POTASSIUM CHLORIDE

White granular powder Freely soluble in water Solution for injection

1 amp= 10 ml= 1.5gm kcl 0.15 gm /ml, 2meq/ ml No buffer or antimicrobial agent added

 KCL syrup In ORS -1.5gm(20mmol)

pharmacokinetics
Absorbed in distal colon Actively by H+k= ATPase 80-90 % excreted in urine Rest in stools; small amount in sweat Kidney does not conserve K

Composition
Na K

intracelllular

9%

89.6%

extracellular

91%

10.4%

Adverse effects
Due to soln & technique febrile reaction infection Venous thrombosis Phlebitis Extravasation local tissue necrosis

Rapid infusion local pain, vein irritation Hypervolemia Hyperkalemia Epigastric heaviness , GIT ulceration, Nausea & vomiting

 Large infusion Cl- may cause loss of HCO3 acidifying effect Over dosage > 6meq/l Discontinue infusion Corrective therapy to reduce K+ levels

K intoxication
Nausea & vomiting, Paraesthesia of extremities ,areflexia Muscular , resp paralysis Mental confusion, weakness Hypotension ,arrhythmia, heart block, ECG changes, cardiac arrest

Indications
Cardiac rhythm disorders due to digitalis toxicity Hypokalemia of different causes ->thiazide overdosage ->treatment with corticosteroids ->k depleted pts ( primary hyperaldosteronism)

Contraindications
Hyperkalemia Addisons disease Acute dehydration Hyperchloremia Uncontrolled DM Renal failure Ulcer disease Oliguria,anuria

Dose & administration

IV infusion1-2amp(1.5-3 gm KCL) in 500ml 5%Dextrose Severe Digitalis toxicity 3gm in 500ml 5%Dextrose not to exceed 1.5L/24 hour or 1.5 gm /hr

Hypokalemia
S.K level >2.5meq/l Oral replacement is safest 60-80 m Eq/d, takes several days IV k given at a rate not to exceed 8-10 meq/ hr Conc of upto 40 meq/l Total dose upto 200meq

If urgent treatment is indicated (k<2meq/l, ECG change, paralysis) Upto 40 meq/hour, Max 400meq /day Central IV line needed

 Monitoring Clinical evaluation Continuous cardiac monitoring essential-serial ECG Lab inv to monitor changes in fluid balance, electolyte conc, acid- base balance

Precautions
Should be given slowly, under close control of BP Great attention in pregnant & lactating mothers Caution in cardiac ,renal disease

Drug interactions
Use of KI, iodine containing Xray contrast media reduces effectiveness of KCl Combination with ACE inhibitor, anticholinergics, beta adrenergic blockers, heparin, K sparing diuretics not advisable

 Insulin -> increases activity of Na+K+ATPase -> k entry into cells, so extracellular K conc decreases

 Epinephrine, NE release K from liver,so initial rise Then increased entry of K into skeletal muscle mediated by beta adrenoceptors, so plasma level falls Alpha receptors oppose this effect