Hypokalemia in Emergency Medicine Medication

  • Author: David Garth, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 25, 2012
 

Medication Summary

Oral is the preferred route for potassium repletion because it is easy to administer, safe, inexpensive, and readily absorbed from the GI tract. For patients with mild hypokalemia and minimal symptoms, oral replacement is sufficient. For patients who have severe hypokalemia and are symptomatic, both intravenous and oral replacement are necessary. While intravenous potassium dosages of up to 40 mEq/h have been advocated, patients should receive no more than 20 mEq/h IV to avoid potential deleterious effects on the cardiac conduction system. Potassium solutions should never be given as an intravenous push and should be administered as a dilute solution. Higher concentrations of intravenous potassium are damaging to the smaller peripheral veins.

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Electrolyte supplements

Class Summary

Potassium is essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function. These agents increase the body's potassium level. In general, 1 mEq/L drop in potassium correlates to a loss of 100-200 mEq of total body potassium. Hypokalemia may result from the movement of potassium into cells without loss of potassium from the body.

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Potassium chloride (Klor-Con, K-Dur)

 

Potassium depletion sufficient to cause 1 mEq/L drop in serum potassium requires a loss of about 100-200 mEq of potassium from total body store.

Available in liquid, powder, or tablet form. Any form may irritate the stomach and cause vomiting. Should be taken with food or after meals to minimize GI discomfort.

Oral potassium preparations include 8 mEq KCI slow-release tablets, 20 mEq KCI elixir, 20 mEq KCI powder, 25 mEq KCI tablet.

In the symptomatic patient with severe hypokalemia, administer up to 40 mEq/h of the IV preparation. Maintain close follow-up care, provide continuous ECG monitoring, and check serial potassium levels.

Higher dosages may increase risk of cardiac complications. Many institutions have policies that limit maximum amount of potassium that can be given per hour.

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Contributor Information and Disclosures
Author

David Garth, MD  Attending Physician, Department of Emergency Medicine, Mary Washington Hospital

David Garth, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

I would like to thank my wife, Mary. Her patience, love, and reassurance, are my bedrock.

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