like potassium chloride, potassium bicarbonate, potassium citrate, potassium acetate, or potassium gluconate are prescribed for such patients.
• Alcoholics, people who underwent bariatric surgery, AIDS patients, and those with eating disorders are at increased risk of developing hypokalemia.

Potassium Chloride Medication

Potassium chloride comes in two forms:
immediate-release and extended-release (ER)

1. 1. Immediate-release potassium chloride:

It usually is available in a packet (20 mEq), a bottle of oral liquid (10 or 20% w/v), and effervescent tablets (25 mEq).

1. 1. Extended-release (ER) potassium chloride:

It is available in regular tablets (8 mEq, 10 mEq, and 20 mEq) and capsules (10 mEq and 8 mEq). The ER capsules and tablets are further categorized based on the coating or capsulation method used.

I. Wax Matrix: This type of coating rules out the likelihood of too much potassium in the gastrointestinal tract.
II. Microencapsulated: This type also ensures potassium is slowly released into the gastrointestinal tract.
III. Film-Coated: A very thin layer of inactive ingredients is coated on the tablet to protect it from moisture and light. With the hydrolytic action of saliva and stomach acid easily breaks the film to empty potassium slowly into the gastrointestinal tract.

How to take potassium chloride?

1. Liquid potassium chloride

Dilute each dose in 4 ounces of cold water or juices to mask the unpleasant taste. Dilution also helps to reduce the possible laxative or stomach irritating effect of the supplement.
Patients on a sodium-restricted diet should consult the doctor before using juices to dilute liquid potassium chloride (Fruits like apple, strawberry, and cranberry have high sodium levels).

2. Soluble potassium chloride granule, powder, or tablet

Do not chew or suck on a potassium pill. It must be dissolved well in cold water or fruit juice. Allow any ‘fizzing’ to stop before drinking the medicine. Drink it slowly, over 5 to 10 minutes in all. To make sure to get the entire dose, add a little more water, swirl gently, and drink right away.

3. Extended-release potassium tablet and capsule:

Swallow them with a full glass of water or fruit juice. Do not chew, suck, or dissolve them in the mouth as they may irritate the tongue or throat. When not properly released, the medicine can irritate the stomach lining and may lead to ulcers.
Warning: Take potassium chloride exactly as directed. Talk to the doctor if instructions aren’t clear. The dosage is recommended based on the underlying medical condition and response to treatment. So, overdoing it a strict ‘no’, especially for patients taking diuretics or digitalis.

Things to discuss with the doctor before taking a Potassium chloride supplement

All medication, including prescription or over-the-counter drugs, can trigger allergies. Extended-release potassium pills may contain inactive ingredients or coating, which can elicit allergic reactions in some people. Before taking this medication, tell your doctor your medical history, especially of:

• Hypoadrenalism or Addison’s disease
• Cardiac diseases
• Kidney disorders
• Bladder infection
• Diabetes
• Ulcerative colitis or Crohn’s disease
• Potassium-restricted diet
• GIT problems such as GERD, ulcers, and constipation
• Dehydration
• Trouble swallowing and slow digestion

Pregnant women and lactating mothers should use potassium chloride only when clearly needed. Consult your doctor for dose, risks, and benefits.

Toxicity and side effect of Potassium chloride

For the most part, potassium chloride isn’t a health hazard (read: when taken as recommended), but sometimes it can irritate the gastrointestinal tract. Side effects that need immediate medical attention:

• Signs of an allergic reaction: skin rash, itching or hives, swelling of the face, lips, tongue, or abdomen.
• Trouble breathing, swallowing or talking
• Shortness of breath or chest pain
• Black or bloody stools
• tingling of the hands and feet
• Difficult or painful swallowing

This medication can cause hyperkalemia (high potassium levels in the blood) when taken higher than the recommended dose. In patients with impaired excretory mechanisms, intravenous administration of potassium chloride can result in fatal hyperkalemia. Get medical help if any of these bothers or do not go away:
• muscle cramps or weakness
• confusion, restlessness
• slow, irregular heartbeat
• nausea or vomiting

Drug Interactions

Drug interactions may change the effectiveness of the medications or increase the risk of fatal side effects. Among the 137 drugs that interact with potassium chloride, the most important (and dangerous) ones are,
1. Angiotensin-Converting Enzyme (ACE) inhibitors: Captopril (Capoten), Enalapril (Vasotec), and Lisinopril (Prinivil and Zestril).
2. Anticholinergics (drugs that block acetylcholine from causing the involuntary muscle in the gastrointestinal tract): Belladonna, Scopolamine, and Benztropine.
3. Bladder or urinary medications: Darifenacin (Enablex), Flavoxate (Urispas), Tolterodine (Detrol), or solifenacin (Vesicare).
4. Antispasmodics: Glycopyrrolate, Oxybutynin, and Morphine.
5. Cardiac medications: Quinidine and Digoxin.
6. Diuretics (water pills): Amiloride, Spironolactone, and Triamterene.
7. Aspirin and other salicylates

About storage and disposal of potassium chloride

Keep potassium pills and capsules in the package they came in, tightly closed, and out of reach of children. Store the medication at room away from direct sunlight and moisture.
Expired or unneeded medications should be discarded carefully to ensure pets or children cannot touch or consume them. Do not flush the pills down the toilet or into the drain.

Potassium chloride overdose – Is it harmful?

Potassium chloride overdose (oral and intravenous) is fatal. Symptoms of overdose may include slow heartbeat, heart attack, chest pain, troubled breathing, passing out, loss of movement, and numbness.
The recommended concentration of potassium for oral solution is 40 to 100 mEq per day. Higher concentrations are recommended in severe cases of potassium deficiency.
In the case of intravenous administration via a peripheral line, the potassium concentration is maintained at 35 to 40 mmol/L. Higher strengths are avoided as they can cause severe pain and phlebitis. Regular monitoring of cardiac functioning and infusion site is recommended to avoid fatality.

Missed a dose. What to do?

Sometimes a missed dose causes no obvious problems. But many drugs won’t work right if they aren’t taken the way you’re supposed to.
Potassium chloride is usually taken as equally spaced 2 to 5 divided doses a day. Ideally, it should be taken at the same time each day. This helps to maintain constant levels of potassium in the body.
Take the missed potassium dose as soon as you remember, then continue taking later doses as usual. In any case, taking a double dose should be avoided.
If you’ve missed more than 2 doses a day, contact the doctor immediately to avoid side effects.

Is there any special diet to follow while on Potassium pills?

In the case of clinical hypokalemia (blood potassium levels below 3.6mmol/L) eating potassium-rich food is proven to be beneficial. Potassium foods also help avoid the most common side effect of potassium supplements, which is hyperkalemia. Consuming banana, prunes, sweet potato, spinach, and milk provides a slow infusion of potassium into the circulation. That is because the fruits and veggies must digest to release potassium.

Remember,
I. Total potassium intake should not be greater than the recommended value unless advised by the doctor.
II. The total potassium that you get every day includes what you get from diet and potassium chloride pills.
III. Read labels of canned or processed foods as they have added potassium.