What is potassium chloride

Potassium is a mineral that is found in many foods and potassium is also an electrolyte that is vital to cell metabolism and is needed for several functions of your body, especially the beating of your heart. Potassium chloride is a mineral used to replenish potassium within your body. Potassium chloride (KCl) is used to prevent or to treat low blood levels of potassium (hypokalemia). Potassium levels can be low as a result of a disease or from taking certain medicines e.g. when thiazide diuretics or corticosteroids, or after a prolonged illness with diarrhea or vomiting or diets poor in potassium. Potassium chloride supplement may irritate your stomach and other side effects generally only occur with higher dosages. Acute oral potassium chloride toxicity is rare because large single doses induce nausea and vomiting, and because potassium chloride is rapidly excreted in the absence of any pre-existing kidney damage. Symptoms of acute poisoning after ingestion of potassium chloride are usually mild. Potassium chloride oral overdoses manifests in neuromuscular signs in the form of hyperkalemia, general muscular weakness and ascending paralysis, listlessness, vertigo, mental confusion, hypotension, acute cardiovascular changes with ECG abnormalities, and heart block. Gastrointestinal symptoms manifest as nausea, vomiting, paralytic ileus, and local mucosal necrosis, which may lead to perforation. There are several case reports of accidental IV (intravenous) or intraperitoneal administrations of potassium chloride. Symptoms of acute poisoning after parenteral administration are similar to symptoms after oral exposure but can appear more promptly and be more severe. A case report of a subcutaneous injection of potassium chloride reports chemical burns and skin lesions.

Potassium chloride (KCl) consists of odorless white crystals or crystalline powder or white granular powder or colorless crystals, with a strong saline taste.

Potassium chloride (KCl) is also used in the treatment of cumulative digitalis poisoning; and as a component of lethal injections. Potassium chloride is also used in the fertilizer industry as potash and in buffer solutions for photography. Potassium chloride has been identified as being used in hydraulic fracturing as a clay stabilizer.

You get most of the potassium you need from the foods that you eat, the usual dietary intake of potassium is 50 to 100 millimole (mmol) per day and most people have an adequate intake of potassium. Your body uses what it requires and your kidneys eliminate the rest in the urine. Your body tries to keep the blood potassium level within a very narrow range. Levels are mainly controlled by aldosterone, a hormone produced by the adrenal glands in the kidneys.

Potassium is absorbed via passive diffusion, primarily in the small intestine ¹. About 90% of ingested potassium is absorbed and used to maintain its normal intracellular and extracellular concentrations ². Potassium is excreted primarily in the urine, some is excreted in the stool, and a very small amount is lost in sweat. The kidneys control potassium excretion in response to changes in dietary intakes, and potassium excretion increases rapidly in healthy people after potassium consumption, unless body stores are depleted ³. The kidneys can adapt to variable potassium intakes in healthy individuals, but a minimum of 5 mmol (about 195 mg) potassium is excreted daily in urine ⁴. This, combined with other obligatory losses, suggests that potassium balance cannot be achieved with intakes less than about 400–800 mg/day.

The total amount of potassium in the adult body is about 45 millimole (mmol)/kg body weight (about 140 g for a 175 pound adult; 1 mmol = 1 milliequivalent [mEq] or 39.1 mg potassium) ⁴. Most potassium resides intracellularly, and a small amount is in extracellular fluid ¹. The intracellular concentration of potassium is about 30 times higher than the extracellular concentration, and this difference forms a transmembrane electrochemical gradient that is maintained via the sodium-potassium (Na+/K+) ATPase transporter ¹. In addition to maintaining cellular tonicity, this gradient is required for proper nerve transmission, muscle contraction, and kidney function.

The intracellular concentration of potassium is approximately 150 to 160 millimole (mmol) per liter. The normal adult plasma concentration is 3.6 to 5.0 mmol per liter. An active ion transport system maintains this gradient across the plasma membrane.

Because the blood concentration of potassium is so small, minor changes can have significant consequences. If potassium levels are too low or too high, there can be serious health consequences; a person may be at risk for developing shock, respiratory failure, or heart rhythm disturbances. An abnormal potassium level can alter the function of the nerves and muscles; for example, the heart muscle may lose its ability to contract.

Potassium helps transport nutrients into cells and removes waste products out of cells. Potassium is also important in muscle function, helping to transmit messages between nerves and muscles.

Potassium, along with other electrolytes such as sodium, chloride, and bicarbonate (total CO2), helps regulate the amount of fluid in your body and maintains a stable acid-base balance. Potassium is present in all body fluids, but most potassium is found within the cells. Only a small amount is present in fluids outside the cells and in the liquid part of the blood (called serum or plasma).

A potassium test is used to detect abnormal concentrations of potassium, including high potassium (hyperkalemia) and low potassium (hypokalemia). It is often used as part of an electrolyte panel or basic metabolic panel for a routine physical.

Potassium urine concentrations must be evaluated in association with blood levels. The body normally eliminates excess potassium, so the concentration in the urine may be elevated because it is elevated in the blood. It may also be elevated in the urine when the body is losing too much potassium; in this case, the blood level would be normal to low. If blood potassium levels are low due to insufficient intake, then urine concentrations will also be low.

• Decreased urinary potassium levels may be due to certain drugs such as NSAIDs, beta blockers, and lithium or due to the adrenal glands producing too little of the hormone aldosterone.
• Increased urinary potassium levels may be due to kidney disease, eating disorders such as anorexia, or muscle damage.

High potassium levels (hyperkalemia) may be seen in conditions such as:

• Kidney disease
• Addison disease
• Injury to tissue
• Infection
• Diabetes
• Dehydration
• Consuming too much potassium (for example, fruits are particularly high in potassium, so excessive intake of fruits or juices may contribute to high potassium)
• In patients on intravenous (IV) fluids, excessive IV potassium
• Certain drugs can also cause high potassium in a small percent of people; among them are non-steroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors, beta blockers (such as propanolol and atenolol), angiotensin-converting enzyme inhibitors (such as captopril, enalapril, and lisinopril), and potassium-sparing diuretics (such as triamterene, amiloride, and spironolactone).

Low potassium levels (hypokalemia) may be seen in conditions such as:

• Diarrhea and vomiting
• Conn syndrome (hyperaldosteronism)
• A complication of acetaminophen overdose
• In diabetes, the potassium level may fall after someone takes insulin, particularly if the person has not managed his or her diabetes well.
• Low potassium is commonly due to “water pills” (potassium-wasting diuretics); if someone is taking these, their healthcare provider will check their potassium level regularly.
• Additionally, certain drugs such as corticosteroids, beta-adrenergic agonists such as isoproterenol, alpha-adrenergic antagonists such as clonidine, antibiotics such as gentamicin and carbenicillin, and the antifungal agent amphotericin B can cause loss of potassium.

The usual dietary intake of potassium by the average adult is 50 mEq to 100 mEq per day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 mEq or more mEq of potassium from the total body store.

Potassium depletion will occur whenever the rate of potassium loss through renal excretion and/or loss from the gastrointestinal tract exceeds the rate of potassium intake. Such depletion usually develops as a consequence of therapy with diuretics, primary or secondary hyperaldosteronism, diabetic ketoacidosis, or inadequate replacement of potassium in patients on prolonged parenteral nutrition. Depletion can develop rapidly with severe diarrhea, especially if associated with vomiting. Potassium depletion due to these causes is usually accompanied by a concomitant loss of chloride and is manifested by hypokalemia and metabolic alkalosis.

Potassium depletion may produce weakness, fatigue, disturbances or cardiac rhythm (primarily ectopic beats), prominent U-waves in the electrocardiogram, and in advanced cases, flaccid paralysis and/or impaired ability to concentrate urine.

If potassium depletion associated with metabolic alkalosis cannot be managed by correcting the fundamental cause of the deficiency, e.g., where the patient requires long-term diuretic therapy, supplemental potassium in the form of high-potassium food or Potassium Chloride may be able to restore normal potassium levels.

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.

Treatment for low potassium may include the use of potassium chloride supplements and increasing the amount of potassium-rich foods in the diet, such as bananas, beef or spinach. Treatment for high potassium may include the use of diuretics, kidney dialysis, or insulin injections.

Potassium chloride medication

You should NOT use potassium chloride if you are allergic to it, or if:

• you have high levels of potassium in your blood (hyperkalemia); or
• you take a “potassium-sparing” diuretic (water pill) such as amiloride, spironolactone, or triamterene.

To make sure potassium chloride medicine is safe for you, tell your doctor if you have ever had:

• kidney disease;
• cirrhosis or other liver disease;
• an adrenal gland disorder;
• a large tissue injury such as a severe burn;
• severe dehydration;
• diabetes;
• heart disease or high blood pressure;
• stomach or intestinal bleeding;
• a blockage in your stomach or intestines; or
• chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

It is not known whether potassium chloride medicine will harm an unborn baby. Your dose needs may be different during pregnancy. Tell your doctor if you are pregnant or breast-feeding.

Do not give this medicine to a child without medical advice.

How should I take potassium chloride?

Take potassium chloride exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Take potassium chloride with a full glass of water. Take the medicine with food or just after a meal.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not crush, chew, or suck on a tablet or capsule. Sucking on the pill could irritate your mouth or throat.

Call your doctor if you have trouble swallowing a potassium chloride capsule or tablet. You may be able to dissolve the tablet in water, or mix the medicine from a capsule with soft food. Carefully follow your doctor’s instructions.

Mix the powder form of this medicine with at least 4 ounces (one-half cup) of cold water or fruit juice before taking. Drink the mixture slowly, over 5 to 10 minutes in all. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

To be sure this medicine is helping your condition, you may need frequent blood tests. You may not notice any change in your symptoms, but your blood work will help your doctor determine how long to treat you with potassium chloride. Your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG). Even if you have no symptoms, tests can help your doctor determine if this medicine is effective.

Your treatment may include a special diet. Follow the diet plan created for you by your doctor or nutrition counselor. Get familiar with the list of foods you should eat or avoid to help control your condition.

Potassium-rich foods include: squash, baked potatoes (skin on), spinach, lentils, broccoli, Brussels sprouts, zucchini, kidney or navy beans, raisins, watermelon, orange juice, bananas, cantaloupe, and low-fat milk or yogurt. Consume only the daily amounts recommended by your doctor or nutrition counselor.

Some tablets are made with a shell that is not absorbed or melted in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective.

Store at room temperature away from moisture and heat. Keep the medication in a closed container.

Potassium in food

What is potassium chloride used for?

Potassium chloride (KCl) is used as prevention and treatment of potassium deficiency, e.g. when thiazide diuretics or corticosteroids are used in case of excessive vomiting or diarrhea, or diets poor in potassium; in the treatment of cumulative digitalis poisoning; and as a component of lethal injections. Potassium chloride (KCl) is also used in the fertilizer industry as potash and in buffer solutions for photography. Potassium chloride has been identified as being used in hydraulic fracturing as a clay stabilizer.

Potassium chloride tablets replace potassium in your body. Potassium chloride tablets are used to prevent and treat low blood levels of potassium (this is also called hypokalemia). Potassium levels can become low if you have had a prolonged bout of either diarrhea or vomiting, have been taking diuretics (water pills), or with some diseases.

• For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxication, and in patients with hypokalemic familial periodic paralysis. If hypokalemia is the result of diuretic therapy, consideration should be given to the use of a lower dose of diuretic, which may be sufficient without leading to hypokalemia.
• For the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop, e.g., digitalized patients or patients with significant cardiac arrhythmias.

The use of potassium salts in patients receiving diuretics for uncomplicated essential hypertension is often unnecessary when such patients have a normal dietary pattern and when low doses of the diuretic are used. Serum potassium should be checked periodically, however, and if hypokalemia occurs, dietary supplementation with potassium-containing foods may be adequate to control milder cases. In more severe cases, and if dose adjustment of the diuretic is ineffective or unwarranted, supplementation with potassium salts may be indicated.

Potassium chloride tablets should be taken with meals and with a glass of water or other liquid. This product should not be taken on an empty stomach because of its potential for gastric irritation.

Patients having difficulty swallowing whole tablets may try one of the following alternate methods of administration:

1. Break the tablet in half, and take each half separately with a glass of water.
2. Prepare an aqueous (water) suspension as follows:
   1. Place the whole tablet(s) in approximately 1/2 glass of water (4 fluid ounces).
   2. Allow approximately 2 minutes for the tablet(s) to disintegrate.
   3. Stir for about half a minute after the tablet(s) has disintegrated.
   4. Swirl the suspension and consume the entire contents of the glass immediately by drinking or by the use of a straw.
   5. Add another 1 fluid ounce of water, swirl, and consume immediately.
   6. Then, add an additional 1 fluid ounce of water, swirl, and consume immediately.

Aqueous suspension of potassium chloride that is not taken immediately should be discarded. The use of other liquids for suspending potassium chloride tablets,  is not recommended.

Potassium chloride dosage

You should NOT use potassium chloride if you have high levels of potassium in your blood (hyperkalemia), or if you also take a “potassium-sparing” diuretic.

• Contraindicated in renal failure. May cause potassium intoxication and life-threatening hyperkalemia in patients with renal insufficiency.
• Never give injectable potassium chloride undiluted.
• Do not infuse rapidly.
• Administer oral potassium with or after food to minimize gastric irritation.
• Take oral potassium with meals and a full glass of water or other liquids.
• TTake this medication as prescribed.
• Check with your physician at once if tarry stools or other signs of gastrointestinal bleeding are noticed.

To be sure potassium chloride is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Serious side effects of potassium include uneven heartbeat, muscle weakness or limp feeling, severe stomach pain, and numbness or tingling in your hands, feet, or mouth.

Do not stop taking this medicine without first talking to your doctor. If you stop taking this medicine suddenly, your condition may become worse.

Do not crush, chew, break, or suck on an extended-release tablet or capsule. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Sucking on a tablet can irritate your mouth or throat. Take potassium chloride with food or just after a meal.

Usual Adult Dose for Hypokalemia (low blood potassium)

Oral:

• 40 to 100 mEq per day, orally, in 2 to 5 divided doses
• Maximum single dose: 20 mEq per dose
• Maximum daily dose: 200 mEq

Parenteral (must be diluted prior to administration):

Dose and rate of administration are dependent on patient condition

• If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and manufacturers recommend that concentration not exceed 40 mEq/L

Maximum daily dose: 200 mEq

• If treatment is urgent (serum potassium less than 2 mEq/L and electrocardiographic changes and/or muscle paralysis), infuse cautiously at up to 40 mEq/hour with continuous cardiac monitoring

Maximum daily dose: 400 mEq

-In critical situations, may administer in saline rather than dextrose (dextrose may lower serum potassium)

Comments:

• Never give injectable potassium chloride undiluted.
• The usual adult dietary intake is 50 to 100 mEq potassium per day.
• Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 mEq or more of the total body stores of potassium.

Usual Adult Dose for Prevention of Hypokalemia (low blood potassium)

Oral:

Typical dose: 20 mEq, orally, daily

• Individualize dose based on serum potassium levels
• Divide dose if more than 20 mEq per day is used

Parenteral (must be diluted prior to administration):

Dose and rate of administration are dependent on patient condition

• If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and manufacturers recommend that concentration not exceed 40 mEq/L

Maximum daily dose: 200 mEq

Comments:

• Never give injectable potassium chloride undiluted
• The usual adult dietary intake is 50 to 100 mEq potassium per day.

Usual Pediatric Dose for Hypokalemia (low blood potassium)

Birth to 16 years:

Oral solution:

• Initial dose: 2 to 4 mEq/kg/day, orally, in divided doses
• Limit to 1 mEq/kg or 40 mEq per dose, whichever is lower

Maximum daily dose: 100 mEq

Parenteral (must be diluted prior to administration):

Dose and rate of administration are dependent on patient condition

• If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and manufacturers recommend that concentration not exceed 40 mEq/L

Maximum daily dose: 200 mEq

• If treatment is urgent (serum potassium less than 2 mEq/L and electrocardiographic changes and/or muscle paralysis), infuse cautiously at up to 40 mEq/hour with continuous cardiac monitoring

Maximum daily dose: 400 mEq

• In critical situations, may administer in saline rather than dextrose (dextrose may lower serum potassium)

Comments:

• Never give injectable potassium chloride undiluted

Usual Pediatric Dose for Prevention of Hypokalemia (low blood potassium)

Birth to 16 years:

Oral solution:

• Initial dose: 1 mEq/kg/day, orally
• Maximum daily dose: 3 mEq/kg/day

Intravenous (must be diluted prior to administration):

Dose and rate of administration are dependent on patient condition

• If serum potassium is 2.5 mEq/L or higher, rate should not exceed 10 mEq/hour, and manufacturers recommend that concentration not exceed 40 mEq/L

Maximum daily dose: 200 mEq

Comments:

• Never give injectable potassium chloride undiluted

Potassium chloride side effects

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Diarrhea, stomach pain, muscle weakness, numbness or tingling in the hands, feet, or mouth, uneven heartbeat. Side effects are more likely if high dosages of potassium chloride are being taken.
• May not be suitable for some people including those with kidney failure, Addison’s disease, severe burns, or severe wounds.
• Should also not be taken by a person who is dehydrated or has high levels of potassium in their blood.
• May interact with several other medicines including digoxin, quinidine, ACE inhibitors, and several diuretics.
• Signs of a high potassium level (hyperkalemia): cardiac arrhythmias, cardiac arrest, slow heartbeat and heart block; listlessness, mental confusion; feeling weak (muscle weakness), lightheaded, or dizzy; feel like passing out; numbness or tingling (paresthesia) of the extremities; or shortness of breath; flaccid paralysis, cold skin, grey pallor, peripheral vascular collapse, fall in blood pressure and paralysis. Electrocardiogram (ECG) abnormalities include disappearance of the P-wave, widening and slurring of QRS complex, changes of the S-T segment, tall peaked T-waves. At extremely high concentrations (8 to 11 mmol/L) may cause death from cardiac depression, arrhythmias, or arrest.
• Chest pain or pressure.
• Signs of bowel problems like black, tarry, or bloody stools; fever; mucus in the stools; throwing up blood or throw up that looks like coffee grounds; very bad belly pain; or very bad hard stools (constipation) or loose stools (diarrhea).
• Very upset stomach or throwing up.
• Gastrointestinal ulceration may be caused by enteric-coated potassium chloride tablets.
• Delayed intestinal transit
• Nausea, vomiting, flatulence, abdominal pain/discomfort, diarrhea, obstruction, bleeding, ulceration, perforation, gastrointestinal hemorrhage, local irritation of the mucosa
• Swelling of belly.
• Local pain and inflammation may develop from intravenous or subcutaneous administration.
• Skin rash, urticaria and pruritus
• Neuromuscular symptoms may occur.

Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Potassium chloride overdose

Cardiac and related effects are the most important risks of potassium chloride overdose.

The administration of oral potassium salts to persons with normal excretory mechanisms for potassium rarely causes serious hyperkalemia. However, if excretory mechanisms are impaired or if potassium is administered too rapidly intravenously, potentially fatal hyperkalemia can result.

It is important to recognize that hyperkalemia is usually asymptomatic and may be manifested only by an increased serum potassium concentration (6.5 mEq to 8 mEq/L) and characteristic electrocardiographic changes (peaking of T-waves, loss of P-waves, depression of S-T segment, and prolongation of the QT-interval).

Late manifestations include muscle paralysis and cardiovascular collapse from cardiac arrest (9 mEq to 12 mEq/L).

Treatment measures for hyperkalemia include the following:

Basic life support measures are essential in severely poisoned patients:

• establish IV-line, obtain blood sample for electrolytes, BUN, glucose and arterial blood gas analysis;
• continuous ECG monitoring should be started for arrhythmias and electrolyte changes;
• cardiac dysrhythmias should be controlled with an appropriate drug regimen;
• emesis or gastric lavage should be performed as soon as possible.

Reduce the plasma concentration of potassium by infusion of sodium bicarbonate, glucose plus insulin, or dialysis. These regimes shift potassium into cells; they do not increase its elimination. Infusion of calcium salts may be necessary to correct ECG changes. Use of exchange resins, hemodialysis, or peritoneal dialysis.

In treating hyperkalemia, it should be noted that in patients who have been stabilized on digitalis, too rapid a lowering of the serum potassium concentration can produce digitalis toxicity.

The extended-release potassium chloride feature means that absorption and toxic effects may be delayed for hours. Consider standard measures to remove any unabsorbed drug.

1. Hinderling PH. The pharmacokinetics of potassium in humans is unusual. J Clin Pharmacol 2016;56:1212-20.[↩][↩][↩]
2. Bailey JL, Sands JM, Franch HA. Water, electrolytes, and acid-based metabolism. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:102-32.[↩]
3. Stone MS, Martyn L, Weaver CM. Potassium intake, bioavailability, hypertension, and glucose control. Nutrients 2016;8.[↩]
4. Preuss HG, Clouatre DL. Sodium, chloride, and potassium. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition. 10th ed. Washington, DC: Wiley-Blackwell; 2012:475-92.[↩][↩]