Crushing K-Dur

[Zee_RN]

OVERHEARD:

NURSE A: "I just gave him his K-Dur." (Pt. is intubated with dobhoff in place with tube feedings.)

NURSE B: "We can't crush K-Dur."

NURSE A: "I know but that's what the doctor ordered, so that's what I gave. It's not my problem."

-----------------------

Personally, this frightens me. I do not, will not, crush a sustained release med just because the doctor wasn't smart enough to realize he was ordering it for a patient on tube feeds.

[NRSKarenRN, BSN, RN]

sustained-release capsules and tablets must be swallowed whole. do not crush, chew, or suck the pills because this may increase side effects. http://www.pharmacy-online.ca/drugs/kdur.jsp

side effects are gastric irritation, ulcer and perforation---have seen this occur 2x in frail patinets whose nurse crushed this med! nursing resposibility to consult with pharmacy on need to change med fomulation.

if pt have trouble swallowing the capsules, ask the doctor or pharmacist about certain brands that may be opened up and the contents sprinkled onto a spoonful of cool, soft food such as applesauce or pudding if eating; othewise liquid med needs to be obtained.

similar situation with dilatin!

[MS._Jen_RN, ASN, RN]

It is possible to dissolve K-Dur in water, just as it is possible to drink Lactated Ringers. It is not however intended to be dissolved or crushed. It is an extended release tablet (they try to clue us in with the "dur" part of the name of the drug). And yes it's generally safe to give a patient the same dose in an immediate release form of potassium chloride (K-lyte comes to mind), but if the MD orders K-Dur and the med needs to be given by enteral tube or patient cannot swallow the tablet then the med needs to be clarified.

Most of the time the MD's don't care if their patient gets K-Dur 20meq or liquid potassium choride 20meq. The best practise is to get them to change the order to the correct form designed for how the patient can take the med.

Extended or sustained release meds should not be crushed or dissolved.

:yeahthat:

As far as I know dissolving is the same as crushing. If you are EVER not sure about a med check with pharmacy. (or your med book) Ignorance isn't always bliss, at times it could kill someone.

Also, as mentioned above, the name can clue you in. Be on the look out for things like SR, CR, XR, -dur, Dura- or anything enteric coated (ASA). But other things you just have to know, like Renagel, or Nicobid.

~Jen

[SharonH, RN]

It is possible to dissolve K-Dur in water, just as it is possible to drink Lactated Ringers. It is not however intended to be dissolved or crushed.

Unlike drinking Lactated Ringers, it is acceptable to dissolve K-Dur, and yes I have done it. Other forms are ideal but hey, sometimes you have to work with what you have.

[SharonH, RN]

can all no crush meds be dissolved in water, or just this one?

how would you know?

I always check in the following order:

1. Drug insert

2. My drug book

3. Micromedex

3. Pharmacist

4. Manufacturer website

http://www.spfiles.com/pikdur.pdf

[MS._Jen_RN, ASN, RN]

Unlike drinking Lactated Ringers, it is acceptable to dissolve K-Dur, and yes I have done it. Other forms are ideal but hey, sometimes you have to work with what you have.

Thanks for the info. Do the little balls of med stay intact or do they disolve? I love learning something new.

~Jen

[SharonH, RN]

Thanks for the info. Do the little balls of med stay intact or do they disolve? I love learning something new.

~Jen

For the most part it dissolves well, but it requires extra water to get the little bit that remains in the bottom of the medicine cup as well as to help prevent gastric irritation. It's a pain in the butt which is why the liquid form is preferable, natch.

[chadash]

I have a very basic question. Why, in particular, does K-dur have an enteric coating? Is it hard on the esophagus, the stomach? Does it taste real yucky? Is it to delay release of the med until it is in the intestine? That would probably determine how it should be handled in a tube feeding.

[Beary-nice]

I have a very basic question. Why, in particular, does K-dur have an enteric coating? Is it hard on the esophagus, the stomach? Does it taste real yucky? Is it to delay release of the med until it is in the intestine? That would probably determine how it should be handled in a tube feeding.

The K-Dur I know is a large...and I mean large whitish colored pill that is scored down the middle and is made up of hundreds of little tiny beads. I would think the enteric coating makes it easier to swallow...well sometimes...it's such a darn big pill...you can break it in half...I have had pts tell me it doesn't taste good and it kinda burns when I have broke it for them. Nonetheless...it is a delayed release tablet...should never be crushed...should never be put down a feeding tube...you need to get an alternative. And yes, potassium chloride is hard on the esophagus and stomach...should be taken with plenty of water and with food.

[chadash]

So sounds like if it is crushed, it might cause gastric irritation with a feeding tube (potassium is an irritant) so if the feeding tube is in the stomach, ouch?

[RN and Mommy]

here's what my davis drug guide says about it...

po: administer with or after meals to decrease gi irritation.

use of tablets and capsules should be reserved for patients who cannot tolerate liquid preparations.

dissolve effervescent tablets in 3-8 oz of cold water. ensure that effervescent tablet is fully dissolved. powders and solutions should be diluted in 3-8 oz of cold water or juice (do not use tomato juice if patient is on sodium restriction). instruct patient to drink slowly over 5-10 min.

tablets and capsules should be taken with a meal and full glass of water. do not chew or crush enteric-coated or extended-release tablets or capsules. micro-k extencaps capsules can be opened and sprinkled on soft food (pudding, applesauce) and swallowed immediately with a glass of cool water or juice.

[Beary-nice]

So sounds like if it is crushed, it might cause gastric irritation with a feeding tube (potassium is an irritant) so if the feeding tube is in the stomach, ouch?

It can cause ulceration indeed, pts shouldn't even chew on the tablets...and there are some out there that will do that. The problem with the feeding tube is that for one if you crush it, you are also crushing all of those tiny sustained released beads in the tablet plus it is a risk in plugging the tube. Never...never do it...get a liquid or like another poster suggested the kind that dissolve in water. K-Dur is meant to release in a specific way once in your system, altering it by crushing it can create huge problems.

[Beary-nice]

here's what my davis drug guide says about it...

po: administer with or after meals to decrease gi irritation.

use of tablets and capsules should be reserved for patients who cannot tolerate liquid preparations.

dissolve effervescent tablets in 3-8 oz of cold water. ensure that effervescent tablet is fully dissolved. powders and solutions should be diluted in 3-8 oz of cold water or juice (do not use tomato juice if patient is on sodium restriction). instruct patient to drink slowly over 5-10 min.

tablets and capsules should be taken with a meal and full glass of water. do not chew or crush enteric-coated or extended-release tablets or capsules. micro-k extencaps capsules can be opened and sprinkled on soft food (pudding, applesauce) and swallowed immediately with a glass of cool water or juice.

good job sabrina's mommy...that is what my davis's says too.

i have given hundreds of k-dur tablets over the years. i shudder when i come on the job on the weekends to find a pt has a feeding tube in place, has potassium supplement ordered, has only k-dur in their med drawer and when i ask where is the liquid stuff at....i get told...oh we have just been crushing those...ugh! you can bet i'm getting that changed pdq!