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Potassium Chlor/nacl 20meq/l Inj

Manufacturer B. BRAUN MEDICAL Active Ingredient Intravenous (IV) Fluids(in truh VEE nuhs FLOO ids) Pronunciation POH-tass-ee-um KLOR-ide / NAY-tree-um KLOR-ide IN-jek-shun
It is used to give fluids to the body when more fluids and electrolytes are needed.It is used as a way to give other drugs as a shot.It may be given to you for other reasons. Talk with the doctor.
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Drug Class
Fluid and Electrolyte Replenisher
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Pharmacologic Class
Crystalloid Solution; Electrolyte
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Pregnancy Category
Category C
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FDA Approved
Jan 1970
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

This medication is an intravenous (IV) fluid that contains essential salts, potassium and sodium, along with water. It's given directly into your vein to help your body stay hydrated and to correct imbalances in your body's salt levels, which are important for your heart, muscles, and nerves to work properly.
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How to Use This Medicine

Proper Use of This Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is administered as an infusion into a vein over a period of time. Your doctor may instruct you on how to self-administer this medication.

Before and after handling the medication, wash your hands thoroughly. Inspect the solution carefully before use; do not use it if it appears cloudy, is leaking, or contains particles. Additionally, do not use the solution if its color has changed.

To dispose of used needles and other sharp objects, use a designated needle/sharp disposal box. Never reuse needles or other items. Once the disposal box is full, follow local regulations for proper disposal. If you have any questions or concerns, consult your doctor or pharmacist.

Storage and Disposal

Typically, this medication is administered in a hospital or doctor's office. If you need to store it at home, follow the storage instructions provided by your doctor.

Missed Dose

If you miss a dose, contact your doctor immediately to determine the best course of action.
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Lifestyle & Tips

  • Report any discomfort at the IV site (pain, swelling, redness).
  • Inform healthcare providers about any new or worsening symptoms, especially muscle weakness, irregular heartbeat, or swelling.
  • Maintain good oral hygiene if on fluid restrictions.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Highly individualized based on patient's fluid and electrolyte status, body weight, and clinical condition. Typically administered as an intravenous infusion at a rate determined by clinical need.

Condition-Specific Dosing:

Hypokalemia: Rate of potassium infusion should not exceed 10-20 mEq/hour in peripheral veins, or 40 mEq/hour in central veins with continuous ECG monitoring. Total daily dose varies based on deficit.
Maintenance Fluid: Typically 20-40 mEq potassium per liter of IV fluid, infused at maintenance rates (e.g., 80-125 mL/hour).
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Pediatric Dosing

Neonatal: Highly individualized. Careful monitoring of fluid and electrolyte balance is critical. Potassium infusion rates generally not exceeding 0.5 mEq/kg/hour.
Infant: Highly individualized. Careful monitoring of fluid and electrolyte balance is critical. Potassium infusion rates generally not exceeding 0.5 mEq/kg/hour.
Child: Highly individualized. Careful monitoring of fluid and electrolyte balance is critical. Potassium infusion rates generally not exceeding 0.5 mEq/kg/hour.
Adolescent: Highly individualized. Careful monitoring of fluid and electrolyte balance is critical. Potassium infusion rates generally not exceeding 0.5 mEq/kg/hour.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor serum potassium and renal function closely.
Moderate: Significant dose reduction or avoidance may be necessary, especially for potassium. Monitor serum potassium and renal function frequently.
Severe: Contraindicated or used with extreme caution and continuous ECG monitoring due to high risk of hyperkalemia. Close monitoring of serum electrolytes and renal function is essential.
Dialysis: Generally avoided in anuric or oliguric patients. If necessary, administer only under strict medical supervision with frequent electrolyte monitoring and ECG.

Hepatic Impairment:

Mild: No specific dose adjustment required, but monitor for fluid retention.
Moderate: No specific dose adjustment required, but monitor for fluid retention and electrolyte imbalances.
Severe: No specific dose adjustment required, but monitor for fluid retention and electrolyte imbalances, especially if associated with renal dysfunction.

Pharmacology

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Mechanism of Action

Potassium Chloride/Sodium Chloride Injection provides essential electrolytes (sodium, potassium, chloride) and water for hydration. Sodium and chloride are the primary extracellular ions, crucial for maintaining osmotic pressure, fluid balance, and acid-base equilibrium. Potassium is the primary intracellular cation, vital for nerve impulse transmission, muscle contraction (including cardiac muscle), and maintaining intracellular tonicity. This solution helps to restore and maintain normal fluid and electrolyte balance, correct hypokalemia and hyponatremia, and provide a vehicle for other compatible medications.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (intravenous administration)
Tmax: Not applicable (immediate distribution)
FoodEffect: Not applicable (IV administration)

Distribution:

Vd: Sodium and chloride distribute primarily in the extracellular fluid (ECF). Potassium distributes primarily in the intracellular fluid (ICF), with a small amount in the ECF.
ProteinBinding: Not protein bound (ions)
CnssPenetration: Limited (ions do not readily cross intact blood-brain barrier, but can affect CNS function via electrolyte imbalances)

Elimination:

HalfLife: Not applicable (ions are continuously exchanged and excreted)
Clearance: Primarily renal clearance; rate depends on renal function and physiological needs.
ExcretionRoute: Renal (urine), small amounts via sweat and feces.
Unchanged: 100% (ions)
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Pharmacodynamics

OnsetOfAction: Immediate (upon IV administration)
PeakEffect: Rapid, as electrolytes are distributed and utilized.
DurationOfAction: Dependent on patient's metabolic state, renal function, and ongoing fluid/electrolyte losses. Effects persist as long as infusion continues and body stores are being replenished/maintained.

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
 Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or change in the amount of urine produced
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or vomiting
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
 Swelling, warmth, numbness, change of color, or pain in a leg or arm
Chest pain or pressure
 Fever
Shortness of breath
 Sudden weight gain
Swelling in the arms or legs

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:

 Irritation or swelling at the injection site
* Pain at the injection site

Reporting Side Effects

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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Seek Immediate Medical Attention If You Experience:

  • Swelling in your hands, feet, or ankles.
  • Difficulty breathing or shortness of breath.
  • Chest pain or irregular heartbeat.
  • Unusual muscle weakness or numbness/tingling.
  • Confusion or dizziness.
  • Excessive thirst or dry mouth.
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
 All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is crucial to avoid potential interactions between this medication and other substances.
* Any existing health problems, as this medication may interact with certain conditions.

To ensure your safety, it is vital to verify that it is safe to take this medication with all your current medications and health conditions. Never start, stop, or adjust the dose of any medication without first consulting your doctor.
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Precautions & Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

If your medication contains potassium, consult with your doctor before using any salt substitutes or products that also contain potassium.

If your medication contains dextrose and you have diabetes (high blood sugar), discuss this with your doctor to ensure safe management of your condition.

Regular blood tests are crucial while taking this medication. Follow your doctor's instructions regarding the frequency and timing of these tests, and discuss the results with your doctor as advised.

When administering this medication to newborns, exercise caution due to the potential for increased risk of side effects in this age group.

If you are pregnant, planning to become pregnant, or are breastfeeding, it is crucial to discuss the use of this medication with your doctor. This conversation will help weigh the benefits and risks of the medication for both you and your baby, ensuring an informed decision about its use.
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Overdose Information

Overdose Symptoms:

  • Hyperkalemia (high potassium): Muscle weakness, paresthesias, flaccid paralysis, bradycardia, cardiac arrhythmias (e.g., peaked T waves, widened QRS, ventricular fibrillation, asystole).
  • Hypernatremia (high sodium): Thirst, dry mucous membranes, lethargy, confusion, seizures, coma.
  • Fluid Overload: Edema (swelling), dyspnea (shortness of breath), crackles in lungs, hypertension, jugular venous distension.

What to Do:

Immediate discontinuation of infusion. Management of hyperkalemia may include IV calcium gluconate, insulin/glucose, sodium bicarbonate, diuretics, or dialysis. Management of hypernatremia involves careful administration of hypotonic fluids. Fluid overload requires diuretics or, in severe cases, dialysis. Call 1-800-222-1222 (Poison Control) for specific guidance.

Drug Interactions

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Contraindicated Interactions

  • Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) in patients receiving potassium-containing solutions (increased risk of severe hyperkalemia).
  • ACE inhibitors (e.g., enalapril, lisinopril) and Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan) in patients with impaired renal function or those at risk of hyperkalemia (increased risk of hyperkalemia).
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Major Interactions

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (e.g., ibuprofen, naproxen): May reduce renal potassium excretion, increasing risk of hyperkalemia.
  • Cyclosporine, Tacrolimus: May increase risk of hyperkalemia.
  • Digoxin: Hyperkalemia can antagonize the effects of digoxin; hypokalemia can potentiate digoxin toxicity.
  • Corticosteroids (e.g., prednisone, hydrocortisone): May cause sodium and fluid retention, leading to hypernatremia or fluid overload.
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Moderate Interactions

  • Insulin: Can cause intracellular shift of potassium, potentially leading to transient hypokalemia (if not already hyperkalemic).
  • Beta-blockers: May impair cellular uptake of potassium, potentially increasing serum potassium levels.
  • Other potassium-containing medications or supplements: Additive effect on serum potassium.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Na, K, Cl)

Rationale: To establish baseline electrolyte status and guide initial dosing.

Timing: Prior to initiation of therapy.

Renal Function (BUN, Creatinine)

Rationale: To assess kidney's ability to excrete electrolytes, especially potassium.

Timing: Prior to initiation of therapy.

Fluid Status (Vital Signs, Edema, Lung Sounds)

Rationale: To assess hydration status and risk of fluid overload.

Timing: Prior to initiation of therapy.

ECG (Electrocardiogram)

Rationale: To assess cardiac rhythm and identify pre-existing abnormalities, especially if hypokalemia or hyperkalemia is suspected or severe.

Timing: Prior to initiation, especially if rapid correction of potassium is needed.

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Routine Monitoring

Serum Electrolytes (Na, K, Cl)

Frequency: Every 4-6 hours initially, then daily or as clinically indicated.

Target: Sodium: 135-145 mEq/L; Potassium: 3.5-5.0 mEq/L; Chloride: 98-107 mEq/L

Action Threshold: Potassium < 3.0 or > 5.5 mEq/L; Sodium < 130 or > 150 mEq/L; significant deviations require immediate intervention.

Renal Function (BUN, Creatinine)

Frequency: Daily or every other day, especially in patients with impaired renal function.

Target: Within normal limits for patient's age/baseline.

Action Threshold: Significant increase in BUN/Creatinine may indicate worsening renal function, requiring dose adjustment.

Fluid Balance (Intake and Output, Daily Weight)

Frequency: Every 4-8 hours (I&O), daily (weight).

Target: Balanced I&O, stable weight (unless fluid removal/addition is goal).

Action Threshold: Significant positive or negative fluid balance, rapid weight changes, signs of fluid overload (e.g., crackles, edema) or dehydration.

Vital Signs (BP, HR, RR)

Frequency: Every 4-8 hours or as per institutional protocol.

Target: Within patient's normal range.

Action Threshold: Significant changes (e.g., hypotension, bradycardia/tachycardia, arrhythmias) may indicate electrolyte imbalance or fluid overload.

ECG (Electrocardiogram)

Frequency: Continuous monitoring if rapid potassium infusion or severe electrolyte imbalance; otherwise, as clinically indicated.

Target: Normal sinus rhythm, absence of T wave changes, U waves, or QRS widening.

Action Threshold: Peaked T waves, flattened T waves, U waves, prolonged PR interval, widened QRS, arrhythmias.

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Symptom Monitoring

  • Signs of hyperkalemia (muscle weakness, paresthesias, flaccid paralysis, cardiac arrhythmias, bradycardia, fatigue).
  • Signs of hypokalemia (muscle weakness, cramps, fatigue, constipation, cardiac arrhythmias, paralytic ileus).
  • Signs of hypernatremia (thirst, dry mucous membranes, lethargy, confusion, seizures, coma).
  • Signs of hyponatremia (headache, nausea, vomiting, confusion, seizures, coma).
  • Signs of fluid overload (dyspnea, crackles, peripheral edema, jugular venous distension, hypertension).
  • Signs of fluid deficit (thirst, dry mucous membranes, decreased skin turgor, orthostatic hypotension, decreased urine output).

Special Patient Groups

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Pregnancy

Potassium and sodium are essential electrolytes. This solution is generally considered safe and often necessary during pregnancy to maintain fluid and electrolyte balance, especially in conditions like hyperemesis gravidarum or pre-eclampsia. Use should be guided by clinical need and careful monitoring.

Trimester-Specific Risks:

First Trimester: No known specific risks beyond general electrolyte imbalances.
Second Trimester: No known specific risks beyond general electrolyte imbalances.
Third Trimester: No known specific risks beyond general electrolyte imbalances. Careful monitoring for fluid overload, especially in pre-eclampsia.
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Lactation

Potassium and sodium are normal components of breast milk and are essential for infant nutrition. Administration of this solution to a lactating mother is generally considered safe and compatible with breastfeeding, as it replenishes physiological electrolytes.

Infant Risk: Low risk. No adverse effects on the breastfed infant are expected with appropriate maternal use.
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Pediatric Use

Pediatric patients, especially neonates and infants, have a higher proportion of body water and less developed renal function compared to adults. This makes them more susceptible to fluid and electrolyte imbalances. Dosing must be highly individualized based on weight, age, clinical condition, and frequent monitoring of serum electrolytes and fluid balance. Rapid infusion or over-correction can lead to severe complications (e.g., hyperkalemia, hypernatremia, fluid overload).

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Geriatric Use

Elderly patients may have age-related decreases in renal function, reduced thirst sensation, and pre-existing cardiovascular conditions, making them more susceptible to fluid overload, hyperkalemia, and hypernatremia. Careful monitoring of fluid status, renal function, and electrolytes is crucial. Lower infusion rates and conservative dosing may be necessary.

Clinical Information

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Clinical Pearls

  • Always verify the concentration of potassium chloride before adding to IV fluids or administering. Errors in potassium concentration can be fatal.
  • Potassium chloride should NEVER be administered as an IV push or undiluted. It must always be diluted in a suitable IV solution and infused slowly.
  • Rapid infusion of potassium can cause fatal cardiac arrhythmias. Adhere strictly to recommended infusion rates.
  • Monitor ECG continuously during rapid potassium infusions or in patients with severe hypokalemia/hyperkalemia.
  • Assess renal function (BUN, creatinine, urine output) before and during therapy, as impaired renal function significantly increases the risk of hyperkalemia.
  • Closely monitor intake and output, daily weights, and signs of fluid overload (e.g., crackles, edema) or dehydration.
  • Compatibility with other IV medications should always be checked before co-administration.
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Alternative Therapies

  • Oral potassium supplements (for mild to moderate hypokalemia)
  • Oral rehydration solutions (for mild dehydration with electrolyte loss)
  • Other crystalloid solutions (e.g., Lactated Ringer's, Plasma-Lyte) for fluid resuscitation and electrolyte balance.
  • Colloid solutions (e.g., albumin) for volume expansion in specific situations.
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Cost & Coverage

Average Cost: Varies widely (e.g., $5 - $50 per liter bag) per 1000 mL bag
Generic Available: Yes
Insurance Coverage: Tier 1 (often covered under medical benefit for inpatient/outpatient administration)
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional, do not flush medications down the toilet or drain. If you are unsure about the proper disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the quantity, and the time of ingestion.