|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 LIQUIDS OR EFFERVESCENT POTASSIUM PREPARATIONS OR FOR PATIENTS IN WHOM THERE IS A PROBLEM OF COMPLIANCE WITH THESE PREPARATIONS.
| Dave's key factors (reduce risk of acute GI ulceration/bleeding/vomiting):
ER Tablets/capsules: Each manufacturer of an extended dosage form (K-Dur tablets, Micro-K capsules, etc), states that the maximum single dose is 20 meq. Higher dosages should be given in divided doses. Example order: K-Dur 80 meq x 1. Recommendation: change to K-Dur 20 meq q2h x 4 doses.
Oral Solutions: Very little support for doses above 50meq (given as a single dose). Must dilute solution based on manufacturer's recommendations.
| The usual dietary potassium intake by the average adult is 50 to 100 mEq per day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mEq of potassium from the total body store.
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.
| Klor-Con®: immediately dispersing extended-release oral dosage form containing 1500 mg of microencapsulated kcl equivalent to 20 mEq of K+ in a tablet.
Klor-Con® M15: 1125 mg =15 mEq of potassium in a tablet.
Klor-Con® M10: 750 mg = 10 mEq of potassium in a tablet.
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).
|Potassium depletion sufficient to cause 1 mEq/L drop in serum potassium requires a loss of about 100-200 mEq of potassium from total body store. Available in liquid, powder, or tablet form. Any form may irritate the stomach and cause vomiting. Should be taken with food or after meals to minimize GI discomfort. All solid dosage forms of potassium supplements are contraindicated in any patient in whom there is cause for arrest or delay in tablet passage through the gastrointestinal tract. In these instances, potassium supplementation should be with a liquid preparation. Slow-release preparations should be avoided in patients at high risk for potassium chloride-induced gastrointestinal lesions, i.e., patients with cardiomegaly, esophageal stricture or compression, dysphagia, recent gastric surgery, delayed intestinal transit, ulcerative bowel disease or diverticulitis. Enteric coated tablets have an unacceptably high rate of gastrointestinal symptoms (40 to 50 incidents per 100 000 patient years) and should not be used.
|Source: American Family Physician. Medications listed in order of use from most to least urgent.
Sodium polystyrene sulfonate (Kayexalate)
|Drug UPDATES: VELTASSA ™- patiromer powder, for suspension
[Drug information / PDF] Click link for the latest monograph
Dosing: Click (+) next to Dosage and Administration section (drug info link)
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
Potassium - Internet journal of internal medicine:
Peripheral administration: Maximum concentration via peripheral line is 10 mEq/100 ml. The maximum infusion rate via peripheral line is 10 mEq per hour. In neonates and pediatrics, the maximum infusion rate via peripheral line is 0.5 - 1 meq/kg/hour.
Central administration: Preferred concentration via central line is 20 mEq/100 ml. The maximum concentration for fluid restricted patients is 20 mEq/50 ml. In adults, the maximum amount of KCl available in each IV minibag is 20 mEq. The maximum infusion rate via central line is 20 mEq/hr. In neonates and pediatrics, the maximum infusion rate via central line is 1 meq/kg/hour.
Monitoring: potassium levels must be checked after a total of 60 mEq has been administered. Potassium levels must be checked no sooner than 60 minutes after a given IV dose. In neonates and pediatrics, potassium levels must be checked after a total of 1 meq/kg has been administered.
Maintenance: Adult doses from 40-100 mEq/day may be required for potassium repletion given in 2 - 4 divided doses per day. In the neonate and pediatric patient, 1-3 meq/kg/day may be required for potassium repletion given in 2 - 4 divided doses per day. In adults, start with 20-40 mEq/day and titrate to desired level.
Dose / Maximum (acute): A 40 mEq dose may be given q2h for a max of 120 mEq within a 6 hour period. In the neonate, start with 0.5 - 1 meq/kg/day and titrate to desired level with the maximum dose of 3 meq/kg within a 6 hour period.
Maximum (oral + IV): When oral potassium therapy is combined with parenteral supplementation for adults, a maximum total dose (IV + PO) is 120 mEq within a 6 hour period. For the neonate, a maximum total dose (IV + PO) is 3 meq/kg within a 6 hour period.
Do not use sustained release potassium products, (e.g., KDur™) when an immediate response is desired. The potassium chloride powder, dissolved in water, or potassium chloride solution, should be used for a quicker response.
Monitoring: Potassium levels must be checked after each replacement dose. If using immediate release preparations (KCl powder), 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. Patients receiving maintenance doses of oral potassium do not require levels after each dose.
Requirements: Normal daily requirements: Oral, IV: 40-80 mEq/day. Prevention of hypokalemia during diuretic therapy: Oral: 20-40 mEq/day in 1-2 divided doses.
Treatment of hypokalemia:
Potassium >2.5 mEq/L:
Oral: 60-80 mEq/day plus additional amounts if needed
IV: 10 mEq q1h prn.
Potassium <2.5 mEq/L:
Oral: Up to 40-60 mEq initial dose, followed by further doses based on lab values
IV: Up to 40 mEq over 1 hour, with doses based on frequent lab monitoring; deficits at a plasma level of 2 mEq/L may be as high as 400-800 mEq of potassium.
National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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