From the Guidelines
Potassium replacement is available in several forms, including oral supplements, intravenous potassium chloride, and alternative salt forms such as potassium bicarbonate, potassium citrate, potassium gluconate, and potassium phosphate. The most common formulation for oral supplements is potassium chloride (KCl), available as tablets, capsules, powders, and solutions in doses ranging from 8-20 mEq per unit 1. For severe deficiency (K+ <2.5 mEq/L) or when oral intake isn't possible, intravenous potassium chloride is used, typically at concentrations of 10-20 mEq in 100mL of compatible solution, administered at rates not exceeding 10 mEq/hour for peripheral lines or 20 mEq/hour for central lines. Some studies suggest that potassium-enriched salt substitutes can be an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths 1. However, it is essential to note that potassium replacement should be guided by regular monitoring of serum levels, with target ranges of 4.0-5.0 mEq/L, as both hypokalemia and hyperkalemia can cause serious cardiac complications. Key points to consider when choosing a potassium replacement therapy include:
- The severity of the deficiency
- The patient's ability to take oral supplements
- The presence of any underlying medical conditions, such as kidney disease or heart failure
- The need for close monitoring of serum potassium levels
- The potential benefits and risks of different formulations, including potassium-enriched salt substitutes. In general, potassium replacement therapy should be individualized to each patient's specific needs and medical status, and should be guided by the most recent and highest-quality evidence available 1.
From the FDA Drug Label
In rare circumstances (e.g., patients with renal tubular acidosis) potassium depletion may be associated with metabolic acidosis and hyperchloremia. In such patients potassium replacement should be accomplished with potassium salts other than the chloride, such as potassium bicarbonate, potassium citrate, potassium acetate, or potassium gluconate. The types of potassium replacement are:
- Potassium chloride
- Potassium bicarbonate
- Potassium citrate
- Potassium acetate
- Potassium gluconate 2
From the Research
Types of Potassium Replacement
- Oral potassium replacement: This is the preferred method for patients with a functioning gastrointestinal tract and a serum potassium level greater than 2.5 mEq per L 3, 4.
- Intravenous potassium replacement: This method is used for patients with severe hypokalemia, those who are symptomatic, or those with electrocardiography abnormalities 5, 3.
Potassium Supplements
- Potassium chloride (KCl) is widely available in both immediate and extended release formulations for oral administration 4.
- Immediate release liquid KCl is optimal for inpatient use due to its rapid absorption and subsequent increase in serum potassium levels 4.
Treatment of Hyperkalemia
- Intravenous calcium is administered to patients with hyperkalemic electrocardiography changes to prevent cardiac conduction disturbances 5, 3.
- Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting 5, 3.
- Sodium polystyrene sulfonate is reserved for subacute treatment, while patiromer and sodium zirconium cyclosilicate are newer potassium binders that may be used in chronic or acute hyperkalemia 3.
Guidelines for Potassium Replacement
- The National Council on Potassium in Clinical Practice has developed guidelines for potassium replacement therapy, which represent a consensus of specialists in various fields 6.