18.104.22.168 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.
(Potassium chloride with potassium bicarbonate)
- Effervescent tablets 600mg/400mg (£9.95 = 20 tablets (£0.10 per tablet))
- Each tablet contains 12mmol of K+ and 8 mmol of Cl-
- Syrup 75mg/ml (£9.58 = 500ml (£0.19 per 10ml))
- Contains 1 mmol each of K+ and Cl- per 1ml
Management of hyperkalaemia
(Calcium polystyrene sulphonate)
- Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients
- Oral, 15g 3–4 times daily in a small amount of water or syrup (not fruit juice which has a high potassium content)
- 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
- NICE TA599: Sodium zirconium cyclosilicate (Lokelma) is recommended as an option for treating hyperkalaemia in adults, (September 2019, updated January 2022) only if used:
- in emergency care for acute life-threatening hyperkalaemia alongside standard care or,
- 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
- Stop sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable
- Oral powder sachets 8.4g, 16.8g
- NICE TA623: Patiromer (Veltassa) is recommended as an option for treating hyperkalaemia in adults, (February 2020) only if used:
- in emergency care for acute life-threatening hyperkalaemia alongside standard care or
- 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
22.214.171.124 Oral sodium and water
- Modified-release tablets 600mg (equivalent to 10mmol sodium) (£9.20 = 100 tablets)
- 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
- 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.
- Oral powder (£2.68 = 6 sachets (all flavours), £6.99 = 20 sachets (citrus), £8.04 = 20 sachets (blackcurrant, plain))
- Fluid and electrolyte loss in diarrhoea
- Reconstitute 1 sachet with 200 mL of water (freshly boiled and cooled for infants)
- 5 sachets reconstituted with 1 litre of water provide Na+ 60 mmol, K+ 20 mmol, Cl- 60 mmol, citrate 10 mmol, and glucose 90 mmol
- When reconstituted with 1 litre of water provide Na+ 75 mmol, K+ 20 mmol, Cl- 85 mmol, citrate 10 mmol, and glucose 75 mmol
St. Mark's Electrolyte Solution
- 1 litre provides Na+ 90 mmol, K+ (nil), Cl- 60 mmol, HCO3- 30 mmol, and glucose 111 mmol
- 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.
- St Mark's Electrolyte Solution is provided as individual ingredients to be prepared before use.
- Capsules, sodium bicarbonate 500mg (approximately 6 mmol each of sodium and bicarbonate) (£4.46 = 56 capsules)
- Liquid 8.4% 1mmol/ml (unlicensed preparation) For use in Plymouth Hospitals NHS Trust
9. Blood and nutrition >
9.2 Fluid and electrolytes >
9.2.1 Oral preparations for fluid and electrolyte imbalance
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