Version May 2024
Note: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. To prevent adverse effects, adhere to standard dilution(s) and rate(s) of administration while closely monitoring serum potassium levels; cardiac monitoring may be required depending on clinical status and infusion rate.
Maintenance potassium IV doses should be incorporated into the patient's maintenance IV fluids; intermittent IV potassium administration should be reserved for severe depletion situations; continuous ECG monitoring should be used for intermittent IV doses >0.5 mEq/kg/hour (ASPEN [Corkins 2015]). Acid/base balance should be considered when selecting a potassium salt for maintenance therapy or treatment of hypokalemia; acetate is converted to bicarbonate in the body and may affect serum pH. Doses provided as mEq of potassium.
Hypokalemia, treatment; severe: Intermittent IV infusion: 0.5 to 1 mEq/kg/dose; continuous ECG monitoring should be used for intermittent IV doses >0.5 mEq/kg/hour (see "Administration: Pediatric" for more detail on rate) (ASPEN [Corkins 2015]; Greenbaum 2020; Lynch 2017); serum concentrations should be evaluated 1 to 2 hours after completion of infusion; may repeat as needed based on lab values.
Parenteral nutrition, maintenance potassium requirement: Preterm and term neonates: IV: 2 to 4 mEq/kg/day of potassium as an additive to parenteral nutrition solution (ASPEN 2020; ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]).
Note: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. To prevent adverse effects, adhere to standard dilution(s) and rate(s) of administration while closely monitoring serum potassium levels; cardiac monitoring may be required depending on clinical status and infusion rate.
Maintenance potassium IV doses should be incorporated into the patient's maintenance IV fluids; intermittent IV potassium administration should be reserved for severe depletion situations; continuous ECG monitoring should be used for intermittent IV doses >0.5 mEq/kg/hour. Acid/base balance should be considered when selecting a potassium salt for maintenance therapy or treatment of hypokalemia; acetate is converted to bicarbonate in the body and may affect serum pH. Doses listed as mEq of potassium.
Hypokalemia, treatment; severe: Infants, Children, and Adolescents: Intermittent IV infusion: 0.5 to 1 mEq/kg/dose; maximum dose: 40 mEq/dose; continuous ECG monitoring should be used for intermittent IV doses >0.5 mEq/kg/hour (see "Administration: Pediatric" for more detail on rate) (ASPEN [Corkins 2015]; Greenbaum 2020; Lynch 2017); serum concentrations should be evaluated 1 to 2 hours after completion of infusion; may repeat as needed based on lab values.
Parenteral nutrition, maintenance potassium requirement (ASPEN 2020; ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]):
Infants and Children weighing ≤50 kg: IV: 2 to 4 mEq/kg/day of potassium as an additive to parenteral nutrition solution.
Children weighing >50 kg and Adolescents: IV: 1 to 2 mEq/kg/day of potassium as an additive to parenteral nutrition solution.
Infants, Children, and Adolescents: IV: There are no specific dosage adjustments provided in the manufacturer's labeling. Based on experience in adult patients, reduce initial dose by at least 50% in patients with renal impairment (Kraft 2005). Potassium acetate administration may also increase serum aluminum and bicarbonate serum concentrations. Contraindicated in patients with renal failure.
There are no dosage adjustments provided in the manufacturer's labeling. Use with caution due to impaired liver utilization of bicarbonate.
(For additional information see "Potassium acetate: Drug information")
Note: All doses in this monograph are expressed as mEq of potassium (1 mEq = 1 mmol potassium). Safety: Do NOT administer undiluted or by IV push; may cause fatal cardiac arrest. To prevent adverse effects, adhere to standard dilution(s) and rate(s) of administration while closely monitoring serum potassium levels; cardiac monitoring may be required depending on clinical status and infusion rate (eg, >10 mEq/hour [consider all IV potassium sources]); refer to institutional protocols (Kraft 2005).
Hypokalemia, treatment: Note: Typically, potassium chloride is preferred because it corrects serum concentrations more quickly than other salts and hypochloremia may develop with potassium acetate use (Asmar 2012; Cohn 2000). Consider use in patients with hypokalemia accompanied by metabolic acidosis (eg, due to diarrhea or renal tubular acidosis) (Kraft 2005). Individualize dosing based on serum potassium levels and clinical factors (eg, underlying cause, presence of symptoms, concomitant medications, ongoing potassium losses) (Clase 2020). Use caution in patients with redistributive hypokalemia (eg, hypokalemic periodic paralysis, theophylline poisoning), as small amounts of administered potassium may result in rebound hyperkalemia and associated cardiotoxicity (Gutmann 2022; Perry 2022). Concurrent hypomagnesemia requires correction to facilitate potassium repletion (Kraft 2005). General guidance is provided below; refer to institutional protocols.
Mild to moderate (serum potassium 3 to 3.4 mEq/L):
Note: IV route is generally used when patient is unable to tolerate oral therapy. Central-line infusion and continuous ECG monitoring highly recommended for infusions >10 mEq/hour (Kraft 2005).
IV: Initial: 20 to 60 mEq once based on serum potassium concentration and clinical factors; maximum infusion rate 10 to 20 mEq/hour; base subsequent dosing on serum potassium monitoring (Kraft 2005; Todd 2009).
Severe (serum potassium <3 mEq/L) or symptomatic: Note: Frequent serum potassium monitoring (eg, every 2 to 4 hours) is recommended to determine subsequent dosing (Kraft 2005; Mount 2022). Central-line infusion and continuous ECG monitoring highly recommended for infusion >10 mEq/hour (Kraft 2005).
Serum potassium 2.5 to 3 mEq/L: IV: Initial: 10 to 20 mEq/hour; adjust based on frequent serum potassium monitoring; maximum infusion rate: 20 mEq/hour with continuous ECG monitoring (Couture 2013; Flurie 2017; Hijazi 2005).
Serum potassium <2.5 mEq/L or life-threatening hypokalemia (not for emergency treatment of cardiac arrest): IV: Initial: 10 to 40 mEq/hour; adjust based on frequent serum potassium monitoring; maximum infusion rate (central line only): 40 mEq/hour with continuous ECG monitoring; some patients may require up to 400 mEq per 24 hours (Couture 2013; Flurie 2017; MacLaren 1999).
Reduce initial dose by at least 50% in patients with renal impairment (Kraft 2005). Potassium acetate administration may also increase serum aluminum and bicarbonate. Contraindicated in patients with renal failure.
There are no dosage adjustment provided in the manufacturer's labeling. Use with caution due to impaired liver utilization of bicarbonate.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Cardiac arrhythmia, heart block, hypotension, paralysis, paresthesia
Central nervous system: Abnormal electroencephalogram, confusion, lethargy
Local: Local tissue necrosis (with extravasation)
Neuromuscular & skeletal: Weakness
Severe renal impairment or adrenal insufficiency; hyperkalemia
Concerns related to adverse effects:
• Extravasation: Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation.
• Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).
Disease-related concerns:
• Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely. In patients with metabolic or respiratory alkalosis, use with caution since use of potassium acetate may worsen alkalosis depending on the amount administered (Khanna 2006).
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.
• Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).
• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated with severe impairment.
Concurrent drug therapy issues:
• Digitalis: Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.
• Potassium-altering therapies: Use with caution in patients receiving concomitant medications or therapies that increase potassium (eg, ACEIs, potassium-sparing diuretics, potassium containing salt substitutes).
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.
Other warnings/precautions:
• Parenteral administration: Use extreme caution with parenteral administration and monitor serum potassium concentrations closely. Evaluate renal function, cardiac and fluid status, and any factors contributing to altered potassium concentrations (eg, acidosis, alkalosis) prior to therapy. Do NOT administer undiluted or IV push; inappropriate parenteral administration may be fatal. Always administer potassium further diluted; refer to appropriate dilution and administration rate recommendations. Pain and phlebitis may occur during parenteral infusion requiring a decrease in infusion rate or potassium concentration.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL)
Yes
Solution (Potassium Acetate Intravenous)
2 mEq/mL (per mL): $0.20 - $0.32
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 4 mEq/mL (50 mL)
Parenteral: Potassium must be diluted prior to parenteral administration. Do not administer IV push. In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition and specific institution policy.
Infusion rates (including all sources) (AAP [Shenoi 2020]; Greenbaum 2020; Hamill 1991; Klaus 1989; Kruse 1990; Lafraniere 2006; Lynch 2017; Schaber 1985):
Noncritical care settings: Usual range: 0.2 to 0.5 mEq/kg/hour; in adults, up to 10 to 20 mEq/hour have been reported.
Critical care settings/situations: General recommendation to infuse at a rate ≤0.5 mEq/kg/hour; higher rates may be used; maximum reported rate: 1 to 2 mEq/kg/hour up to 40 mEq/hour; continuous cardiac monitoring recommended in cases of severe hypokalemia and for rates >0.5 mEq/kg/hour; see institutional policy.
Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see Management of Drug Extravasations for more details); remove needle/cannula; apply dry cold compresses (Hurst 2004; Reynolds 2014); elevate extremity.
Parenteral: Potassium must be diluted prior to parenteral administration. For IV infusion; do not administer IV push. In general, the rate of administration may be dependent on patient condition and specific institution policy. Some clinicians recommend that the maximum concentration for peripheral infusion is 10 mEq/100 mL and maximum rate of administration for peripheral infusion is 10 mEq/hour (Kraft 2005). ECG monitoring is recommended for peripheral or central infusions >10 mEq/hour (Kraft 2005). With central line administration, higher concentrations and more rapid rates of infusion may be used; concentrations of 20 to 40 mEq/100 mL at a maximum rate of 40 mEq/hour via central line have been safely administered (Hamill 1991; Kruse 1990).
Vesicant/irritant (at concentrations >0.1 mEq/mL); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately; leave needle/cannula in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote (Ong 2020; Stefanos 2023).
Hyaluronidase: Intradermal or SUBQ: Inject a total of 1 mL (15 units/mL) as five separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (MacCara 1983; Stefanos 2023; Zenk 1981).
Store at room temperature; do not freeze.
Treatment and prevention of hypokalemia when it is necessary to avoid chloride or acid/base status requires an additional source of bicarbonate (FDA approved in pediatric patients [age not specified] and adults).
Potassium acetate may be confused with sodium acetate
Consider special storage requirements for intravenous potassium salts; IV potassium salts have been administered IVP in error, leading to fatal outcomes.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy
AMILoride: Potassium Salts may enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in select patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Spironolactone: Potassium Salts may enhance the hyperkalemic effect of Spironolactone. Risk X: Avoid combination
Triamterene: Potassium Salts may enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination
Dietary reference intakes for elemental potassium:
Adults ≥19 years of age: 4.7 g/day (adequate intake value) (IOM 2004).
Pregnant women: 4.7 g/day (adequate intake value) (IOM 2004).
Breastfeeding women: 5.1 g/day (adequate intake value) (IOM 2004).
Animal reproduction studies have not been conducted. Potassium requirements are the same in pregnant and nonpregnant women. Adverse events have not been observed following use of potassium supplements in healthy women with normal pregnancies. Use caution in pregnant women with other medical conditions (eg, pre-eclampsia; may be more likely to develop hyperkalemia) (IOM 2004).
Electrolytes (including serum potassium, calcium, magnesium, phosphate, sodium, bicarbonate), glucose, acid-base balance, urine output, renal function, cardiac monitor (if potassium IV infusion rates >0.5 mEq/kg/hour [pediatric] or >10 mEq/hour [adults] [see institutional protocols]). Monitor IV infusion site.
Potassium, serum:
Neonates <7 days: 3.2 to 5.5 mmol/L (Greeley 1993; Lo 2020).
Neonates ≥7 to 30 days: 3.4 to 6 mmol/L (Greeley 1993; Lo 2020).
Infants <6 months: 3.5 to 5.6 mmol/L (Greeley 1993; Lo 2020).
Infants ≥6 months: 3.5 to 6.1 mmol/L (Greeley 1993; Lo 2020).
Children <6 years: 3.3 to 4.6 mmol/L (Adeli 2015; Greeley 1993; Lo 2020).
Children ≥6 years and Adolescents: 3.3 to 4.9 mmol/L (Adeli 2015; Greeley 1993; Lo 2020).
Potassium is the major cation of intracellular fluid and is essential for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretion
Distribution: Enters cells via active transport from extracellular fluid
Excretion: Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed
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