Potassium supplementation (gluconate / citrate / chloride IV)

What is this medication for?

• Prevention/treatment of hypokalemia (CKD losses, diuretic therapy, DKA, post-obstruction, loss of appetite); potassium citrate additionally for metabolic acidosis alkalinization (CKD)

How is it given?

Give exactly as your veterinarian prescribed — never change the dose or stop on your own unless your veterinarian has told you to.

• into a vein rule: the RATE kills, not the dose — 0.5 mEq/kg/h ceiling (1.5 max with ECG in extremis); >10 mEq/h to a small patient is an overdose scenario. Never undiluted push.

What if I miss a dose?

• Give it as soon as you remember — unless it is almost time for the next dose (then skip the missed one; never double up).
• Call your clinic if you miss more than one dose in a row.

Side effects — what should I watch for?

Effects listed as common in this handout

• Hyperkalemia (iatrogenic) (The risk of therapy — bradyarrhythmias, peaked T waves)
• stomach/intestinal distress (oral) (Common)

Worth a phone call to your veterinarian

• Any new symptom that worries you.

⚠️ Contact your veterinarian or an emergency clinic IMMEDIATELY if you notice

• Vein irritation/phlebitis, tissue tissue death (extravasation) (into a vein KCl undiluted/fast)

Before starting (or refilling), tell your veterinarian if your pet:

• has or has had: Hyperkalemia; renal failure/severe impairment; untreated Addison's; acute dehydration; severe hemolysis; stomach/intestinal motility impairment (solid forms)
• has or has had: Digoxin patients (hypokalemia potentiates digoxin toxicity — dual reason to normalize K); acid-base status shifts potassium

• is pregnant, nursing, or used for breeding
• is taking any other medications, supplements, or flea/tick products, including:
  • Digoxin
  • ACE inhibitors / ARBs / K-sparing diuretics (spironolactone)
  • Potassium penicillin, salt substitutes
  • Insulin/dextrose (DKA)

Storage and handling

Oral: tablets/powder (Tumil-K 2 mEq/tablet, 1 mEq/0.5 mL elixir approx.); into a vein: concentrated KCl must ALWAYS be diluted.

Good to know

• into a vein rule: the RATE kills, not the dose — 0.5 mEq/kg/h ceiling (1.5 max with ECG in extremis); >10 mEq/h to a small patient is an overdose scenario. Never undiluted push.
• DKA potassium trap: insulin therapy drops serum K fast — start K supplementation before/during insulin once K >3.3, or arrest + arrhythmia follow.
• CKD pairing: potassium CITRATE fixes hypokalemia AND metabolic acidosis in one salt — the dual-indication elegance.
• Oral-first principle: safer, slower, home-tractable — reserve into a vein for symptomatic/severe deficits.