Indications
Potassium is an essential mineral constituent of the human body and the chief cation found within the intracellular fluid of all cells. Multiple potassium salts can be useful as medications for various indications. Since potassium is an essential electrolyte usually sourced through our diet, any condition in which a patient cannot maintain their dietary intake indicates exogenous replenishment of potassium. Hence, potassium should be included in electrolyte replacement regimens and intravenous maintenance fluids in adult and pediatric patients or as routine prophylaxis following surgery.
FDA-Approved Indications
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Potassium is FDA-approved to treat hypokalemia, a condition in which the serum potassium level falls below a critical range. Hypokalemia can occur due to multiple reasons, such as malnutrition, malabsorption, debilitation, prolonged parenteral nutrition without potassium, or excessive losses of potassium such as vomiting, diarrhea, excessive drainage of gastrointestinal fluids, dialysis, renal diseases, diabetic ketoacidosis, hyperadrenalism, use of diuretics, corticosteroids, and amphotericin B.[1] Hyperactivity of the adrenal cortex, called Cushing syndrome, is another significant cause of hypokalemia. Metabolic alkalosis can also cause hypokalemia by shifting potassium from the extracellular to the intracellular compartment.
Off-Label Uses
Hypertension: Adequate potassium intake is recommended to prevent the development of hypertension. Clinicians may also administer potassium supplements to control blood pressure in patients with known hypertension.[2]
Arrhythmia: Potassium is recommended when cardiac glycoside toxicity occurs due to a potassium loss or in certain tachyarrhythmias following cardiac surgery.
Thallium toxicity: Potassium is administered intravenously in a limited fashion.[3][4]
Hyperthyroidism: Potassium iodide is prescribed as an oral adjunctive medication in the immediate preoperative period for patients with hyperthyroidism undergoing thyroidectomy.[5] Potassium is also useful as an adjunct treatment for critically ill patients with thyrotoxicosis crises.
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Radiation protection: Oral potassium iodide can help protect the thyroid gland by blocking thyroid hormone uptake of radioactive iodine isotopes either from environmental hazards or during treatment with radiopharmaceuticals.[6]
Sporotrichosis: Because of its low cost, oral potassium iodide is considered the drug of choice for fixed cutaneous or lymphocutaneous sporotrichosis in resource-constrained countries.[7] However, there has been no comparison of its efficacy to antifungals such as itraconazole, and prolonged therapy duration correlates with a high number of side effects.
Cough: Historically, clinicians have used potassium iodide to treat chronic cough symptoms as an expectorant of tenacious mucus. However, its efficacy in this role is not well supported.
Alkalinization: Potassium citrate is useful for alkalinizing urine in cases of certain kinds of urinary tract calculi and for managing conditions associated with chronic metabolic acidosis (chronic renal insufficiency and renal tubular acidosis). In these conditions, potassium citrate is an alternative to sodium citrate or sodium bicarbonate when a high quantity of sodium administration is undesirable.
Antibiotics: Potassium is also used as a vehicle or compounding chemical for some antibiotic preparations (eg, potassium benzylpenicillin, potassium penicillin V, and amoxicillin-clavulanate potassium).
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