Treatment and prevention of phosphate depletion in patients who are unable to ingest adequate dietary potassium.
Adjunct therapy of urinary tract infections with methenamine hippurate or mandelate (potassium and sodium phosphates or monobasic potassium phosphate).
Prevention of calcium urinary stones (potassium and sodium phosphates or monobasic potassium phosphate).
Phosphate salts of potassium may be used in hypokalemic patients with metabolic acidosis or coexisting phosphorus deficiency.
Assess patient for signs and symptoms of hypokalemia (weakness, fatigue, arrhythmias, presence of U waves on ECG, polyuria, polydipsia), hypophosphatemia (anorexia, weakness, decreased reflexes, bone pain, confusion, blood dyscrasias), and hypocalcemia (tetany, muscle cramps, Chvostek's sign, Trousseau's sign, arrhythmias, QTc interval prolongation) during therapy.
Monitor BP, HR, and ECG prior to and continuously during IV therapy.
Monitor intake and output ratios and daily weight. Report significant discrepancies.
Lab Test Considerations:
Monitor serum phosphate, potassium, magnesium, and calcium levels prior to and periodically during therapy. ↑ phosphate levels may cause hypocalcemia. Hypomagnesemia may occur.
Monitor renal function prior to and periodically during therapy.
Monitor urinary pH in patients receiving potassium phosphate as a urinary acidifier.
Toxicity and Overdose:
Symptoms of toxicity are those of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QTc interval, widened QRS complexes, loss of P waves, cardiac arrhythmias) and hyperphosphatemia or hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, Chvostek's or Trousseau's sign).
Treatment includes discontinuation of infusion, calcium replacement, and ↓ serum potassium levels (dextrose and insulin to facilitate passage of potassium into cells, sodium polystyrene as an exchange resin, and/or dialysis in patients with renal impairment).
High Alert: Too rapid or bolus IV administration of potassium has resulted in fatalities. See IV administration guidelines below.
PO Dissolve tablets in a full glass of water. Open capsules and mixed thoroughly in ⅓ cup water each. Allow mixture to stand for 2–5 min to ensure that it is fully dissolved.
Administer after meals to minimize gastric irritation and laxative effect.
Do not administer simultaneously with antacids containing aluminum, magnesium, or calcium.
High Alert: Administer only in dilute concentration. Common component of total parenteral nutrition.
Continuous Infusion: Dilution: Dilute with 0.45% NaCl, 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, D5/0.9% NaCl, or TPN solutions. Concentration: Maximum concentration should not exceed 160 mEq/L.
Rate:
High Alert: Infuse at a slow rate; rate is dependent on the patient and the specific institutional policy.
Solutions with osmolarity of ≥900 mOsm/L must be infused through a central catheter.
Store in refrigerator; once IV solution reaches room temperature, use within 4 hr for hypophosphatemia or within 24 hr for total parenteral nutrition. Discard any remaining contents or admixture.
Explain the purpose and side effects of potassium phosphate to patient. If a dose is missed, take as soon as remembered unless within 1–2 hr of the next dose. Explain that tablets and capsules should not be swallowed whole. Tablets should be dissolved in water; capsules should be opened and contents mixed in water. Do not stop taking drug without consulting health care professional. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Advise patient of the importance of maintaining a high fluid intake (drinking ≥8-oz of water each hr) to prevent kidney stones.
Instruct the patient to report diarrhea, weakness, fatigue, palpitations, trouble breathing, muscle cramps, numbness, tingling, or tremors promptly.
Rep: Advise females of reproductive potential to notify health care professional immediately if pregnancy is planned or suspected or if breastfeeding.