>10%: Gastrointestinal: Diarrhea, nausea, stomach pain, flatulence, vomiting (oral)

1% to 10%:

Cardiovascular: Bradycardia

Endocrine & metabolic: Hyperkalemia

Local: Local tissue necrosis with extravasation, pain at the site of injection

Neuromuscular & skeletal: Weakness

Respiratory: Dyspnea

<1%: Abdominal pain, alkalosis, arrhythmia, chest pain, heart block, hypotension, mental confusion, paralysis, paresthesia, phlebitis, rash, throat pain

Symptoms of overdose include muscle weakness, paralysis, peaked T waves, flattened P waves, prolongation of QRS complex, ventricular arrhythmias

Removal of potassium can be accomplished by various means; removal through the GI tract with Kayexalate® administration; by way of the kidney through diuresis, mineralocorticoid administration or increased sodium intake; by hemodialysis or peritoneal dialysis; or by shifting potassium back into the cells by insulin and glucose infusion or sodium bicarbonate; calcium chloride reverses cardiac effects.

Y-site administration: Compatible: Acyclovir, alatrofloxacin, aldesleukin, allopurinol, amifostine, aminophylline, amiodarone, ampicillin, atropine, aztreonam, betamethasone sodium phosphate, calcium gluconate, chlordiazepoxide, chlorpromazine, ciprofloxacin, cisatracurium, cladribine, clarithromycin, cyanocobalamin, dexamethasone sodium phosphate, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin liposome, droperidol, edrophonium, enalaprilat, epinephrine, esmolol, estrogens (conjugated), ethacrynate, etoposide, famotidine, fentanyl, fentanyl and droperidol, filgrastim, fludarabine, fluorouracil, furosemide, gatifloxacin, gemcitabine, granisetron, heparin, hydralazine, idarubicin, inamrinone, indomethacin, insulin (regular), isoproterenol, kanamycin, labetalol, lidocaine, linezolid, lorazepam, magnesium sulfate, melphalan, menadiol, meperidine, methoxamine, methylergonovine, midazolam, milrinone, minocycline, morphine, neostigmine, norepinephrine, ondansetron, oxacillin, oxytocin, paclitaxel, penicillin G potassium, pentazocine, phytonadione, piperacillin/tazobactam, procainamide, prochlorperazine edisylate, propofol, propranolol, pyridostigmine, remifentanil, sargramostim, scopolamine, sodium bicarbonate, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, tirofiban, trimethaphan, trimethobenzamide, vinorelbine, warfarin, zidovudine. Incompatible: Amphotericin B cholesteryl sulfate complex, diazepam, ergotamine, phenytoin. Variable (consult detailed reference): Methylprednisolone sodium succinate, promethazine

Compatibility when admixed: Compatible: Aminophylline, amiodarone, atracurium, bretylium, calcium gluconate, cefepime, ceftazidime, chloramphenicol, cimetidine, ciprofloxacin, clindamycin, corticotropin, cytarabine, dimenhydrinate, dopamine, enalaprilat, erythromycin lactobionate, floxacillin, fluconazole, foscarnet, fosphenytoin, furosemide, heparin, hydrocortisone sodium succinate, hydrocortisone sodium succinate with isoproterenol, lidocaine, metaraminol, methyldopate, metoclopramide, mitoxantrone, nafcillin, norepinephrine, oxacillin, penicillin G potassium, penicillin G potassium with vitamin B complex with C, phenylephrine, piperacillin, propafenone, ranitidine, sodium bicarbonate, thiopental, vancomycin, verapamil, vitamin B complex with C. Incompatible: Amphotericin B. Variable (consult detailed reference): Amikacin, dobutamine, etoposide with cisplatin and mannitol, penicillin G sodium

Absorption: Well absorbed from upper GI tract

Distribution: Enters cells via active transport from extracellular fluid

Excretion: Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed

Normal daily requirements: Oral, I.V.:

Premature infants: 2-6 mEq/kg/24 hours

Term infants 0-24 hours: 0-2 mEq/kg/24 hours

Infants >24 hours: 1-2 mEq/kg/24 hours

Children: 2-3 mEq/kg/day

Adults: 40-80 mEq/day

Prevention during diuretic therapy: Oral:

Children: 1-2 mEq/kg/day in 1-2 divided doses

Adults: 20-40 mEq/day in 1-2 divided doses

Treatment of hypokalemia: Children:

Oral: 1-2 mEq/kg initially, then as needed based on frequently obtained lab values. If deficits are severe or ongoing losses are great, I.V. route should be considered.

I.V.: 1 mEq/kg over 1-2 hours initially, then repeated as needed based on frequently obtained lab values; severe depletion or ongoing losses may require >200% of normal limit needs

I.V. intermittent infusion: Dose should not exceed 1 mEq/kg/hour, or 40 mEq/hour; if it exceeds 0.5 mEq/kg/hour, physician should be at bedside and patient should have continuous ECG monitoring; usual pediatric maximum: 3 mEq/kg/day or 40 mEq/m²/day

Treatment of hypokalemia: Adults:

I.V. intermittent infusion: 5-10 mEq/hour (continuous cardiac monitor recommended for rates >5 mEq/hour), not to exceed 40 mEq/hour; usual adult maximum per 24 hours: 400 mEq/day.

Potassium dosage/rate of infusion guidelines:

Serum potassium >2.5 mEq/L: Maximum infusion rate: 10 mEq/hour; maximum concentration: 40 mEq/L; maximum 24-hour dose: 200 mEq

Serum potassium <2.5 mEq/L: Maximum infusion rate: 40 mEq/hour; maximum concentration: 80 mEq/L; maximum 24-hour dose: 400 mEq

Potassium >2.5 mEq/L:

Oral: 60-80 mEq/day plus additional amounts if needed

I.V.: 10 mEq over 1 hour with additional doses if needed

Potassium <2.5 mEq/L:

Oral: Up to 40-60 mEq initial dose, followed by further doses based on lab values

I.V.: 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

Parenteral: Potassium must be diluted prior to parenteral administration; maximum recommended concentration (peripheral line): 80 mEq/L; maximum recommended concentration (central line): 150 mEq/L or 15 mEq/100 mL; in severely fluid-restricted patients (with central lines): 200 mEq/L or 20 mEq/100 mL has been used; maximum rate of infusion, see Dosage, I.V. intermittent infusion

Oral: Wax matrix tablets must be swallowed and not allowed to dissolve in mouth.

Capsule, extended release: 10 mEq [800 mg]

microK® [microencapsulated]: 8 mEq [600 mg]

microK® 10 [microencapsulated]: 10 mEq [800 mg]

Infusion [premixed in D5W]: 20 mEq (1000 mL); 30 mEq (1000 mL); 40 mEq (1000 mL)

Infusion [premixed in D5W and LR]: 20 mEq (1000 mL); 30 mEq (1000 mL)

Infusion [premixed in D5W and ¹/4NS]: 10 mEq (500 mL, 1000 mL); 20 mEq (1000 mL); 30 mEq (1000 mL); 40 mEq (1000 mL)

Infusion [premixed in D5W and ¹/2NS]: 20 mEq (1000 mL); 40 mEq (1000 mL)

Infusion [premixed in D5 and NS]: 20 mEq (1000 mL); 40 mEq (1000 mL)

Infusion [premixed in D5W and sodium chloride 0.3%]: 10 mEq (500 mL); 20 mEq (1000 mL)

Infusion [premixed in NS]: 20 mEq (1000 mL); 40 mEq (1000 mL)

Infusion [premixed in SWFI]: 10 mEq (50 mL, 100 mL); 20 mEq (50 mL, 100 mL); 30 mEq (100 mL); 40 mEq (100 mL)

Injection, solution [concentrate]: 2 mEq/mL (5 mL, 10 mL, 15 mL, 20 mL, 250 mL)

Powder, for oral solution: 20 mEq/packet (30s, 100s, 1000s)

K+ Care®: 20 mEq/packet (30s) [fruit or orange flavor]

K-Lor®: 20 mEq/packet (30s, 100s)

Kay Ciel® 10%: 20 mEq/packet (30s, 100s) [sugar free]

Klor-Con®: 20 mEq/packet (30s, 100s) [sugar free]

Klor-Con®/25: 25 mEq/packet (30s, 100s) [sugar free]

Solution, oral: 20 mEq/15 mL (480 mL); 40 mEq/15 mL (480 mL)

Kaon-Cl® 20: 40 mEq/15 mL (480 mL) [sugar free; contains alcohol; cherry flavor]

Kay Ciel®: 10%: 20 mEq/15 mL (120 mL, 480 mL) [sugar free; contains alcohol]

Rum-K®: 20 mEq/10 mL (480 mL) [alcohol free, sugar free; butter/rum flavor]

Tablet, extended release: 8 mEq [600 mg]; 10 mEq [800 mg]; 20 mEq [1500 mg]

K+8: 8 mEq [600 mg]

K+10: 10 mEq [800 mg]

K-Dur® 10 [microencapsulated]: 10 mEq [800 mg]

K-Dur® 20 [microencapsulated]: 20 mEq [1500 mg; scored]

K-Tab®: 10 mEq [800 mg]

Kaon-Cl® 10 [film coated]: 10 mEq [800 mg

Klor-Con® 8: 8 mEq [600 mg; wax matrix]

Klor-Con® 10: 10 mEq [800 mg; wax matrix]

Klor-Con® M10 [microencapsulated]: 10 mEq [800 mg]

Klor-Con® M15 [microencapsulated]: 15 mEq [1125 mg]

Klor-Con® M20 [microencapsulated]: 20 mEq [1500 mg; scored]

Tablet, slow release [film coated] (Klotrix®): 10 mEq [800 mg; wax matrix]

Hamill RJ, Robinson LM, Wexler HR, et al, "Efficacy and Safety of Potassium Infusion Therapy in Hypokalemic Critically Ill Patients,"Crit Care Med, 1991, 19(5):694-9.

Khilnani P, "Electrolyte Abnormalities in Critically Ill Children,"Crit Care Med, 1992, 20(2):241-50.

Joint Commission on Accreditation of Healthcare Organizations, "2005 National Patient Safety Goals," available at http://www.jcaho.org/accredited+organizations/patient+safety/05_npsg_guidelines Last accessed October 15, 2004.