Lokelma Nursing Protocol for Hyperkalemia
Initial Dosing and Administration
For acute hyperkalemia treatment, administer Lokelma 10 g orally three times daily for up to 48 hours to achieve normokalemia (potassium 3.5-5.0 mEq/L). 1
Correction Phase Protocol
- Starting dose: 10 g three times daily (TID) for 24-48 hours 1, 2
- Expected onset: Median time to potassium normalization is 2.2 hours, with 84% of patients achieving normokalemia by 24 hours and 98% by 48 hours 2
- Mean potassium reduction: Expect approximately 1.1 mEq/L decrease in serum potassium over 48 hours 3, 2
- Duration: Continue TID dosing until normokalemia is achieved, maximum 48-72 hours 1, 4
Reconstitution and Administration Instructions
- Mix each dose with approximately 3 tablespoons (45 mL) of water in a cup 1
- Stir well and administer immediately as an oral suspension 1
- Medication separation: Administer all other oral medications at least 2 hours before or 2 hours after Lokelma to avoid binding interactions 1
Maintenance Phase Protocol
Once normokalemia is achieved, transition to 10 g once daily and titrate in 5 g increments at weekly intervals to maintain target potassium range. 1
Maintenance Dosing Guidelines
- Initial maintenance dose: 10 g once daily 1
- Dose range: 5-15 g once daily based on serum potassium levels 1, 2
- Titration schedule: Adjust dose by 5 g increments at one-week intervals 1
- Target potassium: Maintain serum potassium between 3.5-5.0 mEq/L 2, 4
- Long-term efficacy: Mean serum potassium of 4.7 mEq/L maintained over 12 months, with 88% of patients achieving potassium ≤5.1 mEq/L 4
Special Population: Chronic Hemodialysis Patients
For patients on chronic hemodialysis, start with 5 g once daily on non-dialysis days only. 1
- Administer on non-dialysis days exclusively 1
- Monitor closely for hypokalemia, which is a specific risk in this population 1
Critical Monitoring Requirements
Potassium Monitoring
- Baseline: Obtain serum potassium before initiating therapy 4
- During correction phase: Check potassium at 24 hours and 48 hours 2
- During maintenance: Monitor serum potassium regularly to guide dose adjustments and prevent hypokalemia 1, 4
- Hypokalemia risk: 10-11% of patients on 10-15 g daily doses develop hypokalemia (potassium <3.5 mEq/L) 2
Edema Monitoring
- Assess for peripheral edema, particularly with maintenance doses ≥10 g daily 5
- Edema incidence increases dose-dependently: 2% with 5 g, 6% with 10 g, and 14% with 15 g daily 2
- Each 10 g dose contains 1200 mg of sodium during correction phase (three times daily), then 400-1200 mg sodium daily during maintenance 5
Additional Safety Monitoring
- Gastrointestinal symptoms: Monitor for constipation, diarrhea, and nausea, which are the most common adverse effects 5
- Patients with motility disorders: Use caution due to potential gastrointestinal adverse events 1
- Abdominal imaging: Be aware that Lokelma has radio-opaque properties and may appear as an imaging agent on abdominal X-rays 1
Common Pitfalls and Contraindications
Critical Limitation
Do not use Lokelma as emergency treatment for life-threatening hyperkalemia due to its delayed onset of action. 1
- While onset begins at 1-2 hours, this is insufficient for life-threatening hyperkalemia requiring immediate intervention 6, 2
- For true emergencies, use insulin/glucose, beta-agonists, or dialysis first 6
Drug Interaction Management
- Separate all oral medications by at least 2 hours before or after Lokelma administration 1
- Lokelma can bind other medications throughout the GI tract, reducing their absorption 7
Contraindications
- No absolute contraindications listed in FDA labeling 1
- Exercise caution in patients with severe gastrointestinal motility disorders 1
Dietary Counseling
- Once hyperkalemia improves with Lokelma therapy, potassium intake restrictions can be liberalized 8
- This dietary flexibility may improve nutritional status, particularly in geriatric patients with multiple comorbidities 8
- Coordinate with dietitian to optimize nutrition while maintaining normokalemia 8