Potassium supplements

Monitoring
If using immediate release preparations (KCl powder, soln or IV dose), a level should be checked no sooner than 60 minutes. If using a sustained release product, a level should be checked no sooner than 3 hours. Levels should be checked for each 60meq of K+ administered.

Dosage must be adjusted to the individual needs of each patient. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day.

Doses of 40-100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose. The dose should be taken after a meal.

 Preparation: Each 20 mEq (one K-LOR mEq packet) of potassium should be dissolved in at least 4 oz cold water or juice.

These formulations are intended to slow the release of potassium so that the likelihood of a high localized concentration of potassium chloride within the gastrointestinal tract is reduced.

Klor-Con® M should be discontinued immediately and the possibility of ulceration, obstruction or perforation considered if severe vomiting, abdominal pain, distention or gastrointestinal bleeding occurs. Doses of 40-100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose.

INDICATIONS AND USAGE: BECAUSE OF REPORTS OF INTESTINAL AND GASTRIC ULCERATION AND BLEEDING WITH EXTENDED-RELEASE POTASSIUM CHLORIDE PREPARATIONS, THESE DRUGS SHOULD BE RESERVED FOR THOSE PATIENTS WHO CANNOT TOLERATE OR REFUSE TO TAKE LIQUID OR EFFERVESCENT POTASSIUM PREPARATIONS OR FOR PATIENTS IN WHOM THERE IS A PROBLEM OF COMPLIANCE WITH THESE PREPARATIONS. Gastrointestinal Lesions --Solid oral dosage forms of potassium chloride can produce ulcerative and/or stenotic lesions of the gastrointestinal tract. Based on spontaneous adverse reaction reports, enteric coated preparations of potassium chloride are associated with an increased frequency of small bowel lesions (40-50 per 100,000 patient years) compared to extended-release wax matrix formulations (less than one per 100,000 patient years).

Calcium gluconate
Dosage:  10 to 20 mL of 10 percent solution IV over two to three minutes.
Onset: Immediate
Length of effect: 30 minutes
MOA: Protects myocardium from toxic effects of potassium; no effect on serum potassium level.
Cautions: Can worsen digoxin toxicity.

Regular insulin
Dosage:  Regular insulin 10 units IV with 50 mL of 50 percent glucose
Onset: 15 to 30 minutes
Length of effect: Two to six hours
MOA: Shifts potassium out of the vascular space and into the cells; no effect on total body potassium.
Cautions: Consider 5 percent dextrose solution infusion at 100 mL per hour to prevent hypoglycemia with repeated doses. Glucose unnecessary if blood sugar elevated above 250 mg per dL (13.9 mmol per L).

Albuterol (Ventolin)
Dosage:  10 to 20 mg by nebulizer over 10 minutes (use concentrated form, 5 mg per mL).
Onset: 15 to 30 minutes
Length of effect: Two to three hours
MOA: Shifts potassium into the cells, additive to the effect of insulin; no effect on total body potassium.
Cautions: May cause a brief initial rise in serum potassium

Furosemide (Lasix)
Dosage:  20 to 40 mg IV, give with saline if volume depletion is a concern
Onset: 15 minutes to one hour
Length of effect: Four hours
MOA: Increases renal excretion of potassium
Cautions: Only effective if adequate renal response to loop diuretic.
Excretion of renal potassium can be increased with the use of diuretics, particularly loop diuretics (e.g., furosemide). Patients with decreased kidney function may be relatively resistant to the effects of diuretics. If the patient is volume depleted, saline can be given with the diuretic. Hemodialysis or continuous renal replacement therapy are the treatments of last resort, with the exception of patients already receiving these therapies.

Sodium polystyrene sulfonate (Kayexalate)
Dosage:  Oral: 50 g in 30 mL of sorbitol solution. Rectal: 50 g in a retention enema.
Onset: One to two hours (rectal route is faster)
Length of effect: Four to six hours
MOA: Removes potassium from the gut in exchange for sodium
Cautions: Sorbitol may be associated with bowel necrosis. May lead to sodium retention.
Gastrointestinal excretion is accomplished using sodium polystyrene sulfonate (Kayexalate), which binds potassium in the colon in exchange for sodium; it can be given orally or as a retention enema. The enema form is faster; the oral route can take four to six hours because it requires the resin to get to the colon before it takes effect. Sodium polystyrene sulfonate often is given with sorbitol to decrease constipation. However, sorbitol can have intestinal complications, with reports of bowel necrosis and perforation in immunocompromised patients. Using furosemide (Lasix) with polystyrene reduces the risk of volume overload because of the sodium that is exchanged for potassium by the resin.

Initial U.S. Approval:  2015

Mechanism of Action: Veltassa is a non-absorbed, cation exchange polymer that contains a calcium-sorbitol counterion.

Veltassa increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels.

INDICATIONS AND USAGE:  Veltassa is indicated for the treatment of hyperkalemia.

Limitation of Use: Veltassa should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action

HOW SUPPLIED:
Veltassa is an off-white to light-brown powder for oral suspension packaged in single-use packets containing 8.4 grams, 16.8 grams or 25.2 grams patiromer.