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# Potassium chloride
## Overview
Potassium chloride is an essential electrolyte supplement used to treat or prevent hypokalemia. It is available in various oral formulations (immediate-release, extended-release, liquids) and intravenous (IV) preparations.
## Primary Indications
* Treatment of hypokalemia.
* Prevention of hypokalemia in patients on diuretics or during therapeutic procedures/illnesses where potassium depletion is expected.
## Adult Dosing
* **Oral (Prevention):** 20 mEq daily.
* **Oral (Mild to Moderate Hypokalemia):** 40–80 mEq daily, divided into 2–4 doses.
* **IV (General):** Typically 10–20 mEq per dose. Do not exceed 10–20 mEq/hour in peripheral lines (risk of phlebitis).
* **IV (Severe/Refractory):** Up to 40 mEq/hour may be administered via central line with continuous EKG monitoring under strict institutional protocol.
## Pediatric Dosing
* **Maintenance:** 2–3 mEq/kg/day.
* **Treatment:** Titrate based on deficit. General starting range: 1–2 mEq/kg/dose (max 40 mEq/dose).
* **Note:** Pediatric dosing is highly dependent on institutional protocols and patient-specific fluid requirements. Consult a pediatric pharmacist or current weight-based formulary.
## Dose Adjustments
* **Renal Impairment:** Reduce dose or avoid in patients with severe renal insufficiency (e.g., CrCl <30 mL/min) or anuria, as hyperkalemia may develop rapidly.
* **Hepatic Impairment:** No standard adjustment required, but use with caution.
## Contraindications
* Severe renal impairment (anuria, oliguria).
* Untreated Addison’s disease.
* Hyperkalemia.
* Acute dehydration or heat cramps.
* Concurrent use of potassium-sparing diuretics (e.g., spironolactone, amiloride) or ACE inhibitors/ARBs without close monitoring.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain. Solid oral dosage forms can cause esophageal or small bowel ulceration/stenosis.
* **Cardiovascular:** Hyperkalemia (paresthesia, cardiac arrhythmias, peaked T-waves, widening QRS).
* **Injection Site:** Phlebitis, pain, or extravasation injury.
## Key Drug Interactions
* **ACE Inhibitors/ARBs:** Increase risk of hyperkalemia.
* **Potassium-Sparing Diuretics:** Significantly increase the risk of severe hyperkalemia.
* **NSAIDs:** May increase potassium levels, especially in patients with impaired renal function.
* **Digoxin:** Hypokalemia increases risk of digitalis toxicity; monitor levels closely when correcting potassium.
## Monitoring
* **Serum Potassium:** Check baseline and monitor frequently until stable.
* **Renal Function:** Monitor BUN and serum creatinine.
* **Cardiac:** EKG monitoring for patients receiving high-dose IV potassium.
* **Clinical:** Watch for signs of hyperkalemia (muscle weakness, dysrhythmias).
## Clinical Pearls
* **IV Administration:** All IV potassium must be diluted. **Never give as an IV push or bolus**, as this can cause fatal cardiac arrest.
* **Oral Formulation:** Administer with a full glass of water and during/after meals to minimize gastric irritation. Do not crush or chew extended-release formulations.
* **Correction Calculation:** As a rough guide, a 10 mEq dose typically raises serum potassium by approximately 0.1 mEq/L, but this varies significantly based on total body stores and acid-base status.
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**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles can change; always verify current prescribing information through local institutional guidelines, package inserts, or clinical decision support tools before administration.
