Potassium chloride - instructions for use, dose, side effects, contraindications

The preparation of potassium replenishes the deficiency of potassium and chloride ions. The potassium ion is the main intracellular ion of most tissues of the human body. Potassium ions participate in most basic physiological processes, including maintaining the tone of the intracellular fluid, transferring nerve impulses, contracting the heart, skeletal and smooth muscles and maintaining normal kidney function. It has a negative chrono and batmotropic effect, in high doses negative foreign, dromotropic (causing a decrease in the heart rate, reduces contractile activity, reduces conduction, automatism and myocardial excitability), as well as a moderate diuretic effect. In small doses, dilates coronary vessels, in large - narrows. With intravenous administration increases the adrenal secretion of adrenaline.

Pharmacokinetics:

Bioavailability with intravenous injection - 100%. The ions of potassium and chlorine are included in the pool of body ions. After intravenous administration of potassium is actively transported from the extracellular fluid into the cells where its concentration is up to 40 times greater than in the extracellular fluid: intracellular concentration - about 140-150 mmol / l in plasma - 3.5-5 mmol / l. Write mainly kidneys (approximately 90%) in the distal tubule, where it participates in sodium-potassium exchange. 10% of potassium is excreted through the gastrointestinal tract. Even in conditions of potassium deficiency, 10-50 mmol of potassium per day is excreted by the kidneys.

Indications:

Hypokalemia of various origins, including arrhythmia caused by hypokalemia.

Contraindications:

Hypersensitivity to the drug, hyperkalemia or hyperchloremia any etiology, complete atrioventricular or intraventricular block, renal failure with oliguria or azotemia, ventricular fibrillation, Addison's disease, giperadrenalizm associated with the adrenogenital syndrome, extensive disintegration of tissues (r. H. Under severe burns) , acute dehydration, heat cramps, conditions with increased sensitivity to the introduction of potassium (includinghereditary episodic adynamia or congenital para-myotonia), concomitant therapy with potassium salts and potassium-sparing diuretics.

Carefully:

Atrioventricular block I-II degree, heart failure, sickle-cell anemia, diseases and conditions accompanied by a violation of potassium excretion, including chronic renal failure, adrenal insufficiency. In patients taking cardiac glycosides, aldosterone antagonists, ACE inhibitors, tacrolimus, ciclosporin, long-acting heparin, suxamethonium or potentially nephrotoxic drugs (non-steroidal anti-inflammatory drugs, peripheral analgesics).

Pregnancy and lactation:

Both potassium ions and chlorine ions are important components of tissues and body fluids. However, supraphysiological concentrations of potassium can have a negative effect on the cardiac activity of the mother and fetus. Exogenously administered potassium can be used as a substitute therapy in pregnant women women with hypokalemia, it is preferable to perform oral medicinal forms.If you need to use potassium chloride during pregnancy, you should carefully monitor the concentration of potassium in the blood plasma.

Potassium is excreted in breast milk. Due to the potential risk of serious adverse events in the child, caution should be exercised when the drug is used during breastfeeding.

Dosing and Administration:

The drug is administered intravenously drip.

The dose and rate of administration depend on the condition of the individual patient.

The maximum recommended concentration of potassium administered is 40 mmol / l. In patients whose serum potassium concentration exceeds 2.5 mmol / l, the infusion rate should not exceed 10 mmol / h. The total dose should not exceed 200 mmol / 24 hours.

Potassium chloride solution 40 mg / ml is diluted 10 times with water for injection, thus obtaining an isotonic solution (potassium chloride concentration is 0.4%, dextrose is 3.34%). The solution is injected intravenously at a rate of 20-30 cap / min. At the same time, no more than 100 ml of solution is administered. If necessary, the infusion can be repeated, but in such a way that the total daily dose does not exceed 300-500 ml.

You can also inject intravenously drip - up to 2.5 g of potassium chloride in 500 ml of a 0.9% solution of sodium chloride or 5% solution of dextrose.

In a critical situation, potassium can be administered in saline (if not contraindicated), and not in glucose solution, because it can reduce the concentration of potassium in the blood serum.

For the treatment of arrhythmias a polarizing mixture is used: potassium chloride solution 2-2.5 g in 500 ml of 5% or 10% dextrose solution and short-acting insulin at the rate of 1 unit for 3-4 g of dry dextrose.

Side effects:

Symptoms and signs of potassium intoxication:

From the cardiovascular system: lowering blood pressure, arrhythmia and heart block, changes on the ECG: disappearance P-waves, complex races QRS, segment changes ST, high peak-shaped tooth T.

From the nervous system: fatigue, muscle weakness, confusion, heaviness in the limbs, muscle cramps, paresthesia, ascending paralysis.

From the digestive system: nausea, vomiting, diarrhea, discomfort in the abdomen.

From the immune system: allergic reactions.

From the side of metabolism and nutrition: acidosis, hyperchloremia, hyperkalemia.

Other: pain or phlebitis at the site of administration when solutions with a potassium concentration of more than 30 mmol / l are administered.

Overdose:

Symptoms: violation of the excretory mechanism or too rapid intravenous administration of potassium can lead to fatal hyperkalemia (muscle hypotension, paresthesia of the limbs, slowing of atrioventricular conduction, arrhythmias, cardiac arrest). Early clinical signs of hyperkalemia usually appear at a concentration of potassium ions in the serum of more than 6 meq / l: tapering of the T wave, disappearance of the P wave, a decrease in the ST segment, prolongation of the QT interval, expansion of the QRS complex. More severe symptoms of hyperkalemia - muscle paralysis and cardiac arrest - develop at a concentration of potassium ions of 9-10 meq / l.

Treatment: stopping the infusion of potassium chloride. Inside or intravenously - a solution of sodium chloride; intravenously 300-500 ml of a 5% solution of dextrose (with 10-20 units of short-acting insulin per 1 liter); correction of acidosis (if any) by intravenous sodium bicarbonate if necessary - hemodialysis and peritoneal dialysis.

Arrhythmia or serum potassium concentration above 6.5 mmol / L requires immediate treatment by intravenous administration of 10-20 ml of 10% calcium gluconate solution for 1-5 minutes.In the treatment of hyperkalemia in patients treated with cardiac glycosides, a rapid decrease in serum potassium concentration can lead to digitalis intoxication.

In the treatment of overdose, continuous ECG monitoring, periodic determination of urea, electrolytes and creatinine in the blood plasma, monitoring the potassium concentration (if necessary, every 2-3 hours), asymptomatic patients should be observed for 6 hours.

Interaction:

Simultaneous administration with potassium-sparing diuretics (including triamterene, spironolactone, amiloride) can lead to severe hyperkalemia due to decreased renal excretion of potassium ions.

ACE inhibitors are a risk of developing hyperkalemia, because ACE inhibitors reduce the secretion of aldosterone, which leads to a delay in potassium in the body.

Beta-adrenoblockers increased both the maximum serum potassium concentration and the time required to return it to the baseline in patients who were urgently given a loading dose of potassium intravenously.

Non-steroidal anti-inflammatory drugs - the risk of hyperkalemia due to the development of secondary hyperaldosteronism after inhibition of prostaglandin synthesis in the kidneys.

Heparin reduces the synthesis of aldosterone, which can lead to the development of hyperkalemia, especially if there is renal failure or other conditions worsening the excretion of potassium from the body.

Potassium-withdrawing diuretics, such as thiazide, increase the risk of developing hypokalemia when they are withdrawn against the background of simultaneous use with potassium supplements.

The introduction of potassium preparations is not recommended in patients with severe and complete heart block, using simultaneously cardiac glycosides. If potassium preparations are used to correct hypokalemia in such patients, careful monitoring is required.

Simultaneous use of insulin, sodium bicarbonate reduces the potassium content in the blood serum.

The following medicines containing potassium, or predisposing to the development of hyperkalemia, can lead to cumulation of potassium at the same time with potassium preparations: aliskiren, angiotensin II receptor antagonists, ciclosporin, tacrolimus.

Pharmaceutically compatible with the following solutions for intravenous administration: Ringer's solution in combination with glucose (dextrose) for injection,Ringer's lactate solution in combination with glucose (dextrose) for injection, 5% glucose solution (dextrose) in Ringer's lactate for injection solution, glucose solution (dextrose) in combination with sodium chloride, 5% glucose solution (dextrose) in 0.9% sodium solution chloride, 2.5%, 5%, 10%, 20% glucose (dextrose) solutions in water for injection, Ringer's injection solution, Ringer's lactate injection solution, 0.45%, 0.9%, 3% sodium chloride solutions.

Pharmaceutically incompatible with dilution with solutions containing: amikacin sulfate, amphotericin B, amoxicillin sodium, benzylpenicillin, diazepam, dobutamine hydrochloride, ergotamine tartrate, etoposide with cisplatin and mannitol, methylprednisolone sodium succinate, phenytoin sodium, promethazine hydrochloride, sodium nitroprusside, streptomycin sulfate, mannitol, a sterile fat emulsion containing soybean oil and lecithin (this list is not exhaustive).

Special instructions:

During the treatment it is necessary to control the content of potassium ions in the blood serum, ECG, in the treatment of hypokalemia - control of the acid-base state.

A diet with a high content of sodium chloride increases the excretion of potassium ions from the body.

In patients with chronic kidney disease or with diseases accompanied by a violation of the excretion of potassium from the body, as well as with rapid intravenous administration of potassium chloride, the development of hyperkalemia is possible. Hyperkalemia develops rapidly and is asymptomatic and can potentially lead to blockade of intracardiac conduction and death. Early signs of hyperkalemia are hypotension and paresthesia of the extremities.

During the treatment it is necessary to monitor the potassium concentration in the blood serum during the administration and to adjust the dose in a timely manner. In addition (especially with heart disease, kidneys, or the presence of acidosis), it is recommended to control the acid-base balance, serum electrolytes, ECG and the clinical state of the patient.

Treatment of hypokalemia should not be performed by the simultaneous administration of potassium salts and potassium-sparing diuretics in order to avoid severe hyperkalemia.

Treatment with potassium preparations should be performed in diseases accompanied by heart blockages, as this can increase the degree of blockade.

At the initial stage of treatment, simultaneous administration with glucose should be avoided, since it may further reduce the potassium concentration.

With the introduction of potassium chloride into the veins of a small diameter, it can be accompanied by soreness at the injection site.

Effect on the ability to drive transp. cf. and fur:

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Form release / dosage:

Concentrate for the preparation of a solution for infusions 40 mg / ml.

Packaging:

For 10 ml in ampoules of colorless neutral glass type I with a color fracture ring or with a colored dot and notch or without a rupture ring, a colored dot and a notch. One, two or three color rings and / or a two-dimensional bar code, and / or alphanumeric coding or without additional color rings, a two-dimensional bar code, and alphanumeric coding can additionally be applied to the ampoules.

5 ampoules per circuit cell packaging made of polyvinylchloride film and aluminum foil foil or polymer film or without foil and without film. Or 5 ampoules are placed in a prefabricated form (tray) made of cardboard with cells for laying ampoules.

1, 2 or 4 contour squares or cardboard trays, together with the instruction for use and a scarifier or knife with an ampoule, or without a scarifier and an ampoule knife, are placed in a cardboard package (bundle).

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years. Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-002561

Date of registration:04.08.2014 / 08.10.2015

Expiration Date:04.08.2019

The owner of the registration certificate:ATOLL, LLC ATOLL, LLC Russia

Manufacturer: & nbsp

OZONE, LLC Russia

Representation: & nbspOZONE LLC OZONE LLC Russia

Information update date: & nbsp26.11.2017

Illustrated instructions

Instructions

Potassium chloride (Potassium chloride)