POTASSIUM

POTASSIUM SALTS are available in a variety of forms and are chiefly used as supplementation with diuretic therapy.
Potassium supplements are available in "slow release" (enteric-coated) tablets which can release large amounts of KCl over a relatively short segment of small bowel. These formulations have been implicated in small bowel ulcers, some of which were fatal.

The newer slow release KCl formulations are somewhat safer, but can cause potential adverse effects if delayed intestinal transit is present.

Potassium (K) Salt mEq K/gram of salt
K-Acetate 10.3
K-Bicarbonate 10
K-Chloride 13.3
K-Citrate H20 9.3
K-Iodide 6
K-Phosphate monobasic 7.4
K-Phosphate dibasic 11.4
Potassium salt substitutes may cause serious poisoning. Below is the potassium content of various salt substitutes (Hoye & Clark, 2003; Hoyt, 1986; Kallen et al, 1976; Yap et al, 1976)
SALT SUBSTITUTE mEq/teaspoon
Adolph's Salt Substitute (unseasoned) 65
Morton's Lite Salt 38
Morton's Salt Substitute 72
No-Salt 64
Nu-Salt 67

SOURCES

FOODS: It is also present in large amounts in certain foods (e.g., cantaloupe, citrus fruits, bananas, tomatoes, and potatoes).
WATER SOFTENER: Water softeners can be a significant source of potassium, especially in patients with underlying renal insufficiency. One softener, K-Life (IMC Kalium Canada) was found to provide 7 mmol potassium per liter of water (Graves, 1998).
LOW SODIUM FOODS: Hyperkalemia developed in dialysis patients when they tripled their potassium intake by switching from the old Campbell's low sodium soups (7-1/2 ounce can containing 0.5 mEq potassium/ounce) to the new Campbell's low sodium soups (10-3/4 ounce can containing 1 mEq potassium/ounce) (Bay & Hartman, 1983).
COCONUT WATER: SUMMARY: Coconut water is used as a rehydration drink. It is sold in the US and other markets as a purported health drink. It has been promoted as an electrolyte-balanced sports drink for healthy exercising individuals (Rees et al, 2012).

ELECTROLYTE CONTENTS: Electrolytes per liter of coconut water: sodium 46.3 mmol/L; potassium 65 mmol/L; magnesium 10.4 mmol/L; and calcium 6.1 mmol/L (Rees et al, 2012).
CASE REPORT: A 26-year-old woman with type 1 diabetes and nephropathy presented with a potassium level of 7.7 mmol/L with T wave changes on an ECG. Upon questioning, the patient reported drinking 2 L of coconut water (potassium content was at least 5 g (130 mmoles)) during the preceding 24 hours; she recovered with supportive care (Rees et al, 2012).

CAUSES OF HYPERKALEMIA

The most common causes of hyperkalemia are acute renal failure, use of potassium-sparing diuretics (spironolactone and triamterene), and over-supplementation.
Most severe hyperkalemia occurs in the face of compromised renal function.
Intentional and unintentional overdoses of KCl have been reported.

CREAM OF TARTAR: A 16-year-old body builder intentionally ingested a bottle of cream of tartar, which is used as a leavening agent in baking (equivalent to 420.5 mEq of potassium), and developed severe hyperkalemia (Sanftleben et al, 2000).

-CLINICAL EFFECTS

GENERAL CLINICAL EFFECTS

USES: Potassium is a metal found naturally in the earth's crust and in most foods. It is taken medically for the prevention and treatment of hypokalemia. Tablets are readily available, including sustained-release formulations. Potassium is used as a salt substitute and is often present in "low-sodium" foods. It is also used as a water softener, and in chemistry and manufacturing processes.

PHARMACOLOGY: Potassium is the human body's main intracellular cation, with only 2% of the body's stores in the intravascular compartment. It is necessary for nerve conduction, and muscle (including cardiac) contraction.

TOXICOLOGY: Local irritation after ingestion causes GI upset. Severe hyperkalemia after large IV or oral overdoses causes muscular dysfunction including weakness, paralysis, cardiac dysrhythmias, and rarely death.

EPIDEMIOLOGY: Potassium toxicity from overdose is rare but may result from intentional ingestion. Iatrogenic overdoses can occur.

WITH POISONING/EXPOSURE

MILD TO MODERATE TOXICITY: Nausea, vomiting, diarrhea, paresthesias, and muscle cramps are common. Rarely, GI bleed may occur.
SEVERE TOXICITY: Muscular weakness progressing to paralysis may occur. Cardiac dysrhythmias often occur with concentrations greater than 8 mEq/L and death from cardiac arrest with concentrations of 9 to 12 mEq/L or higher. Characteristic ECG findings occur in the following order: peaked T waves, QRS complex blends into the T wave, PR interval prolongation, P wave is lost and ST segments depress, merging S and T waves, and finally, sine waves. The presence of the sine wave is a near terminal event, signaling that hemodynamic collapse and cardiac arrest are near. As serum hyperkalemia is corrected, the ECG changes resolve in reverse order.

WITH THERAPEUTIC USE

ADVERSE EFFECTS: SPECIAL SITUATIONS: Inadvertent intrathecal injection of potassium was rapidly fatal in the only case that has been reported. Potassium permanganate crystals are caustic. Potassium carbonate and hydroxide are very alkaline and have been associated with ocular injury.

POTENTIAL HEALTH HAZARDS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)

Inhalation or contact with vapors, substance or decomposition products may cause severe injury or death.
May produce corrosive solutions on contact with water.
Fire will produce irritating, corrosive and/or toxic gases.
Runoff from fire control may cause pollution.

-FIRST AID

FIRST AID AND PREHOSPITAL TREATMENT

EMESIS

Consider inducing emesis only if a recent oral overdose and the patient is not already vomiting and can protect their airway.

ACTIVATED CHARCOAL

LACK OF EFFICACY: There is no role for activated charcoal as it does not bind potassium.

-MEDICAL TREATMENT

LIFE SUPPORT

Support respiratory and cardiovascular function.

SUMMARY

FIRST AID - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)

Move victim to fresh air.
Call 911 or emergency medical service.
Give artificial respiration if victim is not breathing.
Administer oxygen if breathing is difficult.
Remove and isolate contaminated clothing and shoes.
In case of contact with substance, wipe from skin immediately; flush skin or eyes with running water for at least 20 minutes.
Keep victim warm and quiet.
Ensure that medical personnel are aware of the material(s) involved and take precautions to protect themselves.

-RANGE OF TOXICITY

MINIMUM LETHAL EXPOSURE

SUMMARY

NORMAL SERUM CONCENTRATIONS: 3.5 to 5 mEq/L (Prod Info KLOR-CON(R) extended release tablets, 2005; Schonwald, 2004).
MINIMAL TOXICITY: Potassium concentrations under 6.5 mEq/L. Evidence of cardiac toxicity is rare below 6.5 mEq/L (Schonwald, 2004).
MODERATE TOXICITY: Concentrations between 6.5 and 8 mEq/L produce lassitude, fatigue, and weakness.
SEVERE TOXICITY: Concentrations over 8 mEq/L, complete neuromuscular paralysis may dominate the clinical picture. Cardiac manifestations of toxicity are also common at concentrations above 8 mEq/L (Schonwald, 2004). Death from cardiac arrest usually occurs at 9 to 12 mEq/ L (Prod Info KLOR-CON(R) extended release tablets, 2005).

ROUTE OF EXPOSURE

INTRAVENOUS INJECTION: Although potassium kinetics are complicated, some useful approximations may be made. For bolus intravenous injections, the human lethal dose is 0.75 to 0.9 mEq/kg (54 to 63 mEq/70 kg).

CASE REPORTS

ORAL

ADULT

A 26-year-old man died after ingesting approximately 40 Slow-K tablets (each containing 600 mg of potassium chloride; total potassium dose 320 mEq) with a serum potassium of 9.3 mEq/L. This dose is equivalent to 4 mEq/kg based on the assumption of an 80 kg body weight (Illingworth & Proudfoot, 1980).
A 32-year-old woman ingested 47 potassium chloride tablets (strength unspecified) and died. The postmortem level (18 hours later) was 10.8 mEq/L (Wetli & Davis, 1978).
A 46-year-old woman ingested 100 Slow-K tablets (each containing 600 mg (8 mEq) of potassium chloride) and was in full cardiopulmonary arrest within an hour. The ingested dose was 16 mEq/kg. Her initial serum potassium was 9.6 mEq/L. She died 14 days after ingestion despite aggressive care (Saxena, 1988).
An 8-month-old child ingested 26 mEq/kg of potassium (a blood level of 10.2 mEq/L) and nearly died (Kallen et al, 1976).

INJECTION

ADULT

POTASSIUM ASPARTATE: A man and a woman, both in their thirties, injected potassium aspartate intravenous solutions in a fatal suicide attempt. Approximately 150 mL of a 761 mEq/L concentrated solution had been administered to the woman and approximately 30 mL of a 746 mEq solution, plus 35 mL from a syringe solution containing 690 mEq/L, had been administered to the man. Potassium levels on autopsy for the woman and man were 62.8 and 49.7 mEq/L, respectively. Serum levels also indicated toxic levels of phenobarbital, promethazine, chlorpromazine, and low plasma levels of etizolam and brotizolam for both patients(Watanabe et al, 2011).

MAXIMUM TOLERATED EXPOSURE

SUMMARY

2 to 2.5 mEq/kg: Normal homeostatic mechanisms can be overwhelmed following acute ingestion of about 2 to 2.5 mEq/kg or more in patients with normal renal function (Illingworth & Proudfoot, 1980; Saxena, 1989).

This is equivalent to 2 to 3 tablets containing 8 mEq for a child weighing 10 kg. Smaller oral doses of 30 to 45 mEq can lead to hyperkalemia in adult patients with renal insufficiency (Saxena, 1989).

THE AMOUNT OF POTASSIUM NEEDED TO INCREASE SERUM LEVELS is dependent on factors such as absorption rate, renal function, intracellular potassium stores, and acid-base status. Kinetics are nonlinear at higher doses (Freitag & Miller, 1980). Thus calculations used to derive doses for hypokalemic patients may not be applicable to normokalemic patients who overdose.

CASE REPORTS

CASE REPORT (BEZOAR): A 44-year-old woman developed hyperkalemia (serum potassium concentration, 7.3 mmol/L) after ingesting an unknown amount of extended-release potassium tablets and alprazolam. Based on the patient's prescription usage, it was suggested that she ingested about 600 mEq (thirty 20-mEq tablets) of extended-release potassium tablets and 60 mg (sixty 1-mg tablets) of alprazolam. Initially, she was treated with albuterol, calcium gluconate, insulin, dextrose, and sodium bicarbonate; however, a radiographic study revealed a bezoar containing potassium in the gastric fundus. Since the patient did not tolerate whole bowel irrigation using a nasogastric tube, esophagogastroduodenoscopy (EGD) was used successfully to remove the bezoar and her serum potassium concentration normalized about 11 hours after presentation (Briggs & Deal, 2014).
ADULT: A 42-year-old woman presented to the emergency department on two separate occasions after intentionally ingesting sustained-release tablets each containing 8 mEq of potassium chloride. During the first episode she presented with a potassium level of 5.5 mmol/L 90 minutes after ingesting 40 tablets and was successfully treated with supportive care, including whole bowel irrigation. At the second episode, she presented with a potassium level of 8.5 mmol/L approximately 5 hours after ingesting 100 tablets and was successfully decontaminated during 10 hours of hemodialysis. Whole bowel irrigation was not attempted during the second episode as most of the tablets had been absorbed. In each case she was discharged to psychiatric care within 2 to 3 days without sequelae (Gunja, 2011).
ADULT: A 58-year-old woman survived a potassium ingestion of approximately 20 tablets (each containing 630 mg (8 mEq) of potassium chloride). Her serum potassium peaked at 6 hours postingestion at 9.1 mEq/L (Illingworth & Proudfoot, 1980).
One case where 164 mEq (2 mEq/kg based on an 80 kg body weight) was ingested acutely resulted in a peak level of 9.1 mEq/L in 6 hours (Illingworth & Proudfoot, 1980).
CASE REPORT: A 67-year-old hemodialysis patient was diagnosed with severe hyperkalemia (potassium concentration: 9.3 mmol/L; reference levels: 3.5 to 4.7 mmol/L) after developing unconsciousness and leg paralysis. Following supportive care, including treatment with calcium, insulin, glucose, sodium polystyrene sulfonate, and a hemodialysis session, the patient's condition improved and the ECG normalized. It was determined that the patient was using about 40 mmol/day of added potassium from a low-sodium/potassium-enriched spread (Becel pro.activ) to improve his blood pressure (van der Steen et al, 2012).
CASE REPORT: Hyperkalemia developed in a 57-year-old woman who was being treated with continuous ambulatory peritoneal dialysis (CAPD; 3 daily exchanges with 2.5% dextrose solution) for end-stage renal disease secondary to renal tuberculosis and obstructive uropathy. She was compliant with her low-potassium diet regimen and used 600 mg of potassium chloride daily to maintain normal serum potassium concentrations. During a routine blood test, more than a year after starting CAPD, hyperkalemia (potassium: 6.7 mmol/L; bicarbonate of 23 mmol/L) was discovered. Following treatment with ion-exchange resin, her potassium concentration returned to normal, but increased again to 6 mmol/L. Three weeks later, it was determined that she was using a new brand of salt (LoSalt) containing potassium chloride (estimated daily intake of LoSalt: 3750 mg; 95 mmol of potassium daily). She recovered completely following the discontinuation of the potassium-containing salt (Yip et al, 2012).

PEDIATRIC

A 6-year-old boy developed hyperkalemia (potassium level 7.6 mmol/L on admission) after ingesting an unknown amount of sustained-release potassium chloride tablets. Approximately 50 potassium chloride tablets (Slow-K) were recovered from the vomitus. Following supportive care, including continuous venovenous hemodialysis, he recovered and was discharged on day 3. Whole bowel irrigation was not attempted as most of the tablets had been absorbed (Gunja, 2011).
A 6-week-old infant was successfully resuscitated from an iatrogenic potassium intoxication resulting in a potassium level of 17.7 mmol/L. Following cardiac surgery, the infant erroneously received a 15% potassium chloride solution (total 30 mmol) intravenously instead of a 5% glucose solution. Potassium levels were lowered with conventional measures; hemodialysis was not performed. The authors theorized that conventional measures were successful because the acute nature of the exposure had not allowed the infused potassium to be distributed into the extravascular space (Horisberger et al, 2004).

TOXICITY AND RISK ASSESSMENT VALUES

TOXICITY VALUES

Potassium (metal):
- LD50- (INTRAPERITONEAL)MOUSE:

-STANDARDS AND LABELS

SHIPPING REGULATIONS

SURFACE

DOT -- Table of Hazardous Materials and Special Provisions for UN/NA Number 2257 (49 CFR 172.101, 2005):

Hazardous materials descriptions and proper shipping name: Potassium

Symbol(s): Not Listed
Hazard class or Division: 4.3

4.3: Dangerous when wet material. See 49 CFR section 173.124 for definitions.

Identification Number: UN2257
Packing Group: I

I: Packing Group I - indicates the degree of danger presented by the material is great.

Label(s) required (if not excepted): 4.3

4.3: Dangerous When Wet.

Special Provisions: A7, A19, A20, B27, IB4, IP1, N6, N34, T9, TP3, TP7, TP33

A7: Steel packagings must be corrosion-resistant or have protection against corrosion.
A19: Combination packagings consisting of outer fiber drums or plywood drums, with inner plastic packagings, are not authorized for transportation by aircraft.
A20: Plastic bags as inner receptacles of combination packagings are not authorized for transportation by aircraft.
B27: Tanks must have a service pressure of 1,034 kPa (150 psig). Tank car tanks must have a test pressure rating of 1,379 kPa (200 psig). Lading must be blanketed at all times with a dry inert gas at a pressure not to exceed 103 kPa (15 psig).
IB4: Authorized IBCs: Metal (11A, 11B, 11N, 21A, 21B, 21N, 31A, 31B and 31N).
IP1: IBCs must be packed in closed freight containers or a closed transport vehicle.
N6: Battery fluid packaged with electric storage batteries, wet or dry, must conform to the packaging provisions of sxn. 173.159 (g) or (h) of this subchapter.
N34: Aluminum construction materials are not authorized for any part of a packaging which is normally in contact with the hazardous material.
T9: Minimum test pressure (bar): 4; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): 6 mm; Pressure-relief requirements (See sxn.178.275(g)): Normal; Bottom opening requirements (See sxn.178.275(d)): Prohibited.
TP3: The maximum degree of filling (in %) for solids transported above their melting points and for elevated temperature liquids shall be determined by the following: [Degree of filling = 95 x (dr/df)], where df and dr are the mean densities of the liquid at the mean temperature of the liquid during filling and the maximum mean bulk temperature during transport respectively.
TP7: The vapor space must be purged of air by nitrogen or other means.
TP33: The portable tank instruction assigned for this substance applies for granular and powdered solids and for solids which are filled and discharged at temperatures above their melting point which are cooled and transported as a solid mass. Solid substances transported or offered for transport above their melting point are authorized for transportation in portable tanks conforming to the provisions of portable tank instruction T4 for solid substances of packing group III or T7 for solid substances of packing group II, unless a tank with more stringent requirements for minimum shell thickness, maximum allowable working pressure, pressure-relief devices or bottom outlets are assigned in which case the more stringent tank instruction and special provisions shall apply. Filling limits must be in accordance with portable tank special provision TP3. Solids meeting the defnintion of an elevated temperature material must be transported in accordance with the applicable requirements of this subchapter.

Packaging Authorizations (refer to 49 CFR 173.***):

Exceptions: None
Non-bulk packaging: 211
Bulk packaging: 244

Quantity Limitations:

Passenger aircraft or railcar: Forbidden
Cargo aircraft only: 15 kg

Vessel Stowage Requirements:

Vessel stowage location: D

D: The material must be stowed "on deck only" on a cargo vessel and on a passenger vessel carrying a number of passengers limited to not more than the larger of 25 passengers or one passenger per each 3 m of overall vessel length, but the material is prohibited on passenger vessels in which the limiting number of passengers is exceeded.

Vessel stowage other: 52

52: Stow "separated from" acids.

ICAO International Shipping Name for UN2257 (ICAO, 2002):

Proper Shipping Name: Potassium
UN Number: 2257

-PERSONAL PROTECTION

SUMMARY

RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)

Wear positive pressure self-contained breathing apparatus (SCBA).
Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection.
Structural firefighters' protective clothing provides limited protection in fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.

-PHYSICAL HAZARDS

FIRE HAZARD

SUMMARY

POTENTIAL FIRE OR EXPLOSION HAZARDS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Produce flammable gases on contact with water.
- May ignite on contact with water or moist air.
- Some react vigorously or explosively on contact with water.
- May be ignited by heat, sparks or flames.
- May re-ignite after fire is extinguished.
- Some are transported in highly flammable liquids.
- Runoff may create fire or explosion hazard.

FIRE CONTROL/EXTINGUISHING AGENTS

FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- DO NOT USE WATER or FOAM.
SMALL FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Dry chemical, soda ash, lime or sand.
LARGE FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- DRY sand, dry chemical, soda ash or lime or withdraw from area and let fire burn.
- Move containers from fire area if you can do it without risk.
LITHIUM OR MAGNESIUM FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Magnesium Fires:
- Lithium Fires:
TANK OR CAR/TRAILER LOAD FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Fight fire from maximum distance or use unmanned hose holders or monitor nozzles.
- Do not get water inside containers.
- Cool containers with flooding quantities of water until well after fire is out.
- Withdraw immediately in case of rising sound from venting safety devices or discoloration of tank.
- ALWAYS stay away from tanks engulfed in fire.

REACTIVITY HAZARD

METAL: One of the most reactive of metals, reacting with oxygen, water, acid, halogens, and sulfides. It reduces silicates, nitrates, hydroxides of heavy metals, oxides, carbonates, phosphates, and sulfates.

EVACUATION PROCEDURES

SUMMARY

Editor's Note: This material is not listed in the Table of Initial Isolation and Protective Action Distances.
LARGE SPILL - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Increase, in the downwind direction, as necessary, the isolation distance of at least 50 meters (150 feet) for liquids and 25 meters (75 feet) for solids in all directions.
FIRE - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- If tank, rail car or tank truck is involved in a fire, ISOLATE for 800 meters (1/2 mile) in all directions; also, consider initial evacuation for 800 meters (1/2 mile) in all directions.
PUBLIC SAFETY MEASURES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- CALL Emergency Response Telephone Number on Shipping Paper first. If Shipping Paper not available or no answer, refer to appropriate telephone number:
- For additional details see the section entitled "WHO TO CALL FOR ASSISTANCE" under the ERG Instructions.
- As an immediate precautionary measure, isolate spill or leak area in all directions for at least 50 meters (150 feet) for liquids and at least 25 meters (75 feet) for solids.
- Keep unauthorized personnel away.
- Stay upwind.
- Keep out of low areas.
- Ventilate the area before entry.

CONTAINMENT/WASTE TREATMENT OPTIONS

SUMMARY

SPILL OR LEAK PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- ELIMINATE all ignition sources (no smoking, flares, sparks or flames in immediate area).
- Do not touch or walk through spilled material.
- Stop leak if you can do it without risk.
- Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact spilled material.
- DO NOT GET WATER on spilled substance or inside containers.
POWDER SPILL PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Cover powder spill with plastic sheet or tarp to minimize spreading and keep powder dry.
- DO NOT CLEAN-UP OR DISPOSE OF, EXCEPT UNDER SUPERVISION OF A SPECIALIST.
RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Wear positive pressure self-contained breathing apparatus (SCBA).
- Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection.
- Structural firefighters' protective clothing provides limited protection in fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.

SMALL LEAK/SPILL

SMALL SPILL PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 138 (ERG, 2004)
- Cover with DRY earth, DRY sand or other non-combustible material followed with plastic sheet to minimize spreading or contact with rain.
- Dike for later disposal; do not apply water unless directed to do so.

-PHYSICAL/CHEMICAL PROPERTIES

MOLECULAR WEIGHT

POTASSIUM CHLORIDE: 74.55 (Prod Info potassium chloride in dextrose and sodium chloride injection, 2004)

POTASSIUM CITRATE: 324.41 (Prod Info potassium citrate extended-release oral tablets, 2009)

DESCRIPTION/PHYSICAL STATE

POTASSIUM is a silvery-white metal which tarnishes in air (Budavari, 1996)

POTASSIUM CHLORIDE is a white granular powder or colorless crystals, is odorless, and has a saline taste. It is freely soluble in water and insoluble in alcohol (Prod Info KLOR-CON(R) extended release tablets, 2005).

POTASSIUM CITRATE is a white granular powder that is insoluble in organic solvents, almost insoluble in alcohol, and soluble in water at 154 g/100 mL (Prod Info potassium citrate extended-release oral tablets, 2009).

POTASSIUM GLUCONATE is a white, odorless crystalline powder with a slightly bitter taste.

DENSITY

TEMPERATURE AND/OR PRESSURE NOT LISTED

SOLID: 0.856 g/cm(3) (Budavari, 1996)

FREEZING/MELTING POINT

MELTING POINT

63.2 degrees C (Budavari, 1996)

BOILING POINT

765.5 degrees C (Budavari, 1996)

SOLUBILITY

IN WATER

POTASSIUM CHLORIDE: freely soluble in water (Prod Info KLOR-CON(R) extended release tablets, 2005)
POTASSIUM CITRATE: soluble in water at 154 g/100 mL (Prod Info potassium citrate extended-release oral tablets, 2009)

IN ORGANIC SOLVENTS

POTASSIUM CITRATE: insoluble in organic solvents (Prod Info potassium citrate extended-release oral tablets, 2009)
soluble in ammonia (1 g), ethylenediamine, aniline, and several metals

-REFERENCES

GENERAL BIBLIOGRAPHY

49 CFR 172.101: Department of Transportation - Table of Hazardous Materials. National Archives and Records Administration (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Aug 11, 2005.

AMA Division of Drugs: AMA Drug Evaluations, 5th ed, American Medical Association, Chicago, IL, 1983.

Abdel-al YK, Badawi MH, Yaeesh SA, et al: Bartter's syndrome in Arabic children: review of 13 cases. Pediatr Int 1999; 41(3):299-303.

Addiego JE, Ridgway D, & Bleyer WA: The acute management of intrathecal methotrexate overdose: pharmacologic rationale and guidelines. J Pediatr 1981; 98(5):825-828.

Allen AC, Boley SJ, & Schultz L: Potassium-induced lesions of the small bowel. JAMA 1965; 193:85-90.

Anon: American Heart Association/International Liaison Committee on Resuscitation: Guidelines 2000 for Cardiopulmonary Resuscitation and emergency Cardiovascular Care: an international consensus on science. Circulation 2000; 102:I1-I384.

Barkin RM: Emergency Pediatrics, 2nd ed, CV Mosby Co, St. Louis, MO, 1986.

Bay WH & Hartman JA: High potassium in low-sodium soups. N Engl J Med 1983; 308:1166-1167.

Baylen BG, Johnson G, Tsang R, et al: The occurrence of hyperaldosteronism in infants with congestive heart failure. Am J Cardiol 1980; 45(2):305-310.

Bedford PD: Acute potassium intoxication. Lancet 1954; 2:268-270.

Bhatkhoude CY & Joglekar VS: Fatal poisoning by potassium in human and rabbit. Forensic Sci 1977; 9:33-36.

Blaney SM, Poplack DG, Godwin K, et al: Effect of body position on ventricular CSF methotrexate concentration following intralumbar administration. J Clin Oncol 1995; 13(1):177-179.

Briggs AL & Deal LL: Endoscopic removal of pharmacobezoar in case of intentional potassium overdose. J Emerg Med 2014; 46(3):351-354.

Budavari S: The Merck Index, 12th ed, Merck & Co, Inc, Whitehouse Station, NJ, 1996.

Caravati EM, Knight HH, & Linscott MS: Esophageal laceration and charcoal mediastinum complicating gastric lavage. J Emerg Med 2001; 20:273-276.

Chameides L: Textbook of Pediatric Advanced Life Support, American Heart Association, Dallas, TX, 1988.

Chaturvedi AK, Rao NGS, & Moor MD: Poisoning associated with potassium. Human Toxicol 1986; 5:377-380.

Coke GA, Baschat AA, Mighty HE, et al: Maternal cardiac arrest associated with attempted fetal injection of potassium chloride. Int J Obstet Anesth 2004; 13(4):287-290.

Colledge NR, Northridge B, & Fraser DM: Survival after massive overdose of slow-release potassium. Scott Med J 1988; 33:279.

Cox M: Potassium homeostasis. Med Clin North Am 1981; 65:363-38.

DeFronzo RA & Bia M: Intravenous potassium chloride therapy. JAMA 1981; 245:2446.

ERG: Emergency Response Guidebook. A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/Hazardous Materials Incident, U.S. Department of Transportation, Research and Special Programs Administration, Washington, DC, 2004.

Edelman IS & Leibman J: Anatomy of body water and electrolytes. Am J Med 1959; 256-277.

Ellenhorn MJ & Barceloux DG: Medical Toxicology. Diagnosis and Treatment of Human Poisoning, Elsevier, New York, NY, 1988.

Feld LG, Kaskel FJ, & Schoeneman MJ: The approach to fluid and electrolyte therapy in pediatrics. Adv Pediatr 1988; 35:497-535.

Franko DL & Banitt PF: Abuse of potassium by a patient with bulimia nervosa. Am J Psychiatry 1991; 148:682.

Freitag JJ & Miller LW: Manual of Medical Therapeutics, 23rd ed, Little Brown and Company, Boston, MA, 1980, pp 31.

Geluk M & Braitberg G: Ipecac for slow-release potassium poisoning: Pariah or phoenix?. Emerg Med 2000; 12:226-231.

Gosselin S & Isbister GK: Re: Treatment of accidental intrathecal methotrexate overdose. J Natl Cancer Inst 2005; 97(8):609-610.

Grant WM & Schuman JS: Toxicology of the Eye, 4th ed, Charles C. Thomas, Springfield, IL, 1993.

Graves JW: Hyperkalemia due to a potassium-based water softener (letter). New Eng J Med 1998; 339:1790.

Gunja N: Decontamination and enhanced elimination in sustained-release potassium chloride poisoning. Emerg Med Australas 2011; 23(6):769-772.

Handy CA: Radiopacity of oral nonliquid medications. Radiology 1971; 98:525-533.

Hobbins SM, Fowler RS, Rowe RD, et al: Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease. Arch Dis Child 1981; 56(12):934-938.

Holland OB & Fuchs JE Jr: Oral potassium repletion. Pharmacy Newsletter UTMB, Galveston, TX 1983; 2:1-2.

Horisberger T, Fischer JE, & Waldvogel K: Long-term outcome of an infant resuscitated from iatrogenic potassium intoxication with a serum level of 17.7 mmol/L. Eur J Pediatr 2004; 163:48-49.

Hoye A & Clark A: Iatrogenic hyperkalaemia. Lancet 2003; 361:2124.

Hoyt RE: Hyperkalemia due to salt substitutes. JAMA 1986; 256:1726.

ICAO: Technical Instructions for the Safe Transport of Dangerous Goods by Air, 2003-2004. International Civil Aviation Organization, Montreal, Quebec, Canada, 2002.

Illingworth RN & Proudfoot AT: Rapid poisoning with slow-release potassium. Br Med J 1980; 281:485-486.

Jospe N & Forbes G: Fluids and electrolytes--clinical aspects. Pediatr Rev 1996; 17(11):395-403.

Kallen RJ, Rieger CHL, & Cohen HS: Near fatal hyperkalemia due to ingestion of salt substitute by an infant. JAMA 1976; 235:2125-2126.

Khilnani P: Electrolyte abnormalities in critically ill children. Crit Care Med 1992; 20(2):241-250.

Kirshenbaum LA, Mathews SC, & Sitar DS: Whole-bowel irrigation versus activated charcoal in sorbitol for the ingestion of modified-release pharmaceuticals. Clin Pharmacol Ther 1989; 46:264-271.

Lillemoe KD, Romolo JL, & Hamilton SR: Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support of the hypothesis. Surgery 1987; 101:267-272.

Linshaw MA: Potassium homeostasis and hypokalemia. Pediatr Clin North Am 1987; 34(3):649-681.

Martin ML, Hamilton R, & West MF: Potassium. Emerg Med Clin North Am 1986; 4:131-144.

Mattu A, Brady WJ, & Robinson DA: Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med 2000; 18:721-729.

McLean SA, Paul ID, & Spector PS: Lidocaine-induced conduction disturbance in patients with systemic hyperkalemia. Ann Emerg Med 2000; 36:615-618.

Meel B: Inadvertent intrathecal administration of potassium chloride during routine spinal anesthesia: case report. Am J Forensic Med Pathol 1998; 19(3):255-257.

Michelagnoli MP, Bailey CC, Wilson I, et al: Potential salvage therapy for inadvertent intrathecal administration of vincristine. Br J Haematol 1997; 99:364-367.

Ninji AA: Drug induced electrolyte disorders. Drug Intell Clin Pharm 1983; 17:175-185.

O'Brien RP, McGeehan PA, & Helmeczi AW: Detectability of drug tablets and capsules by plain radiography. Am J Emerg Med 1986; 4:302-312.

O'Marcaigh AS, Johnson CM, & Smithson WA: Successful treatment of intrathecal methotrexate overdose by using ventriculolumbar perfusion and trathecal instillation of carboxypeptidase G2. Mayo Clin Proc 1996; 71:161-165.

Oseas RS, Phelps DL, & Kaplan SA: Pediatrics 1982; 69:117-118.

Pang PS, Look RB, Brown DFM, et al: Wide complex rhythm and cardiac arrest. J Emerg Med 2004; 26:197-200.

Park SM, Sohn YD, & Ahn JY: Chemical burn caused by dermal injection of potassium chloride. Clin Toxicol (Phila) 2011; 49(5):436-437.

Ponce SP, Jennings AE, & Madias NE: Drug-induced hyperkalemia. Medicine 1985; 64:357-370.

Product Information: KAYEXALATE(R) oral powder for suspension rectal powder for suspension, sodium polystyrene sulfonate oral powder for suspension rectal powder for suspension. Sanofi-Aventis, US, LLC, Bridgewater, NJ, 2010.

Product Information: KAYEXALATE(R) oral suspension, rectal suspension, sodium polystyrene sulfonate oral suspension, rectal suspension. Sanofi-Synthelabo Inc, New York, NY, 2003.

Product Information: KLOR-CON(R) extended release tablets, potassium chloride extended release tablets. Upsher Smith Laboratories,Inc., Minneapolis, MN, 2005.

Product Information: KLOR-CON(R) powder for oral solution, potassium chloride powder for oral solution. Upsher-Smith, Maple Grove, MN, 2009.

Product Information: UROCIT(R)-K extended-release oral tablets, potassium citrate extended-release oral tablets. Mission Pharmacal Company, San Antonio, TX, 2009.

Product Information: potassium chloride extended-release oral tablets, potassium chloride extended-release oral tablets. Andrx Pharmaceuticals,Inc., Ft. Lauderdale, FL, 2006.

Product Information: potassium chloride in dextrose and sodium chloride injection, potassium chloride in dextrose and sodium chloride injection. B.Braun Medical,Inc., Scarborough, Ontario, 2004.

Product Information: potassium chloride injection, potassium chloride injection. Hospira,Inc., Lake Forest, IL, 2004.

Product Information: potassium citrate extended-release oral tablets, potassium citrate extended-release oral tablets. Corepharma, LLC, Middlesex, NJ, 2009.

Rees R, Barnett J, Marks D, et al: Coconut water-induced hyperkalaemia. Br J Hosp Med (Lond) 2012; 73(9):534-534.

Sanftleben J, Smith J, & Rusyniak D: A cream of tartar misadventure (abstract). Clin Toxicol 2000; 38:523-524.

Savitt DL, Hawkins HH, & Roberts JR: The radiopacity of ingested medications. Ann Emerg Meg 1987; 16:331-339.

Saxena K: Clinical features and management of poisoning due to potassium chloride. Med Toxicol Adv Drug Exp 1989; 4:429-443.

Saxena K: Death from potassium chloride overdose. Postgrad Med 1988; 84:97-102.

Schaber DE, Uden DL, Stone FM, et al: Intravenous KCl supplementation in pediatric cardiac surgical patients. Pediatr Cardiol 1985; 6(1):25-28.

Schim van der Loeff HJ, Strack van Schijndel RJ, & Thijs LG: Cardiac arrest due to oral potassium intake. Intens Care Med 1988; 15:58-59.

Schonwald S: Potassium Chloride and Potassium Permanganate. In: Dart RC, Carvati EM, McGuigan MA, eds. Medical Toxicology, 3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2004.

Shanker KB, Palkar NV, & Nishkala R: Paraplegia following epidural potassium chloride. Anaesthesia 1985; 40:45-47.

Smith JD, Bia MJ, & DeFronza RA: Clinical disorders of potassium metabolism. In: Arieff AI & DeFronzo RA (Eds): Fluid, Electrolyte, and Acid-Base Disorders, Vol 1, Churchill Livingstone, New York, NY, 1985, pp 413-510.

Smith SW, Ling LJ, & Halstenson CE: Whole-bowel irrigation as a treatment for acute lithium overdose. Ann Emerg Med 1991; 20:536-539.

Sollmann T: A Manual of Pharmacology, 8th ed, WB Saunders Co, Philadelphia, PA, 1957.

Stanaszek WF & Romandiewicz JA: Current approaches to management of potassium deficiency. Drug Intell Clin Pharm 1985; 19:176-184.

Su M, Stork C, & Ravuri S: Sustained-release potassium chloride overdose. Clin Toxicol 2001; 39:641-648.

Tenenbein M, Cohen S, & Sitar DS: Whole bowel irrigation as a decontamination procedure after acute drug overdose. Arch Int Med 1987; 147:905-907.

Townsend CM, Remmers AR Jr, & Sarles HE: Intestinal obstruction from medication bezoar in patients with renal failure. N Engl J Med 1973; 288:1058.

USPDI: Drug Information for the Health Care Professional, 19th Ed, 1, US Pharmacopeial Convention, Inc, Rockville, MD, 1999.

Udezue FO & Harrold BP: Hyperkalaemic paralysis due to spironolactone. Postgrad Med J 1980; 56:254-255.

Vale JA, Kulig K, American Academy of Clinical Toxicology, et al: Position paper: Gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943.

Vale JA: Position Statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997; 35:711-719.

Ward C, Hamid S, & Dow J: Gastric complication of massive Slow-K overdose. Br J Surg 1987; 74:490.

Warr OS & Nash JP: JAMA 1967; 199:217.

Watanabe K, Hasegawa K, & Suzuki O: A double-suicide autopsy case of potassium poisoning by intravenous administration of potassium aspartate after intake of some psychopharmaceuticals. Hum Exp Toxicol 2011; 30(7):777-781.

Welch DW, Johnson PN, & Driscoll JL: In vitro potassium binding: a comparison of activated charcoal and sodium polystyrene sulfonate. Vet Hum Toxicol 1986; 28:495.

Wetli CV & Davis JH: Fatal hyperkalemia from accidental overdose of potassium chloride. JAMA 1978; 240:1339.

Whitaker RJ & Maguire JE: Slow-release potassium overdose: clinical features and the role of whole bowel lavage in management. Emerg Med 2000; 12:218-225.

Widemann BC, Balis FM, Shalabi A, et al: Treatment of accidental intrathecal methotrexate overdose with intrathecal carboxypeptidase G2. J Nat Cancer Inst 2004; 96(20):1557-1559.

Wilde WS, Ginsburg J, & Walker WG: The distribution kinetics of intravenous potassium. Lancet 1953; 73:168-171.

Williams ME, Rosa RM, & Epstein FH: Hyperkalemia. Adv Intern Med 1986; 31:265-291.

Yap V, Patel A, & Thomsen J: Hyperkalemia with cardiac arrhythmia: induction by salt substitutes, spironolactone and azotemia. JAMA 1976; 236:2775-2776.

Yip T, Wan W, Hui PC, et al: Severe hyperkalemia in a peritoneal dialysis patient after consumption of salt substitute. Perit Dial Int 2012; 32(2):206-208.

Young LY & Koda-Kimble MA (Eds): Applied Therapeutics: The Clinical Use of Drugs, 4th. Applied Therapeutics, Inc, Vancouver, WA, 1988.

van der Steen M, Luderer S, & Veltman B: A dialysis patient with a life-threatening hyperkalaemia due to the use of a low-salt spread. Neth J Med 2012; 70(7):330-331.

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Information to evaluate chemical incidents

Information to evaluate chemical incidents