9.2.1.1 Oral potassium

Kay-Cee-L

(Potassium chloride)

• Syrup 75mg/ml (£10.15 = 500ml (£0.20 per 10ml)
  • Contains 1 mmol each of K+ and Cl- per 1ml

Indication

• Proven hypokalaemia

Notes

1. National Patient Safety Alert (21 October 2024): UPDATE: Discontinuation of Kay-Cee-L (potassium chloride 375mg/ml) (potassium chloride 5mmol/5ml) syrup
   1. Kay-Cee-L syrup will be discontinued from late November 2024.
   2. Primary and Secondary care providers MUST:
      1. Not initiate new patients on Kay-Cee-L syrup.
      2. Proactively review all patients currently prescribed Kay-Cee-L syrup to establish if potassium supplementation is still required, and switch to an alternative treatment, if considered necessary, ensuring no intolerance of excipients..
2. Care is needed to ensure selection of the most appropriate oral potassium supplement. Ensure patients and/or carers are trained on administering the correct dose. Refer to the NatPSA for alternative products, guidance from the Neonatal and Paediatric Pharmacist Group and information to give to patients.
3. Sando-K (potassium bicarbonate 400mg and potassium chloride 600mg) effervescent tablets remain available and can support a full increase in demand. One effervescent tablet contains 12mmol potassium.
4. Unlicensed potassium chloride oral solutions manufactured within the UK are available via Specials manufacturers.

Sando-K

(Potassium chloride with potassium bicarbonate)

• Effervescent tablets (600mg + 400mg) (£1.99 = 20 tablets (£0.10 per tablet))

Indication

• Proven hypokalaemia

Notes

1. Each tablet contains 12mmol of K⁺ and 8 mmol of Cl^-

Management of hyperkalaemia

Calcium Resonium

(Calcium polystyrene sulphonate)

• Powder (£82.16 = 300g)

Indications

• Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients

Dose

• Oral, 15g 3–4 times daily in a small amount of water or syrup (not fruit juice which has a high potassium content)

Notes

1. Caution: calcium containing resin should not be used in hypercalcaemic states; sodium containing resin should be avoided in cardiac failure and renal failure.

Resonium A

(Sodium polystyrene sulfonate)

• Powder (£81.11 = 454g)

Sodium zirconium cyclosilicate

• Oral powder sachets 5g, 10g

Notes

1. NICE TA599: Sodium zirconium cyclosilicate (Lokelma) is recommended as an option for treating hyperkalaemia in adults, (September 2019, updated January 2022) only if used:
   1. in emergency care for acute life-threatening hyperkalaemia alongside standard care or,
   2. 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.
   3. Stop sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable.

Patiromer calcium

• Oral powder sachets 8.4g, 16.8g

Notes

1. NICE TA623: Patiromer (Veltassa) is recommended as an option for treating hyperkalaemia in adults, (February 2020) only if used:
   1. in emergency care for acute life-threatening hyperkalaemia alongside standard care or
   2. 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.

9.2.1.2 Oral sodium and water

Sodium chloride

• Modified-release tablets 600mg (10mmol of Na+) (£9.20 = 100 tablets)

Indications

• Sodium depletion

Dose

• 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 rehydration therapy

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.

Dioralyte

• Oral powder (£2.91 = 6 sachets (all flavours), £6.99 = 20 sachets (citrus), £8.74 = 20 sachets (blackcurrant, plain))

Indications

• Fluid and electrolyte loss in diarrhoea

Notes

1. Reconstitute 1 sachet with 200mL of water (freshly boiled and cooled for infants).
2. Each sachet contains sodium chloride 470mg, potassium chloride 300mg, disodium hydrogen citrate 530mg, glucose 3.56g.
3. Oral rehydration solutions in UK are lower in sodium and higher in glucose than WHO recommendations, but may be useful in mild to moderate diarrhoea.
4. Available to buy in different flavours over the counter.
5. Fluid and electrolyte repletion is the primary treatment for acute diarrhoea and gastroenteritis, see 1.4 Antimotility drugs

9.2.1.3 Oral bicarbonate

Sodium bicarbonate is given orally for the chronic acidosis of renal disease. It is rarely used in diabetic ketoacidosis, even if this is severe. For other forms of severe or acute metabolic acidosis it may be given intravenously.

Sodium bicarbonate

• Capsules 500mg (£3.10 = 56 capsules)