II. Indications

III. Precautions

  1. Adjust protocol for renal disease
    1. Oliguria: Urine Output < 30 ml/hour
    2. Renal Failure: Serum Creatinine > 3.0 mg/dl

IV. Preparations

  1. Extended release Potassium tablets (preferred)
    1. Order generic Potassium chloride ER ($15 per month)
    2. KDUR brand-name is not available in U.S. as of 2016
  2. Immediate-release Potassium powder
    1. Expensive ($290 per month)
    2. Diluted in liquid and are less than palatable
    3. Better tolerated in divided dosing (20 mEq at a time)
    4. Indicated in patients with Feeding Tubes and those with Delayed Gastric Emptying
  3. References
    1. (2016) Presc Lett 23(4): 23

V. Management: Oral Potassium Replacement

  1. Dietary Sources: Fruits and Vegetables
    1. See Foods with High Potassium Content
    2. May supply 40-60 meq/day
      1. However 40 meq is equivalent to 4 bananas which may be difficult to sustain
    3. Dietary Potassium (Potassium phosphate) is less effective replacement than KCl
      1. Most Hypokalemia is associated with concurrent chloride depletion
  2. Oral KCl powder 20 meq in water or juice or KCl tablets
    1. Serum Potassium < 3.0
      1. Give KCl 20 meq orally every 2 hours for 4 doses
    2. Serum Potassium: 3.0 to 3.5
      1. Give KCl 20 mEq orally every 2 hours for 2 doses OR
      2. KCl 40 mEq once
  3. Maintenance dosing
    1. KCl 20 mEq orally daily when on Loop Diuretics or for Hyperaldosteronism

VI. Management: IV Potassium Replacement

  1. IV Preparations
    1. Potassium Chloride (KCl) 10 meq IV "K bump"
    2. Potassium Chloride (KCl) 20 meq use is limited to delivery via Central IV Access
  2. IV Replacement Algorithm
    1. Use 10 meq KCl IV in 50ml solution over 30 minutes minimum
      1. Dextrose containing IV solution not recommended
        1. Risk of Insulin induced exacerbation of Hypokalemia
      2. In select situations, may give up to 40 meq in 1 hr
      3. Example indication for faster delivery: DKA
      4. Cardiac monitoring if replacing >10 mEq per hour
      5. Recheck Serum Potassium after 30 mEq given
    2. Serum Potassium < 3.0
      1. Give KCl 10 meq IV slowly every hour for 5 doses
    3. Serum Potassium: 3.0 to 3.5
      1. Give KCl 10 meq IV slowly every hour for 3 doses

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Ontology: Potassium supplementation (C0561938)

Concepts Pharmacologic Substance (T121)
SnomedCT 284093001
Dutch kaliumsupplement
French Apport complémentaire de potassium
German Kaliumpraeparat
Italian Integrazione di potassio
Portuguese Administração de suplemento de potássio
Spanish Aportación suplementaria de potasio, suplemento de potasio, suplementación con potasio, suplemento con potasio (producto), suplemento con potasio, suplemento de potasio (producto)
Japanese カリウム補給, カリウムホキュウ
Czech Suplemetace draslíku
Hungarian Kálium kiegészítés
English Potassium supplementation, Potassium supplementation (product), Potassium supplementation (substance)

Ontology: Potassium replacement (C0920228)

Concepts Therapeutic or Preventive Procedure (T061)
Dutch kaliumvervanging
French Potassium supplétif
German Kaliumsubstitution
Italian Reintegrazione di potassio
Portuguese Substituição de potássio
Spanish Suplemento de potasio
Japanese カリウム補充, カリウムホジュウ
Czech Substituce draslíku
English potassium replacement, Potassium replacement
Hungarian Káliumpótlás