SYLVITAS 15% CONCENTRATE FOR SOLUTION FOR INFUSION

Indications

• Hypokalemia
• Prevention of hypokalemia in patients with normal diets
• Electrolyte imbalance

Dosage

Children: 0.5–1 g/kg daily in divided doses; maximum 60 g per day for children. For neonates, 0.5–1 g/kg daily, with irrigation of the colon to remove resin after 8–12 hours.

Adults: 2–4 g daily in divided doses, or as determined by serum potassium levels. For intravenous infusion, the dose is dependent on the deficit or daily maintenance requirements.

Mechanism of action

Potassium chloride acts as a supplemental source of potassium, which is the principal cation that mediates osmotic balance in body fluids. It restores normal potassium levels in the bloodstream and is crucial for maintaining cell volume and pressure, as well as for the generation of electrical potentials necessary for muscle and nerve function. It also plays a role in maintaining acid-base balance and is involved in various metabolic pathways.

Pharmacodynamics

Potassium is the primary intracellular cation in most body tissues and is involved in essential physiological processes such as maintaining intracellular tonicity, facilitating nerve impulse transmission, and enabling muscle contraction. The normal adult plasma concentration of potassium is between 3.5 to 5 mEq per liter. Potassium chloride supplementation helps to prevent potassium depletion, which can occur due to diuretic therapy, hyperaldosteronism, or gastrointestinal losses.

Pharmacokinetics

Potassium chloride is absorbed in the gastrointestinal tract, with an onset of action typically observed within 1 hour post-administration. It is distributed throughout the body's tissues and is excreted primarily by the kidneys. The pharmacokinetics can vary based on the formulation used (oral or intravenous) and the individual patient's renal function.

Contra-indications

• Hyperkalaemia
• Severe renal impairment
• Obstructive bowel disease
• Reduced gut motility

Adverse effects

• Diarrhoea
• Flatulence
• Nausea
• Vomiting
• Abdominal pain
• Fluid imbalance
• Oedema
• Constipation

Precautions

• Caution in patients with cardiac disease
• Caution in the elderly
• Close monitoring required in renal impairment
• Risk of hyperkalaemia in patients with anuria or severe oliguria

Pregnancy

Manufacturer advises avoiding use due to limited data; animal studies do not indicate toxicity.

Breast-feeding

Use with caution; potassium is excreted in breast milk.

Storage

Store in a cool, dry place away from light.

Formulations

• Effervescent tablets
• Oral powder sachets

Mechanism of action

Supplemental potassium in the form of high potassium food or potassium chloride may be able to restore normal potassium levels. K+ is the principal cation mediating the osmotic balance of the body fluids. In animals, the maintenance of normal cell volume and pressure depends on Na+ and K+ pumping. The K+/Na+ separation has allowed for evolution of reversible transmembrane electrical potentials essential for nerve and muscle action in animals, and both potassium and chloride are important in transmission of nerve impulses to the muscle fibers. /postasium/ The reported mutagenic effect of KCl most probably results from a disruption of osmotic balance of cells with a subsequent interference with chromosomal stability. This may result in the clastogenic effects (DNA breakage and chromosome structural instability) due to K+ effects on sequestering of Mg2+ ions required for normal maintenance of chromatin integrity. Other chemicals may also exert such effect (e.g. NaCl, sucrose). Potassium and chloride is also important in the regulation of the acid-base balance of the body. Potassium is the principal base in tissues of blood cells, and Cl maintains electrochemical neutrality by anion exchange with bicarbonate (the chloride shift) in the CO2 transport in the blood red cells.

Pharmacodynamics

The potassium ion is in the principle intracellular cation of most body tissues. Potassium ions participate in a number of essential physiological processes including the maintenance of intracellular tonicity, the transmission of nerve impulses, the contraction of cardiac, skeletal and smooth muscle, and the maintenance of normal renal function. The intracellular concentration of potassium is approximately 150 to 160 mEq per liter. The normal adult plasma concentration is 3.5 to 5 mEq per liter. An active ion transport system maintains this gradient across the plasma membrane. Potassium is a normal dietary constituent and under steady-state conditions the amount of potassium absorbed from the gastrointestinal tract is equal to the amount excreted in the urine. The usual dietary intake of potassium is 50 to 100 mEq per day. 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, primarily 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 concomitant loss of chloride and is manifested by hypokalemia and metabolic alkalosis. Potassium depletion may produce weakness, fatigue, disturbances of 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.