Contraindications
Hypersensitivity
Untreated Addison disease
Hyperkalemia
Concomitant use with triamterene and amiloride
Renal failure
Cautions
Depending on volume and rate of IV infusion, and patient’s underlying clinical condition, intravenous administration of potassium chloride in sodium chloride can cause electrolyte disturbances such as overhydration/hypervolemia and congested states including central (e.g., pulmonary edema) and peripheral edema
Solutions containing sodium ions should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there is sodium retention with edema
Administration of sodium and potassium in patients with or at risk of severe renal impairment may result in hypernatremia, hyperkalemia and/or fluid overload; avoid potassium chloride in sodium chloride Injection, USP in patients with severe renal impairment
In patients with or at risk of hyperchloremia, potassium chloride injection may exacerbate or result in hyperchloremia; monitor plasma chloride levels and renal function in such patients
If use cannot be avoided, monitor patients with severe renal impairment for development of these adverse reactions
Rapid correction of hypernatremia is potentially dangerous with risk of serious neurologic complications; excessively rapid correction of hypernatremia is also associated with a risk for serious neurologic complications such as osmotic demyelination syndrome (ODS) with risk of seizures and cerebral edema
Rapid correction of hyponatremia is potentially dangerous with risk of serious neurologic complications; brain adaptations reducing risk of cerebral edema make the brain vulnerable to injury when chronic hyponatremia is too rapidly corrected, which is known as osmotic demyelination syndrome (ODS); to avoid complications, monitor serum sodium and chloride concentrations, fluid status, acid-base balance, and signs of neurologic complications
Avoid potassium chloride in sodium chloride injection, USP in patients with or at risk for fluid and/or solute overloading; if use cannot be avoided, monitor fluid balance, electrolyte concentrations and acid base balance as needed and especially during prolonged use
Solutions containing potassium ions should be used with great care, if at all, in patients with hyperkalemia, severe renal failure, and in conditions in which potassium retention is present
The risk for hyponatremia is increased in postoperative patients, those with psychogenic polydipsia, and in patients treated with medications that increase risk of hyponatremia (such as diuretics, certain antiepileptic and psychotropic medications)
Use with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank cardiac decompensation
Extraordinary electrolyte losses such as may occur during protracted nasogastric suction, vomiting, diarrhea or gastrointestinal fistula drainage may necessitate additional electrolyte supplementation
Additional essential electrolytes, minerals and vitamins should be supplied as needed
Sodium-containing solutions should be administered with caution to patients receiving corticosteroids or corticotropin, or to other salt-retaining patients
Care should be exercised in administering solutions containing sodium or potassium to patients with renal or cardiovascular insufficiency, with or without congestive heart failure, particularly if they are postoperative or elderly
Potassium therapy should be guided primarily by serial electrocardiograms, especially in patients receiving digitalis
Serum potassium levels are not necessarily indicative of tissue potassium levels
Solutions containing potassium should be used with caution in the presence of cardiac disease, particularly when accompanied by renal disease
Potassium chloride in sodium chloride may cause hyponatremia; hyponatremia can lead to acute hyponatremic encephalopathy characterized by headache, nausea, seizures, lethargy, and vomiting; patients with brain edema are at particular risk of severe, irreversible and life-threatening brain injury
Solutions containing dextrose should be used with caution in patients with overt or known subclinical diabetes mellitus, or carbohydrate intolerance for any reason
Perform continuous cardiac monitoring in patients requiring highly concentrated solutions and perform frequent testing for serum potassium and acid-base balance, especially if they receive digitalis
Avoid potassium chloride injection in patients with or at risk for hyponatremia; if use cannot be avoided, monitor serum sodium concentrations
Elderly patients are at increased risk of developing hyponatremia as well as for developing hyponatremic encephalopathy
Closely monitor plasma electrolyte concentrations in pediatric patients who may have impaired ability to regulate fluids and electrolytes; in very low birth weight infants, excessive or rapid administration of potassium chloride in dextrose injection may result in increased serum osmolality and risk of intracerebral hemorrhage
Extravasation
- Care must be taken when infusing concentrated potassium solutions, including potassium chloride injection, to prevent paravenous administration or extravasation; such solutions may be associated with tissue damage, which may be severe and include vascular, nerve, and tendon damage, leading to surgical intervention, including amputation
- Secondary complications including pulmonary embolism from thrombophlebitis reported as a consequence of tissue damage from potassium chloride
Oral administration
- Solid oral dosage forms of potassium chloride can produce ulcerative and/or stenotic lesions of gastrointestinal tract, particularly if drug maintains contact with gastrointestinal mucosa for prolonged periods; consider use of liquid potassium in patients with dysphagia, swallowing disorders, or severe gastrointestinal motility disorders
- If severe vomiting, abdominal pain, distention, or gastrointestinal bleeding occurs, discontinue therapy and consider possibility of ulceration, obstruction or perforation
- Oral formulation should not be taken on an empty stomach because of its potential for gastric irritation
Drug interaction overview
- Administration of potassium chloride in dextrose injection in patients treated concurrently or recently with other products that can cause hyperkalemia or increase risk of hyperkalemia (eg, potassium-sparing diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers) increases risk of severe and potentially fatal hyperkalemia, in presence of other risk factors for hyperkalemia
- Avoid use of potassium chloride in 5% dextrose injection in patients receiving such products; if use cannot be avoided, monitor serum potassium concentrations
