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# Potassium Chloride ## Overview Potassium chloride (KCL) is an electrolyte used to treat or prevent hypokalemia. It is available in oral and intravenous formulations. ## Primary Indications * Treatment and prevention of hypokalemia. * Potassium supplementation in patients receiving diuretics that deplete potassium. ## Adult Dosing * **Oral:** * Prevention: 20 mEq (1.5 g) per day. * Treatment: 40-100 mEq (3-7.5 g) per day, divided into 2-4 doses. * Maximum single oral dose: Typically 20-25 mEq (1.5-1.9 g). Higher doses may be used in severe deficiency under close medical supervision. * **Intravenous:** * Dosing is highly individualized based on serum potassium levels, clinical status, and rate of correction desired. * See "Monitoring" for guidance on infusion rates. ## Pediatric Dosing * **Oral:** * Prevention: 1-2 mEq/kg/day (0.07-0.15 g/kg/day), maximum 20 mEq/day. * Treatment: 2-5 mEq/kg/day (0.15-0.37 g/kg/day), divided into 2-4 doses. * **Intravenous:** * Dosing is highly individualized. * See "Monitoring" for guidance on infusion rates. ## Dose Adjustments * Renal impairment: Use with caution and reduce dose as potassium excretion is impaired. Close monitoring of serum potassium is essential. ## Contraindications * Hyperkalemia. * Conditions causing inability to swallow intact tablets (e.g., esophageal compression, delayed gastric emptying). ## Adverse Effects * **Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain). * **Serious:** Hyperkalemia (potentially fatal), cardiac arrhythmias, cardiac arrest, gastrointestinal ulceration or perforation (especially with sustained-release formulations). ## Key Drug Interactions * **ACE inhibitors, ARBs, potassium-sparing diuretics (e.g., spironolactone, amiloride), NSAIDs:** Increased risk of hyperkalemia. * **Digitalis glycosides:** Hypokalemia increases the risk of digitalis toxicity. Hyperkalemia can reduce the efficacy of digitalis. ## Monitoring * **Serum Potassium:** Monitor frequently, especially during IV administration, in patients with renal impairment, or those at high risk for hyperkalemia. * **Renal function:** Assess baseline and periodically. * **ECG:** For signs of hyperkalemia (peaked T waves, widening QRS complex). * **Intravenous Infusion Rates:** * Peripheral line: Typically not to exceed 10 mEq per hour, maximum concentration 40 mEq/L. * Central line: May infuse faster, up to 20 mEq per hour, maximum concentration 100 mEq/L. * Infusion rates greater than 10-20 mEq/hour and concentrations greater than 40-100 mEq/L (depending on line type and patient status) carry a higher risk of hyperkalemia and cardiac complications and require close cardiac monitoring. Dosing higher than 40 mEq/hour is reserved for severe, life-threatening hypokalemia. ## Clinical Pearls * Administer oral potassium chloride with food or immediately after meals to minimize gastrointestinal upset. * Dilute oral liquid preparations as directed to reduce gastrointestinal irritation. * Sustained-release formulations should be swallowed whole and not crushed or chewed. * IV potassium chloride is a vesicant; extravasation can cause tissue necrosis. * Hypokalemia can be asymptomatic or manifest as muscle weakness, fatigue, constipation, or cardiac arrhythmias. *** *This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.*