Potassium Citrate + Citric Acid interactions

Conditions

Conditions in which Potassium Citrate + Citric Acid needs care, as documented in this source.

• Dehydration

  Major

  Administration of potassium salts in severe dehydration may predispose to renal impairment. Therapy with potassium salts should be administered cautiously in patients with acute dehydration (e.g., due to severe or prolonged diarrhea or heat stress). Close monitoring of serum potassium concentrations is recommended, as potentially fatal hyperkalemia can develop rapidly and is often asymptomatic, manifested only by an increased potassium level (6.5 to 8 mEq/L) and characteristic electrocardiographic changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of the QT interval). Late manifestations include muscle paralysis and cardiovascular collapse from cardiac arrest (9 to 12 mEq/L). Continuous or serial electrocardiography may be appropriate in some patients during replacement therapy, particularly if given intravenously.

  4 sources

  1. "Product Information. K-Dur (potassium chloride)." Schering Corporation (2001):
  2. "Product Information. Potassium Acetate (potassium acetate)." Abbott Pharmaceutical (2002):
  3. "Product Information. K-Lyte (potassium bicarbonate-potassium citrate)." Bristol-Myers Squibb (2002):
  4. "Product Information. Kaon (potassium gluconate)." Savage Laboratories (2002):

• Gastrointestinal Diseases

  Major

  The use of all solid oral formulations of potassium is contraindicated in patients with arrested or delayed gastrointestinal (GI) transit, whether due to structural, pathological, or pharmacological causes. Potassium is irritating to the GI mucosa and may cause ulcerative and/or stenotic lesions during prolonged physical contact. Based on spontaneous adverse reaction reports, the frequency of small bowel lesions associated with enteric-coated preparations of potassium chloride is 40 to 50 per 100,000 patient-years, while that for wax matrix controlled-release formulations is less than one per 100,000 patient years. Esophageal ulceration has also been reported following administration of controlled-release formulations of potassium chloride in cardiac patients with esophageal compression due to enlarged left atrium. Potassium supplementation should be administered as a liquid preparation or as an aqueous suspension in patients with esophageal obstruction and/or delayed gastrointestinal transit time. Because of ulcerogenic effects, oral potassium should be administered cautiously in patients with peptic ulcers or other upper gastrointestinal diseases associated with inflammation, bleeding, or perforation. Patients should be advised not to crush, chew, or break potassium tablets or capsules, and to take them with meals and a full glass of water or other liquid. Potassium liquids should be diluted prior to consumption.

  73 sources

  1. Mason SJ, O'Meara TF "Drug-induced esophagitis." J Clin Gastroenterol 3 (1981): 115-20
  2. Bronson DL, Gamelli RL "Jejunal ulceration and stricture due to wax-matrix potassium chloride tablets and amitriptyline." J Clin Pharmacol 27 (1987): 788-9
  3. Teplick JG, Teplick SK, Ominsky SH, Haskin ME "Esophagitis caused by oral medication." Radiology 134 (1980): 23-5
  4. Dietz MW "Iatrogenic jejunal ulcer." Am J Roentgenol Radium Ther Nucl Med 99 (1967): 136-8
  5. Reinus FZ, Weinberger HA, Fischer WW "Medication-induced ulceration of the small bowel." Am J Surg 112 (1966): 97-101
  6. Wagner W, Longerbeam JK, Smith LL, Feikes HL "Drug-induced ulcers of the small bowel causing intestinal obstruction or perforation." Am Surg 33 (1967): 7-11
  7. Campbell JR, Knapp RW "Small bowel ulceration associated with thiazide and potassium therapy: review of 13 cases." Ann Surg 163 (1966): 291-6
  8. Berg EH, Schuster F, Segal GA "Thiazides with potassium producing intestinal stenosis." Arch Surg 91 (1965): 998-1001

  Show all 73 sourcesShow fewer sources

  9. Naiken VS, Rachman R "Giant ulcers of the transverse colon." JAMA 217 (1971): 344
  10. Ball JR "Letter: Potassium strictures of the upper alimentary tract." Lancet 1 (1976): 495-6
  11. Holland GW "Stenosing ulcers of the small bowel associated with thiazide and potassium therapy." N Z Med J 64 (1965): 383-5
  12. Watts CD, Curry C, Randolph RP "Intestinal complications found from potassium chloride. Case report." J Natl Med Assoc 57 (1965): 492-3
  13. Jacobs E, Pringot J "Gastric ulcers due to the intake of potassium chloride." Am J Dig Dis 18 (1973): 289-94
  14. Eng J, Sabanathan S "Drug-induced esophagitis." Am J Gastroenterol 86 (1991): 1127-33
  15. Lambert JR, Newman A "Ulceration and stricture of the esophagus due to oral potassium chloride (slow release tablet) therapy." Am J Gastroenterol 73 (1980): 508-11
  16. Lewis JH "Gastrointestinal injury due to medicinal agents." Am J Gastroenterol 81 (1986): 819-34
  17. Barloon TJ, Moore SA, Mitros FA "A case of stenotic obstruction of the jejunum secondary to slow- release potassium." Am J Gastroenterol 81 (1986): 192-4
  18. Watson MR, Mark JB "Ulceration of the small intestine. Relation to enteric-coated potassium." Am J Surg 112 (1966): 421-5
  19. Billig DM, Jordan GL Jr "Nonspecific ulcers of the small intestine." Am J Surg 110 (1965): 745-9
  20. Barkin JS, Harary AM, Shamblen CE, Lasseter KC "Potassium chloride and gastrointestinal injury." Ann Intern Med 98 (1983): 261-2
  21. Antonescu CG, Barritt AS 3d "Potassium chloride and gastric outlet obstruction." Ann Intern Med 111 (1989): 855-6
  22. Strom BL, Carson JL, Schinnar R, Sim E, Maislin G, Soper K, Morse ML "Upper gastrointestinal tract bleeding from oral potassium chloride. Comparative risk from microencapsulated vs wax-matrix formulations." Arch Intern Med 147 (1987): 954-7
  23. Peters JL "Benign oesophageal stricture following oral potassium chloride therapy." Br J Surg 63 (1976): 698-9
  24. Davies DR, Brightmore T "Idiopathic and drug-induced ulceration of the small intestine." Br J Surg 57 (1970): 134-9
  25. Ward C, Hamid S, Dow J "Gastric complication of massive Slow-K overdose." Br J Surg 74 (1987): 490
  26. Collins FJ, Matthews HR, Baker SE, Strakova JM "Drug-induced oesophageal injury." Br Med J 1 (1979): 1673-6
  27. Tresadern J, Rickwood AM, Spitz L "Multiple small bowel strictures in a child and accidental potassium chloride ingestion." Br Med J 2 (1977): 1124-5
  28. Moorhouse RA "Letter: Ulceration of small intestine and slow-release potassium tablets." Br Med J 3 (1975): 542
  29. Farquharson-Roberts MA, Giddings AE, Nunn AJ "Perforation of small bowel due to slow release potassium chloride (slow-K)." Br Med J 3 (1975): 206
  30. Ashby WB, Humphreys J, Smith SJ "Small-bowel ulceration induced by potassium chloride." Br Med J 5475 (1965): 1409-12
  31. Wynn V "Potassium chloride and bowel ulceration." Br Med J 5477 (1965): 1546
  32. Rosenthal T, Adar R, Militianu J, Deutsch V "Esophageal ulceration and oral potassium chloride ingestion." Chest 65 (1974): 463-5
  33. McMahon FG, Ryan JR, Akdamar K, Ertan A "Effect of potassium chloride supplements on upper gastrointestinal mucosa." Clin Pharmacol Ther 35 (1984): 852-5
  34. Brower RA "Jejunal perforation possibly induced by slow-release potassium in a patient with Crohn's disease." Dig Dis Sci 31 (1986): 1387-90
  35. Shuster F, Berg EH "Enteric-coated potassium and bowel obstruction." JAMA 194 (1965): 570
  36. McMahon FG, Ryan JR, Akdamar K, Ertan A "Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial." Lancet 2 (1982): 1059-61
  37. Learmonth I, Weaver PC "Letter: Potassium stricture of the upper alimentary tract." Lancet 1 (1976): 251-2
  38. Moorhouse RA "Letter: Potassium-induced stricture of the small bowel." Lancet 1 (1976): 365
  39. Roberts HJ "Potassium chloride and intestinal ulceration." Lancet 2 (1965): 1127
  40. Lakhani M, Stewart WK "Hazards of potassium chloride solution." Lancet 2 (1985): 453
  41. Leijonmarck CE, Raf L "Gastrointestinal lesions and potassium chloride supplements." Lancet 1 (1985): 56-7
  42. Hasker W, McCaffrey J "Ulceration of a Meckel's diverticulum due to a potassium chloride tablet." Med J Aust 2 (1972): 261-2
  43. Lubbe WF, Cadogan ES, Kannemeyer AH "Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement." N Z Med J 90 (1979): 377-9
  44. Lawson DH "Adverse reactions to potassium chloride." Q J Med 43 (1974): 433-40
  45. Lofgren RP, Rothe PR, Carlson GJ "Jejunal perforation associated with slow-release potassium chloride therapy." South Med J 75 (1982): 1154-5
  46. Delaney T, Hoxworth PI "Enteric-coated potassium chloride enteropathy." Surg Gynecol Obstet 127 (1968): 76-80
  47. Hartman SW, Greaney EM Jr, Rottapel D "Small-bowel ulceration due to enteric-coated potassium ingestion in a two-year-old child." Surgery 61 (1967): 814-5
  48. Riker J, Swanson M, Schweigert B "Esophageal ulceration caused by wax-matrix potassium chloride." West J Med 128 (1978): 542-3
  49. Leijonmarck CE, Fenyo G, Raf L "Nontraumatic perforation of the small intestine." Acta Chir Scand 150 (1984): 405-11
  50. Leijonmarck CE, Raf L "Ulceration of the small intestine due to slow-release potassium chloride tablets." Acta Chir Scand 151 (1985): 273-8
  51. Raf LE "Enteric-coated potassium chloride tablets and ulcer of the small intestine." Acta Chir Scand Suppl 374 (1967): 32-50,73-74,76-77
  52. Phillips BL "Potassium-induced bowel ulceration." Br J Clin Pract 28 (1974): 143-4
  53. Trewby PN "Drug-induced peptic ulcer and upper gastrointestinal bleeding." Br J Hosp Med 23 (1980): 185-8,190
  54. Sinar DR, Bozymski EM, Blackshear JL "Effects of oral potassium supplements on upper gastrointestinal mucosa: multicenter clinical comparison of three formulations and placebo." Clin Ther 8 (1986): 157-63
  55. Moore JG, Alsop WR, Freston JW, Tolman KG "The effect of oral potassium chloride on upper gastrointestinal mucosa in healthy subjects: healing of lesions despite continuing treatment." Gastrointest Endosc 32 (1986): 210-2
  56. Lech Y, Hey H, Jorgensen F, Matzen P, Ostergaard O "Evaluation of the ulcerogenic effect of potassium chloride by endoscopy and fecal blood loss." J Clin Pharmacol 27 (1987): 206-9
  57. Folk FS, Spellman MW, Hoffler OW "Stenosing small bowl ulceration. Apparently secondary to enteric- coated potassium chloride." J Natl Med Assoc 61 (1969): p315-8assim
  58. Sandor F "Complications of "slow-K" therapy." J R Coll Gen Pract 26 (1976): 595-8
  59. Emerson DN "Potassium therapy and gastrointestinal lesions." Nebr State Med J 55 (1970): 518-23
  60. Henry JG, Shinner JJ, Martino JH, Cimino LE "Fatal esophageal and bronchial artery ulceration caused by solid potassium chloride." Pediatr Cardiol 4 (1983): 251-2
  61. Skoutakis VA, Acchiardo SR, Wojciechowski NJ, Carter CA "Liquid and solid potassium chloride: bioavailability and safety." Pharmacotherapy 4 (1984): 392-7
  62. Javett S "Slow k ulcer." S Afr J Surg 13 (1975): 64
  63. Strahan J, Sweeney PJ "A case of small bowel perforation." Ulster Med J 34 (1965): 22
  64. Graham DY, Smith JL, Bouvet AA "What happens to tablets and capsules in the stomach: endoscopic comparison of disintegration and dispersion characteristics of two microencapsulated potassium formulations." J Pharm Sci 79 (1990): 420-4
  65. Trechot P, Moore N, Bresler L, Castot A, Gay G, Netter P, Royer R "Potassium chloride tablets and small bowel stenoses and perforations: two studies in the french pharmacovigilance system." Am J Gastroenterol 89 (1994): 1268
  66. "Potassium chloride and bowel ulceration." Br Med J 5475 (1965): 1383-4
  67. McLoughlin JC "Gastrointestinal lesions and potassium chloride supplements." Lancet 1 (1985): 581-2
  68. "Small-intestine ulceration and enteric-coated potassium chloride." Med Lett Drugs Ther 7 (1965): 57-8
  69. Weiss SM, Rutenberg HL, Paskin DL, Zaren HA "Gut lesions due to slow-release KCI tablets." N Engl J Med 296 (1977): 111-2
  70. "Potassium and gastrointestinal lesions. I." Nutr Rev 24 (1966): 138-41
  71. "Product Information. K-Dur (potassium chloride)." Schering Corporation (2001):
  72. "Product Information. Urocit-K (potassium citrate)." Mission Pharmacal Company
  73. "Product Information. Kaon (potassium gluconate)." Savage Laboratories (2002):

• Hyperkalemia

  Major

  The use of potassium salts is contraindicated in patients with hyperkalemia, since a further increase in serum potassium concentration in such patients can lead to cardiac arrhythmias or arrest. Potassium therapy should be administered cautiously in patients with conditions predisposing to hyperkalemia, such as chronic renal failure, systemic acidosis, acute dehydration, hypoaldosteronism (e.g., due to primary adrenal insufficiency or congenital adrenal enzyme deficiency), uncontrolled diabetes mellitus, and extensive tissue breakdown (e.g., due to severe burns, intravascular hemolysis, tumor lysis syndrome, or rhabdomyolysis). Close monitoring of serum potassium concentrations is recommended, as potentially fatal hyperkalemia can develop rapidly and is often asymptomatic, manifested only by an increased potassium level (6.5 to 8 mEq/L) and characteristic electrocardiographic changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of the QT interval). Late manifestations include muscle paralysis and cardiovascular collapse from cardiac arrest (9 to 12 mEq/L). Continuous or serial electrocardiography may be appropriate in some patients during replacement therapy, particularly if given intravenously.

  20 sources

  1. Kopman EA, Ramirez-Inawat RC "Persistent electromechanical cardiac arrest following administration of cardioplegic and glucose-insulin-potassium solutions." Anesth Analg 59 (1980): 69-71
  2. Chakko SC, Frutchey J, Gheorghiade M "Life-threatening hyperkalemia in severe heart failure." Am Heart J 117 (1989): 1083-91
  3. Lankton JW, Siler JN, Neigh JL "Letter: Hyperkalemia after administration of potassium from nonrigid parenteral-fluid containers." Anesthesiology 39 (1973): 660-1
  4. Illingworth RN, Proudfoot AT "Rapid poisoning with slow-release potassium." Br Med J 281 (1980): 485-6
  5. Wetli CV, Davis JH "Fatal hyperkalemia from accidental overdose of potassium chloride." JAMA 240 (1978): 1339
  6. Kallen RJ, Rieger CH, Cohen HS, Sutter MA, Ong RT "Near-fatal hyperkalemia due to ingestion of salt substitute by an infant." JAMA 235 (1976): 2125-6
  7. Saxena K "Death from potassium chloride overdose." Postgrad Med 84 (1988): 97-8,101-2
  8. Lawson DH "Adverse reactions to potassium chloride." Q J Med 43 (1974): 433-40

  Show all 20 sourcesShow fewer sources

  9. Lawson DH "Clinical use of potassium supplements." Am J Hosp Pharm 32 (1975): 708-11
  10. Perez GO, Oster JR, Pelleya R, Caralis PV, Kem DC "Hyperkalemia from single small oral doses of potassium chloride." Nephron 36 (1984): 270-1
  11. Cox J, Starbuck M "Hyperkalemic cardiac arrest during an infusion of potassium chloride following an overdose of propranolol." Resuscitation 14 (1986): 255-6
  12. Ceuppens H, Hitchcock JF, Damen J, Jambroes G, Ae Dion R "Severe hypotension due to potassium-induced pericardial injury." Thorax 37 (1982): 546-7
  13. "Product Information. K-Dur (potassium chloride)." Schering Corporation (2001):
  14. Schrier RW, Regal EM "Influence of aldosterone on sodium, water and potassium metabolism in chronic renal disease." Kidney Int 1 (1972): 156-68
  15. "Product Information. Urocit-K (potassium citrate)." Mission Pharmacal Company
  16. "Product Information. K-Phos Neutral (potassium phosphate)." Beach Pharmaceuticals (2001):
  17. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  18. "Product Information. Potassium Acetate (potassium acetate)." Abbott Pharmaceutical (2002):
  19. "Product Information. K-Lyte (potassium bicarbonate-potassium citrate)." Bristol-Myers Squibb (2002):
  20. "Product Information. Kaon (potassium gluconate)." Savage Laboratories (2002):

• Kidney Diseases

  Major

  The use of potassium salts is contraindicated in patients with severe renal impairment characterized by oliguria, anuria, or azotemia. Since potassium is excreted by the kidney, the administration of potassium salts in such patients, particularly by the intravenous route, may produce hyperkalemia and cardiac arrhythmias or arrest. Therapy with potassium salts should be administered cautiously in patients with diminished renal function or other conditions which impairs potassium excretion (e.g. adrenal insufficiency). Close monitoring of serum potassium concentrations is recommended, as potentially fatal hyperkalemia can develop rapidly and is often asymptomatic, manifested only by an increased potassium level (6.5 to 8 mEq/L) and characteristic electrocardiographic changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of the QT interval). Late manifestations include muscle paralysis and cardiovascular collapse from cardiac arrest (9 to 12 mEq/L). Continuous or serial electrocardiography may be appropriate in some patients during replacement therapy, particularly if given intravenously.

  5 sources

  1. "Product Information. K-Dur (potassium chloride)." Schering Corporation (2001):
  2. "Product Information. Urocit-K (potassium citrate)." Mission Pharmacal Company
  3. "Product Information. Potassium Acetate (potassium acetate)." Abbott Pharmaceutical (2002):
  4. "Product Information. K-Lyte (potassium bicarbonate-potassium citrate)." Bristol-Myers Squibb (2002):
  5. "Product Information. Kaon (potassium gluconate)." Savage Laboratories (2002):

• Paralyses, Familial Periodic

  Major

  Administration of potassium salts may precipitate attacks in familial hyperkalemic periodic paralysis or paramyotonia congenita. Therapy with potassium preparations should be administered cautiously in patients with these conditions.

  1 source

  1. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):

• Urinary Tract Infections

  Major

  The use of potassium citrate for management of renal tubular acidosis and renal stones is contraindicated in patients with active urinary tract infection caused by urea-splitting organisms. Its ability to increase urinary citrate may be attenuated by bacterial enzymatic degradation of citrate. Moreover, the rise in urinary pH resulting from potassium citrate therapy might promote further bacterial growth.

  1 source

  1. "Product Information. Urocit-K (potassium citrate)." Mission Pharmacal Company

• Acid-Base Imbalance

  Moderate

  Alkalinizing agents act as proton acceptors and/or dissociate to provide bicarbonate ions. Elimination of bicarbonate is decreased in patients with renal impairment and can result in metabolic alkalosis. Symptoms of metabolic alkalosis include hyperirritability or tetany, arrhythmia, and/or seizures (altered pH = altered calcium), or lactic acidosis due to impaired oxygen release. Therapy with alkalinizing agents should be administered with extreme caution in patients with compromised renal function. Clinical monitoring of renal function, acid/base balance and electrolytes is recommended.

  3 sources

  1. "Product Information. Urocit-K (potassium citrate)." Mission Pharmacal Company
  2. "Product Information. Tham (tromethamine)." Abbott Pharmaceutical (2001):
  3. "Product Information. Sodium Lactate (sodium lactate)." Abbott Pharmaceutical (2001):

• Alkalosis

  Moderate

  Hypokalemia in patients with metabolic or respiratory alkalosis should generally be treated with potassium chloride rather than an alkalinizing potassium salt (i.e. acetate, bicarbonate, citrate, or gluconate), since alkali therapy may exacerbate the condition. In addition, hypochloremia may accompany alkalosis, which is best treated with potassium chloride. Close monitoring of acid-base balance, serum electrolytes, electrocardiogram, and clinical status is recommended.

  4 sources

  1. Walker WG, Jost LJ "Relative roles of patassium and chloride in correction of hypokalemic hypochloremic alkalosis." Johns Hopkins Med J 120 (1967): 148-54
  2. "Product Information. Potassium Acetate (potassium acetate)." Abbott Pharmaceutical (2002):
  3. "Product Information. K-Lyte (potassium bicarbonate-potassium citrate)." Bristol-Myers Squibb (2002):
  4. "Product Information. Kaon (potassium gluconate)." Savage Laboratories (2002):