General

Pronunciation:
poe-tass-ee-um

potassium citrate

Trade Name(s)

• Urocit-K

potassium bicarbonate/potassium citrate

Trade Name(s)

• Effer-K

Ther. Class.

mineral and electrolyte replacements/supplements

Indications

• Treatment of renal tubular acidosis with calcium stones, hypocitraturic calcium oxalate nephrolithiasis of any etiology, or uric acid lithiasis with or without calcium stones (potassium citrate only).
• Treatment/prevention of potassium depletion.

Action

• Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.
• Creates an alkaline environment in urine; it creates an environment less conducive to the crystallization of salts that can lead to stone formation.
• Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

Therapeutic Effect(s):

• Replacement of potassium.
• Prevention of potassium deficiency.
• Reduction in stone formation.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Enters extracellular fluid; then actively transported into cells.

Metabolism and Excretion: Excreted by the kidneys.

Half-life: Unknown.

TIME/ACTION PROFILE (increase in serum potassium concentrations)

Contraindication/Precautions

Contraindicated in:

• Hyperkalemia;
• Severe renal impairment, uncontrolled diabetes mellitus, acute dehydration, adrenal insufficiency, or concurrent use of potassium-sparing diuretics (↑ risk of hyperkalemia);
• Delayed gastric emptying, esophageal compression, intestinal obstruction, or concurrent use of anticholinergic medications (extended-release tablets);
• Peptic ulcer disease;
• Untreated Addison's disease;
• Some products may contain tartrazine (FDC yellow dye #5) or alcohol; avoid using in patients with known hypersensitivity or intolerance;
• Hyperkalemic familial periodic paralysis.

Use Cautiously in:

• Cardiac disease;
• Renal impairment;
• Diabetes mellitus (liquids may contain sugar);
• Hypomagnesemia (may make correction of hypokalemia more difficult);
• GI hypomotility, including dysphagia or esophageal compression from left atrial enlargement (tablets);
• Patients receiving potassium-sparing drugs.

Adverse Reactions/Side Effects

CV: ARRHYTHMIAS, ECG changes

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting tablets, capsules only: GI ulceration, stenotic lesions

Neuro: confusion, paralysis, paresthesia, restlessness, weakness

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Use with  potassium-sparing   diuretics,  ACE inhibitors,  angiotensin II receptor antagonists, or  NSAIDs may lead to hyperkalemia.
•  Anticholinergics  may ↑ GI mucosal lesions in patients taking wax-matrix potassium chloride preparations.

Route/Dosage

Expressed as mEq of potassium. Potassium acetate contains 10.2 mEq/g; potassium bicarbonate contains 10 mEq potassium/g; potassium chloride contains 13.4 mEq potassium/g; potassium citrate contains approximately 10 mEq/g

Normal Daily Requirements

PO (Adults): 40–80 mEq/day.

PO (Children): 2–3 mEq/kg/day.

PO (Neonates): 2–6 mEq/kg/day.

Urinary Alkalinizer (Stone Prevention)

PO (Adults): Severe hypocitraturia (urinary citrate <150 mg/day): 20 mEq 3 times daily  or  30 mEq twice daily; may titrate dose, as needed, based on 24-hr urinary citrate and/or urinary pH measurements (max dose = 100 mEq/day).  Mild to moderate hypocitraturia (urinary citrate >150 mg/day): 10 mEq 3 times daily  or  15 mEq twice daily; may titrate dose, as needed, based on 24-hr urinary citrate and/or urinary pH measurements (max dose = 100 mEq/day).

Prevention of Hypokalemia During Diuretic Therapy

PO (Adults): 20–40 mEq/day in 1–2 divided doses; single dose should not exceed 20 mEq.

PO (Neonates , Infants and Children): 1–2 mEq/kg/day in 1–2 divided doses.

Treatment of Hypokalemia

PO (Adults): 40–100 mEq/day in divided doses.

PO (Neonates , Infants and Children): 2–5 mEq/kg/day in divided doses.

Availability (generic available)

Potassium Citrate

Extended-release tablets: 540 mg (5 mEq), 1080 mg (10 mEq), 1620 mg (15 mEq)

Potassium Bicarbonate/Potassium Citrate

Tablets for effervescent oral solution: 10 mEq, 20 mEq, 25 mEq

Assessment

• Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and hyperkalemia (see Toxicity and Overdose).

Lab Test Considerations:

Monitor serum potassium before and periodically during therapy. Monitor renal function, serum bicarbonate, and pH. Determine serum magnesium level if patient has refractory hypokalemia; hypomagnesemia should be corrected to facilitate effectiveness of potassium replacement. Monitor serum chloride because hypochloremia may occur if replacing potassium without concurrent chloride.

• For urinary alkalinization:  Monitor serum electrolytes (sodium, potassium, chloride, and carbon dioxide), serum creatinine, and CBC every 4 mo and more frequently in patients with cardiac disease, renal disease, or acidosis. Treatment should be discontinued if there is hyperkalemia, a significant rise in serum creatinine, or a significant fall in blood hematocrit or hemoglobin.

Symptoms of toxicity are those of hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea; peaked T waves; depressed ST segments; widened QRS complexes; loss of P waves; and cardiac arrhythmias).

• Treatment includes discontinuation of potassium, administration of sodium bicarbonate to correct acidosis, dextrose and insulin to facilitate passage of potassium into cells, calcium salts to reverse ECG effects (in patients who are not receiving digoxin), sodium polystyrene used as an exchange resin, and/or dialysis for patient with impaired renal function.

Implementation

• For most purposes, potassium chloride should be used, except for renal tubular acidosis (hyperchloremic acidosis), in which other salts are more appropriate (potassium bicarbonate, potassium citrate, or potassium gluconate).
• If hypokalemia is secondary to diuretic therapy, consider decreasing dose of diuretic, unless there is a history of significant arrhythmias or concurrent digoxin therapy.
• PO Administer with or after meals to decrease GI irritation.
  • Reserve use of tablets for patients who cannot tolerate liquid preparations.
  • Dissolve effervescent tablets in 3–8 oz of cold water. Ensure tablet is fully dissolved. Instruct patient to drink slowly over 5–10 min.
  • Take tablets with a meal and full glass of water.  DNC: Do not chew or crush extended-release tablets. 

Patient/Family Teaching

• Explain to patient purpose of medication and need to take as directed, especially when concurrent digoxin or diuretics are taken. Advise patient to take effervescent tablets without crushing, chewing, or sucking the tablet. A missed dose should be taken as soon as remembered within 2 hr; if not, return to regular dose schedule. Do not double dose.
• Encourage patient to maintain a diet limiting salt intake (avoidance of high-salt foods and of added salt at the table) and maintaining high fluid intake (urine volume should be at least 2 L/day)
• Instruct patient to avoid salt substitutes or low-salt milk or food unless approved by health care professional. Advise patient to read all labels to prevent excess potassium intake.
• Advise patient regarding sources of dietary potassium (see food sources for specific nutrients). Encourage compliance with recommended diet.
• Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dose may require adjustment.
• Emphasize the importance of regular follow-up exams to monitor serum levels and progress.

Evaluation/Desired Outcomes

• Prevention and correction of serum potassium depletion.
• Reduction in stone formation.