Monitor serum electrolytes (K, Cl, Na), bicarbonate, serum creatinine and CBC every 4 mth; urinary citrate and/or urinary pH at initiation or dose change and every 4 mth; periodically ECG.
Symptoms: Hyperkalaemia manifested by increased serum K concentration and ECG changes; late manifestations include muscle paralysis and CV collapse from cardiac arrest. Management: Eliminate medications containing K, agents w/ K sparing properties (e.g. K-sparing diuretics, ACE inhibitors, NSAIDs) and food w/ high K content (e.g. almonds, beans, milk, salmon). May give IV Ca gluconate if the patient is at no risk or low risk of developing digitalis toxicity. Administer IV dextrose 10% containing 10-20 U of crystalline insulin per 1,000 mL at a rate of 300-500 mL/hr. Acidosis may be corrected w/ IV Na bicarbonate. May perform haemodialysis or peritoneal dialysis.
Risk of severe hyperkalaemia w/ K-sparing diuretics. Increased incidence of GI irritation w/ drugs that slow GI transit time (e.g. anticholinergics).
Description: Potassium citrate is metabolised to bicarbonate, producing an alkaline load which in turn increases urinary pH and raises urinary citrate by augmenting citrate clearance w/o altering ultrafilterable serum citrate. Pharmacokinetics: Metabolism: Metabolised hepatically to bicarbonate.