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PubMed1985

Paraplegia following epidural potassium chloride.

A patient is presented in whom 15 ml of 15% potassium chloride (30 mM) mixed with bupivacaine was injected epidurally for relief of pain resulting from widespread pelvic malignancy. Within minutes the patient complained of severe pain in both the lower limbs and rapidly became paraplegic with bladder and bowel incontinence. The paraplegia was permanent. The transient symptoms of pain may have been partly due to the irritant effects of a hyperosmolar solution of potassium chloride in the epidural space, while the permanent neurological damage might have been due to the very high extracellular concentration of potassium leading on to a depolarising phenomenon initially followed by nerve tissue necrosis.

Adult↗
PubMedDate not supplied

Determination of thallium in potassium chloride and electrolyte replenishers by electrothermal atomic absorption spectrometry.

Thallium in potassium chloride and electrolyte replenishers was determined by electrothermal atomic absorption spectrometry (ETAAS) with direct injection of a resin suspension. Thallium(III) was extracted on fine particles of a cellulose nitrate resin (CNR) from dilute HCl (pH 1.6) in the presence of ammonium pyrrolidine-1-carbodithioate. The CNR particles were collected on a membrane filter by filtration under suction, suspended in 1.0 mL 10mM HNO3, and then delivered directly to ETAAS as the suspension. The effects of chloride ions were thoroughly investigated. The results showed that the addition of 0.5mM NaCl to the suspension (10mM HNO3) was recommended, after CNR and a membrane filter holding the CNR were washed thoroughly with 0.025M HCl, to eliminate interference from chloride ions. No chemical modifier was required. Extraction from the solution containing up to 2M chloride ion was allowable. The proposed method gave a concentration factor of 50 for a 50 mL sample volume. The detection limit (3sigma, n = 5) was 1 ng (20 pg/mL). The relative standard deviation was 4.9% (n = 5) at 30 ng level of thallium. The content of thallium in potassium chloride was 15.7-32.8 ng/g, and in electrolyte replenishers was 0.18-4.16 ng/mL.

Calibration↗
PubMedDate not supplied

Liquid and solid potassium chloride: bioavailability and safety.

Studies have suggested that microencapsulated preparations of potassium chloride may pose less risk to the upper gastrointestinal mucosa than the currently available wax-matrix preparations. Based on our own clinical experience and data available from the literature, we have concluded that (1) liquid and slow-release preparations of potassium chloride are safe and effective when used appropriately and (2) at present there is no conclusive evidence to suggest that lesions of the upper gastrointestinal tract are more prevalent with one slow-release preparation than with another.

Biological Availability↗
PubMed1986

The effect of oral potassium chloride on upper gastrointestinal mucosa in healthy subjects: healing of lesions despite continuing treatment.

The effects of two dosage forms of wax-polymer matrix potassium chloride on the upper gastrointestinal mucosa were compared with placebo in 44 healthy volunteers. After 2 weeks of potassium chloride treatment, mucosal toxicity was observed. There was no correlation between the presence of lesions and symptoms. Six of seven volunteers with lesions healed spontaneously despite continuing treatment with potassium chloride.

Administration, Oral↗
PubMed1992

Efficacy of lignocaine in alleviating potassium chloride infusion pain.

A double-blind study was set up to investigate the effect of pretreatment with lignocaine on the incidence of potassium chloride infusion pain. Twenty-eight patients were randomly allocated into two equal groups. Patients in both groups were hypokalaemic and were scheduled for replacement consisting of potassium chloride 20 mmol diluted to 100 ml in dextrose 5% solution administered over two hours. Group A (lignocaine) patients were pretreated with a bolus dose lignocaine 3 ml 1%, Group B (control) received isotonic saline 3 ml. The incidence of potassium chloride infusion pain was significantly reduced in Group A. There was no adverse effect reported. This study demonstrates the efficacy of bolus dose of lignocaine in alleviating injection pain for the duration of a two-hour continuous infusion.

Adult↗
PubMed1995

Conversion of postischemic ventricular fibrillation with intraaortic infusion of potassium chloride.

BACKGROUND: Ventricular fibrillation after declamping of the aorta after cardioplegic arrest is commonly managed by direct-current countershock. However, in coronary artery bypass grafting, placement of the electrodes can cause mechanical damage to the grafts and anastomoses, and the surgical procedure must be interrupted. As an alternative, intraaortic infusion of potassium chloride through the arterial line from the heart-lung machine was investigated. METHODS: In a series of 100 patients with postischemic ventricular fibrillation (group P), 20 mmol of potassium chloride (plus 10 mmol later if necessary) was added to the oxygenator reservoir and perfused through the arterial line into the proximal aorta. The results were compared with those in a matched control group of 100 patients primarily treated with direct-current countershock (group DC). RESULTS: In group P, the ventricular fibrillation was effectively converted to a supraventricular rhythm in 82% of the patients. The remaining 18 patients required significantly (p < 0.005) fewer electric shocks than the patients in group DC. Serum K+ levels were slightly elevated for a short period after the potassium chloride infusion. Otherwise there were no significant differences in regard to incidence of heart block, temporary epicardial pacing, myocardial infarction, or atrial fibrillation between the two groups. CONCLUSIONS: Conversion of postischemic ventricular fibrillation with potassium chloride administered through the arterial line from the heart-lung machine is an effective, gentle, and convenient method. No side effects were noted.

Adult↗
PubMed1982

Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial.

The effects of a new microencapsulated potassium chloride formulation on upper gastrointestinal tract mucosa was compared with that of a popular wax-matrix formulation in 48 healthy volunteers. After a week of KCl, subjects were gastroscoped, the endoscopist being blind to the type of preparation taken. Wax-matrix formulations were associated with a higher incidence of upper gastrointestinal lesions. The lesions were not accompanied by epigastric symptoms. Glycopyrrolate, given to some volunteers to decrease gastric emptying, aggravated the effects of potassium chloride.

Acute Disease↗
PubMed1995

[Potassium citrate versus potassium chloride in essential hypertension. Effects on hemodynamic, hormonal and metabolic parameters].

A study was conducted on 25 patients (18 men, seven women; mean age 48 [24-70] years) with essential hypertension (EH) to see whether an increase in potassium supply influences blood pressure as well as metabolic and hormonal parameters, and whether the anion administered together with potassium affects the results. In a randomized, cross-over trial sequence the patients daily received 120 mmol potassium chloride, 120 mmol potassium citrate or a placebo, each for 8 weeks. Between each of the three periods there was a "wash-out" phase of 4 weeks each. After 8 weeks of potassium citrate intake the systolic and diastolic pressures were reduced significantly, by a mean of 6.2/3.8 mm Hg (P < 0.05). But after potassium chloride there was only a small, not significant, reduction. Metabolic and hormonal parameters (fasting glucose concentration, glucose tolerance test, lipid electrophoresis; plasma renin activity, plasma concentration of aldosterone, noradrenaline and insulin) were not significantly changed.--These findings suggest that an increased supply of potassium has a favourable haemodynamic effect, but this varies markedly between different potassium salts. An increase in potassium supply should thus be considered as an additional measure in the treatment of EH. As long as renal function is normal no unfavourable metabolic effect need be feared.

Adult↗
PubMed1971

Cable parameters, sodium, potassium, chloride, and water content, and potassium efflux in isolated external intercostal muscle of normal volunteers and patients with myotonia congenita.

In isolated fiber bundles of external intercostal muscle from each of 13 normal volunteers and each of 6 patients with myotonia congenita, some or all of the following were measured: concentrations of Na(+), K(+), and Cl(-), extracellular volume, water content, K(+) efflux, fiber size, fiber cable parameters, and fiber resting potentials. Muscle from patients with myotonia congenita differed significantly (0.001 <P< 0.025) with respect to the following mean values (myotonia congenita vs. normal): the membrane resistance was greater (5729 vs. 2619 omega.cm(2)), the internal resistivity was less (75.0 vs. 123.2 omega.cm), the water content was less (788.2 vs. 808.2 ml/kg wet weight), and the mean resting potential was greater (68 vs. 61 mv).NO SIGNIFICANT DIFFERENCES WERE FOUND WITH RESPECT TO THE FOLLOWING VARIABLES: K(+) content (73.5 vs. 66.7 mEq/kg wet weight) and the calculated intracellular K(+) concentration (215 vs. 191 mEq/liter fiber water), fiber capacitance (5.90 vs. 5.15 muf/cm(2)), Na(+) content (97.7 vs. 94.1 mEq/kg wet weight), Cl(-) content (79.0 vs. 74.7 mEq/kg wet weight), mannitol extracellular volume (45.1 vs. 46.6 cc/100 g wet weight), and K(+) efflux (23.2 vs. 21.5 moles x 10(-12) cm(-2).sec(-1)). These abnormalities of skeletal muscle in human myotonia congenita are like those of skeletal muscle in goats with hereditary myotonia. We tentatively conclude that a decreased Cl(-) permeability accounts for some of the abnormal electrical properties of skeletal muscle in myotonia congenita.

Action Potentials↗
PubMed1994

Safety and efficacy of a concentrated potassium chloride solution infusion for rapid correction of hypokalemia.

Twenty children with hypokalemia (plasma potassium concentration < or = 3.5 mmol/L) with electrocardiographic (ECG) changes were given an infusion of concentrated solution of potassium chloride (200 mmol/L) at a rate of 0.25 mmol per kg per hour till ECG changes reverted to normal, under close monitoring of vital signs and ECG. The regimen effectively corrected the ECG changes in 1 to 6 hours with a mean increase in serum potassium by 0.75 +/- 0.49 mmol/L. No complications occurred. Controlled infusion of a concentrated solution of potassium chloride at a rate of 0.25 mmol/kg/hour is a safe and effective way to achieve rapid correction of hypokalemia with ECG changes, using minimal fluid volumes.

Child↗
PubMed2001

Differential elution of sodium or potassium dihydrogen- and hydrogenphosphate ions from a sephadex G-15 column with sodium or potassium chloride solution.

When a mixed solution of sodium or potassium dihydrogenphosphate and disodium or dipotassium hydrogenphosphate was eluted from a Sephadex G-15 column with either a sodium or potassium chloride solution, the elution profiles of ions showed that the hydrogenphosphate ion was eluted more rapidly than the dihydrogenphosphate ion. When the sample solutions containing potassium dihydrogenphosphate and/or dipotassium hydrogenphosphate, all of which were supplemented with phosphorus-32-labelled potassium dihydrogenphosphate, were eluted with sodium chloride solution, the elution profiles of radioactivity showed that the dihydrogenphosphate ion changed to hydrogenphosphate ion and vice versa, depending on the pH values of the sample solution and the availability of the cation of the eluent during elution for the phosphate ion to pair with.

Chromatography, Ion Exchange↗
PubMed1991

Factors affecting the formulation of sustained release potassium chloride tablets.

In this study, influence of several formulation factors on the release kinetics of potassium chloride from directly compressed matrices are investigated. Formulations containing hydrophilic (methylcellulose, carbomer), plastic (polyvinyl chloride), and wax (glycerol palmitostearate) matrix materials at concentrations of 10, 15 and 20%, incorporated with potassium chloride as active ingredient and insoluble excipients were prepared and studied in vitro using the USP XXI/NF XVI rotating paddle method. Hardness had no markedly effect on the release characteristics of formulations except for wax matrix material formulation. Results of goodness of fit analysis applied to release data had shown that the release mechanism was described by the Higuchi diffusion controlled model. Positive deviations from Higuchi equation might be due to the erosion of gel layer. Analysis of in vitro release mechanisms indicated that the most suitable results were obtained by methylcellulose and glycerol palmitostearate.

Chemistry, Pharmaceutical↗
PubMed1982

Potential life-threatening variations of drug concentrations in intravenous infusion systems: potassium chloride, insulin, and heparin.

The investigation of concentrations of active agents in common carrier media for intravenous infusion revealed that potassium chloride tends to form a pool when it is added without mixing to carrier media in glass or polyvinyl chloride (PVC) containers which are already suspended in their functional position with ports pointing downwards. Heparin behaves in a similar fashion when added without mixing to carrier media in PVC containers. Such uneven distribution may expose a patient to potentially dangerous, possibly lethal, concentrations of a drug even when a relatively small amount of it is used. Insulin floats to the top of a Haemaccel container if its contents are not adequately mixed after addition of insulin. The resultant irregularity of insulin dosage may make the management of diabetic ketoacidosis more difficult. It is recommended that the instructions for the adequate mixing of contents should appear on all containers of carrier media for intravenous infusions.

Drug Packaging↗
PubMed1992

Potassium chloride lowers blood pressure and causes natriuresis in older patients with hypertension.

Epidemiologic surveys, experimental studies in animals, and clinical trials in young and middle-aged patients with hypertension indicate that dietary potassium lowers blood pressure. The mechanism of the antihypertensive effect is not well defined. Variations in serum potassium within the physiologic range may directly affect vascular smooth muscle tone. Potassium may also influence the regulation of blood pressure through effects on sodium handling, aldosterone secretion, the renin/angiotensin system, renal kallikrein, eicosanoids, and atrial natriuretic peptide. This study was undertaken to confirm the blood pressure-lowering effect of potassium in older patients and to determine the mechanism of the antihypertensive effect. Twenty-two patients greater than or equal to 60 yr of age were admitted to a Clinical Research Unit for 8 days after a 2-wk period free of antihypertensive medication. Patients were placed on an isocaloric diet containing 200 mmol/day of Na+, 70 mmol/day of K+, and 500 mg/day of Ca2+ and were treated in a randomized, double-blinded manner with either potassium chloride (120 mmol/day) or placebo. After 4 days, patients were crossed over to the alternate treatment. Systolic blood pressure decreased 8.6 mm Hg (95% confidence interval -14.6, -2.6), and diastolic blood pressure decreased 4.0 mm Hg (-6.9, -1.0) during potassium chloride supplementation. There was no significant change in blood pressure during treatment with placebo. Serum K+ was 3.9 +/- 0.1 mmol/L after 3 days of placebo and 4.3 +/- 0.1 after 4 days of potassium chloride (P less than 0.002). Urinary sodium excretion averaged 192 +/- 11 mmol/day after placebo and 221 +/- 8 after potassium treatment (P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

[Studies on bacteriologic contamination of potassium chloride solution 25% in multidose containers regularly used on hospital wards].

The use of multidose containers poses the problem of in-use microbial contamination. In a clinical investigation sterility tests of 25% potassium chloride solution (w/v) in multidose containers have been performed in-use on two surgical wards. The contents of 80 vials used for 1, 3, 7 or 10 days (with registered withdrawals) were sterility tested with the aid of blood agar plates. None of the 80 bottles were contaminated. It has been shown that lege artis withdrawals of 25% potassium chloride solution (w/v) from multidose containers involves a very low risk of contamination. However, the theory that contaminants have been killed must not be excluded. In final laboratory tests, multidose containers of 25% sterile potassium chloride solution (w/v) were artificially contaminated. Test microorganisms were E. coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 and Staph. aureus ATCC 25923. Microbial control after 1 or 2 days storage showed absence or significant germ reduction with the experimental technique described.

Drug Contamination↗
PubMed1976

The influence of adenine nucleotides and oxidizable substrates on triethyltin-mediated chloride uptake by rat liver mitochondria in potassium chloride media.

In a 100 mM-KCl medium, pH 6.8, containing ATP increasing concentrations of triethyltin cause an uptake of Cl- into mitochondria with a maximum at 1 muM. This can be inhibited by atractylate or oligomycin, but is virtually unaffected by the presence of rotenone. When the medium contains substrate (pyruvate, beta-hydroxybutyrate or succinate), both in the presence and absence of adenine nucleotides, Cl- uptake is greater with a maximum at 1-10 muM-triethyltin. If substrate oxidation is blocked by respiratory-chain inhibitors the Cl- uptake mediated by triethyltin is inhibited except in the media containing ATP, when the characteristics of Cl- uptake similar to that found in the medium containing ATP alone are observed. Under all conditions tested Cl- uptake is decreased by the presence of 2,4-dinitrophenol. It is concluded that energy from either the oxidation of substrate or the hydrolysis of ATP is associated with the generation of sufficient OH- to enable the triethyltin-mediated Cl-/OH- exchange to occur under the metabolic conditions relevant to this action of triethyltin.

Adenosine Triphosphate↗
PubMed1998

Multifetal pregnancy reduction of both fetuses of a monochorionic pair by intrathoracic potassium chloride injection of one fetus.

The purpose of this study was to determine if a monochorionic pair of fetuses in a higher-order multiple gestation can be reduced by injecting only one fetus with potassium chloride. Three quadruplet and two quintuplet gestations, each with a monochorionic pair of fetuses, were referred for pregnancy reduction. In each case, reduction was performed by injecting one of the monochorionic pair with potassium chloride. Patients returned for a follow-up sonogram within 1 week of the procedure. The reductions were performed at an average 12.1 weeks' gestation, with a range of 10.7 to 14.0 weeks. Follow-up scans 4 to 7 days after the procedure showed that both monochorionic fetuses were dead and all other fetuses were alive. One quintuplet pregnancy underwent a second reduction procedure to twins. One quintuplet and two quadruplet pregnancies that were reduced to twins resulted in the birth of live twins between 30.8 weeks and 36.8 weeks' gestations. The third quadruplet pregnancy reduced to twins is still ongoing; the mother is pregnant with twins at 20 weeks' gestation. The quintuplet pregnancy reduced to triplets resulted in delivery of live triplets at 24.1 weeks' gestation, but two of the neonates died in the first few days of life. Reduction of both fetuses of a monochorionic pair in a higher-order multiple gestation can be accomplished by intrathoracic injection of potassium chloride into only one of the pair.

Female↗