9.2.1.1 Oral potassium

Potassium supplements should be given at a dosage between 25 – 100mmols in 24 hours to correct hypokalaemia by the oral route.

Slow-K tablets have not been included because they only contain 8mmol potassium per tablet and are associated with oesophageal ulceration.

Sando-K

(Potassium chloride with potassium bicarbonate)

• Effervescent tablets 600mg/400mg (£1.99 = 20 tablets (£0.10 per tablet))

Indication

• Proven hypokalaemia

Notes

1. Each tablet contains 12mmol of K⁺ and 8 mmol of Cl^-

Kay-Cee-L

(Potassium chloride)

• Syrup 75mg/ml (£10.15 = 500ml (£0.20 per 10ml)
  • Contains 1 mmol each of K+ and Cl- per 1ml

Indication

• Proven hypokalaemia

Notes

1. National Patient Safety Alert (21 October 2024): UPDATE: Discontinuation of Kay-Cee-L (potassium chloride 375mg/ml) (potassium chloride 5mmol/5ml) syrup
2. Kay-Cee-L syrup will be discontinued from late November 2024.
3. Primary and Secondary care providers MUST:
   1. Not initiate new patients on Kay-Cee-L syrup.
   2. Proactively review all patients currently prescribed Kay-Cee-L syrup to establish if potassium supplementation is still required, and switch to an alternative treatment, if considered necessary, ensuring no intolerance of excipients.
4. Care is needed to ensure selection of the most appropriate oral potassium supplement. Ensure that patients and/or carers are trained on administering the correct dose. Refer to the NatPSA for alternative products, guidance from the Neonatal and Paediatric Pharmacist Group and information to give to patients.
5. Sando-K (potassium bicarbonate 400mg and potassium chloride 600mg) effervescent tablets remain available and can support a full increase in demand. One effervescent tablet contains 12mmol potassium.
6. Unlicensed potassium chloride oral solutions manufactured within the UK are available via Specials manufacturers.

Management of hyperkalaemia

Calcium Resonium

(Calcium polystyrene sulphonate)

• Powder (£82.16 = 300g)

Indications

• Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients

Dose

• Oral, 15g 3–4 times daily in a small amount of water or syrup (not fruit juice which has a high potassium content)

Notes

1. Caution: calcium containing resin should not be used in hypercalcaemic states; sodium containing resin should be avoided in cardiac failure and renal failure.

Sodium zirconium cyclosilicate

• Oral powder sachets 5g, 10g

Notes

1. NICE TA599: Sodium zirconium cyclosilicate (Lokelma) is recommended as an option for treating hyperkalaemia in adults, (September 2019, updated January 2022) only if used:
   1. in emergency care for acute life-threatening hyperkalaemia alongside standard care or,
   2. for people with persistent hyperkalaemia and chronic kidney disease stage 3b to 5 or heart failure, if they:
      • have a confirmed serum potassium level of at least 6.0 mmol/litre, and
      • because of hyperkalaemia are not taking an optimised dosage of renin-angiotensin-aldosterone system (RAAS) inhibitor, and
      • are not on dialysis.
   3. Stop sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable.

Patiromer calcium

• Oral powder sachets 8.4g, 16.8g

Notes

1. NICE TA623: Patiromer (Veltassa) is recommended as an option for treating hyperkalaemia in adults, (February 2020) only if used:
   1. in emergency care for acute life-threatening hyperkalaemia alongside standard care or
   2. for people with persistent hyperkalaemia and stages 3b to 5 chronic kidney disease or heart failure, if they:
      • have a confirmed serum potassium level of at least 6.0 mmol/litre and
      • are not taking, or are taking a reduced dosage of, a renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and
      • are not on dialysis.

9.2.1.2 Oral sodium and water

Slow Sodium

(Sodium chloride)

• Modified-release tablets 600mg (equivalent to 10mmol sodium) (£9.20 = 100 tablets)

Indications

• Sodium depletion

Dose

• Prophylaxis of sodium chloride deficiency 4–8 tablets daily with water (in severe depletion up to maximum 20 tablets daily)
• Chronic renal salt wasting, up to 20 tablets daily with appropriate fluid intake

Sodium Chloride

• Oral solution 29.2% (5mmol in 1ml) 100ml (unlicensed preparation)

Oral rehydration therapy

Oral rehydration solutions used in the UK such as Dioralyte® and Electrolade® contain less sodium than the WHO formulation and St. Mark's Electrolyte solution, since; in general, patients suffer less severe sodium loss.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is acute diarrhoea in adults.

Many diarrhoea products; for example, loperamide 2mg capsules and oral rehydration sachets are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Dioralyte

• Oral powder (£2.91 = 6 sachets)

Indications

• Fluid and electrolyte loss in diarrhoea

Notes

1. Reconstitute 1 sachet with 200mL of water (freshly boiled and cooled for infants)
2. 5 sachets reconstituted with 1 litre of water provide Na+ 60mmol, K+ 20mmol, Cl- 60mmol, citrate 10mmol, and glucose 90mmol

WHO formulation

• Oral powder

Notes

1. When reconstituted with 1 litre of water provide Na+ 75mmol, K+ 20mmol, Cl- 85mmol, citrate 10mmol, and glucose 75mmol

St. Mark's Electrolyte Solution

Notes

1. 1 litre provides Na+ 90mmol, K+ (nil), Cl- 60mmol, HCO3- 30mmol, and glucose 111mmol
2. St. Mark's Electrolyte solution is used for the treatment of dehydration in patients with short bowel syndrome or high output stomas. Dioralyte is not adequate in these patients.
3. St Mark's Electrolyte Solution is provided as individual ingredients to be prepared before use.

Oral bicarbonate

Sodium bicarbonate

• Capsules 500mg (approximately 6mmol each of sodium and bicarbonate) (£3.10 = 56 capsules)
• Liquid 8.4% 1mmol/ml (unlicensed preparation) For use in Plymouth Hospitals NHS Trust