PO liquid potassium vs. PO tablet potassium??

rotteluvr31, ADN, RN · Mar 13, 2010

Perhaps they meant po vs IV?

oramar · Mar 13, 2010

A lot of times you have to work with the preferences of the patient. Some of them refuse to take it one way or the other.

sasha1224 · Mar 14, 2010

I maybe could see this if the pill being used is the Extended Release type. Could that be what they meant?

mamamerlee, LPN · Mar 14, 2010

If it needs to come up fast, IV is the way to go. Otherwise, oral is oral, some can't tolerate the liquid form even in juice, some can't swallow the pills.

gwapo · Mar 14, 2010

Someone told me the potassium PO tablet form was for maintenance of serum potassium, while the potassium PO liquid form is for repletion. Therefore, if the pt's serum potassium is low, the PO liquid form should be ordered, and not the PO tablet form. Is there any truth to that? I can't find anything about this statement on the internet. Any answers would be much appreciated!

No, they are the same. people who can't swallow the pill ( those with NGT/PEG) has to use the liquid forn since you can't crush the pill. It is the dose that matters. if you are giving 10mEq BID, that could be maintenance. if you are giving 60 mEq stat, then that is replacement.

PatsFan1969 · Mar 14, 2010

My coworker told me that liquid form tends to work a little quicker than the tablets. If we get a patient in during the middle of the night that needs K replacement, she will give the patient the liquid form to get the K level up quicker in time for the am lab draws.

core0 · Mar 14, 2010

Someone told me the potassium PO tablet form was for maintenance of serum potassium, while the potassium PO liquid form is for repletion. Therefore, if the pt's serum potassium is low, the PO liquid form should be ordered, and not the PO tablet form. Is there any truth to that? I can't find anything about this statement on the internet. Any answers would be much appreciated!

I'll preface this by stating that everything I know about potassium I've learned form our transplant nephrologists who are the true experts.

There are essentially three forms of Potassium. Immediate release, extended release, and IV. Potassium has a strong local effect on the GI tract and immediate release oral potassium can cause ulcers. Therefore its almost always given in a liquid form. The dilution of the potassium and the liquid form prevents localized concentrations and speeds it into the small bowel where it is absorbed.

Extended release is made to delay absorption so that local concentrations are not achieved again avoiding GI upset. It comes in an easily handled form making it preferred. Absorption is fast but slightly delayed. As a rule of thumb you can see results in around 2-3 hours for extended release as opposed to one hour for the immediate release.

IV potassium gives immediate effect. However, its limited by how fast you can give it. Most hospitals will allow 10meq/hr by peripheral IV and 20 meq/hr by central line. Therefore if you want to replete potassium fastest you use oral Potassium. IV potassium is generally used when you have severe hypokalemia (k+ 40 meq).

The other issue that causes most places to avoid liquid preparations are that they are messy and its hard to tell how much you give (look in the bottom of the cup sometime).

For example if we have someone in our clinic with a K+ 2.8, we would give extended release potassium (such as K-dur) and recheck in 3-4 hours. Then supplement as necessary. On the other hand if someone showed up with a k+ of 2.3 (which happens with some regularity) we would give 40 meq of oral potassium as well as 40 meq of IV potassium over four hours. If someone showed up with a potassium of 1.6 they would get a central line, liquid oral potassium, IV K+ at 20 meq/hr and a trip to the ICU (happens every once and a while).

To answer your question you can use either liquid or pill form for replacement or supplementation. Most places will use pill form for both since they are easier to handle. Some patients prefer liquid form since the pills can be kind of large but they both do basically the same thing.

Hope this helps.

David Carpenter, PA-C

RunningRNBSN · Mar 14, 2010

I actually had this same exact situation arise a month ago on the PICU. I had a patient who was on fluid restriction, a low K+, and only have a PIV. Thus the physician did not want to order a K+ IV rider and instead wanted it given PO. She asked that I call pharmacy and ask that it not be given in an extended release tablet but rather a more immediate acting form. The pharmacist said they only carry the extended release form in tablet and the immediate reacting would be given in a liquid suspension.

According to the pharmacist, the liquid suspension can increase the K+ in 1 - 1.5 hours where the extended release takes 3 - 4 hours.

On a side note -- liquid K+ tastes absolutely horrible!! It is EXTREMELY salty and even putting it in juice doesn't help mask the flavor.