Potassium (K)

Scientific Evidence

Uses	Grade*
Vitamin and nutrient deficiency (hypokalemia, potassium deficiency) Potassium deficiency, or hypokalemia, may occur for various reasons, including decreased potassium intake, increased potassium excretion caused by certain drugs, loss of potassium due to vomiting, or decreased potassium absorption. Potassium is approved by the U.S. Food and Drug Administration (FDA) for the treatment of hypokalemia.	A
Hypertension (high blood pressure) Information from laboratory experiments and studies performed in humans indicate that increased dietary potassium may decrease diastolic and systolic blood pressure. However, there is some conflicting evidence from other studies. Further research is warranted.	B
Alcohol withdrawal The use of potassium supplementation in alcohol withdrawal to maintain electrolyte levels has been assessed with mixed results. Further trials are warranted.	C
Cardiovascular disease (prevention) It has been reported that the favorable impact of diets rich in fruit and vegetables on heart health may be due to the potassium supplied by these foods. Studies performed in humans have found that a high dietary potassium intake may cause a decrease in the risk of coronary heart disease and cardiovascular disease. Further research is warranted.	C
Critical illness Hyperglycemia (increased blood glucose) is a common problem in patients with critical illnesses who are in hospital wards and intensive care units. Hyperglycemia has been reported to increase the risk of mortality and morbidity in hospitals. Tight control of glycemia may improve patient outcomes. The use of glucose, insulin, and potassium (GIK) has been proposed to have several beneficial effects. In studies performed in humans, the results are mixed. Further research is needed.	C
Dehydration (elderly) Dehydration in the elderly is a common and serious condition, due to various factors. Limited evidence in humans suggests that potassium chloride may be used in hypodermoclysis (subcutaneous infusion) to treat dehydration. Further research is warranted.	C
Dental pain (dentin hypersensitivity) Dentin is the layer of tooth between the enamel and the pulp layers. Multiple forms of potassium salts have been studied for their affects on dentin to decrease sensitivity. In humans, potassium-containing therapies have shown mixed results. Further studies are warranted.	C
Diarrhea Many electrolytes are decreased in patients with diarrhea, including potassium. It is common clinical practice to treat diarrhea with oral rehydration solutions that contain potassium and other electrolytes. Rehydration with such solutions has been reported to decrease death in children due to diarrhea.	C
Edema Potassium has been supplemented, in addition to diuretics, in the treatment of edema (swelling) of cardiac origin, with beneficial effects. Further studies are warranted.	C
Heart protection during surgery Cardiac surgery is associated with several risks, including atrial fibrillation. Glucose-insulin-potassium (GIK) therapy may help to decrease the risk of morbidity and mortality associated with atrial fibrillation. In patients undergoing cardiac surgery, GIK has been used with mixed results. Further research is warranted.	C
Hypercalciuria (high urine calcium levels) Hypercalciuria, or high levels of calcium in the urine, may lead to kidney stones. Potassium citrate has an inhibitory activity on calcium oxalate crystallization, aggregation, and agglomeration and has shown benefit in patients at risk of kidney stones. There is evidence that potassium-magnesium citrate is effective at decreasing the recurrence of calcium stones in patients without symptoms. Thiazides and neutral potassium phosphate decreased urinary calcium levels in symptomatic patients. Although the results in this area are promising, further research is needed.	C
Kwashiorkor Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. Potassium depletion is common and contributes to the high mortality rate associated with kwashiorkor. In children, high potassium supplementation was a beneficial kwashiorkor treatment. Further research is needed.	C
Myocardial infarction The use of glucose-insulin-potassium (GIK) for myocardial infarction (heart attack) has been in practice for over 40 years. In human studies, GIK administration resulted in reduced mortality from myocardial infarction, although further research is needed in this area.	C
Osteoporosis (prevention) In healthy children, a high dietary potassium intake correlated with high bone density. Low dietary potassium intakes are associated with low bone mineral density in premenopausal women and risk of bone loss in postmenopausal women. In women, increasing dietary potassium intake may contribute to a decreased risk of osteoporosis. Further research is needed in this area.	C
Poisoning (thallium) Thallium poisoning occurs in cases of suicide, murder attempt, or accident. Thallium is considered one of the most toxic heavy metals. It enters the potassium distribution pathways and alters a number of potassium-dependent processes. Potassium treatment increases the clearance of thallium by the kidneys but should be used cautiously, due to the risk of neurologic and cardiovascular toxicities.	C
Pre-eclampsia A case control study found that diets high in fiber and potassium are associated with a reduced risk of hypertension, indicating that maternal intake of foods rich in potassium and other nutrients may reduce the risk of pre-eclampsia. Further studies are warranted.	C
Rheumatoid arthritis Patients with rheumatoid arthritis have significantly lower serum potassium concentrations than healthy subjects. Potassium supplementation reduced pain levels in hypokalemic patients with rheumatoid arthritis. Further studies are warranted.	C
Stroke Low potassium intake and low serum potassium are associated with increased stroke mortality. High potassium intake was associated with a decrease in stroke incidence in adults. Further research is required to determine if potassium supplementation would prevent stroke.	C

*Key to grades:

A: Strong scientific evidence for this use;

B: Good scientific evidence for this use;

C: Unclear scientific evidence for this use;

D: Fair scientific evidence against this use (it may not work);

F: Strong scientific evidence against this use (it likely does not work).

Tradition

• Acne, allergies, antivenom (scorpion), constipation, diabetes, headaches, infantile colic, insulin potentiation, Ménière's disease, menopause.

Dosing

Adults (18 years and older)

• The 2004 guidelines of the Institute of Medicine specify an recommended daily allowance (RDA) of 4.7 grams of potassium for adults. Initial dosages may be adjusted to specific patient needs based on steady-state serum potassium concentrations.
• Oral potassium chloride should be taken with food and/or a full glass of water to prevent gastrointestinal irritation. Dissolvable potassium chloride tablets, powder, or concentrated solutions may be mixed with 3-8 ounces of water.
• For hypertension, 17-200 millimoles of potassium supplements (potassium chloride, potassium citrate, potassium bicarbonate, etc.) or dietary potassium daily has been used for five days to 28 weeks.
• For treatment of hypokalemia, 40-100 milliequivalents have been taken by mouth once daily, using formulations that include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution, or powder for dissolution mixed with an appropriate volume of water or juice. 40-100 milliequivalents of potassium chloride for injection diluted in an appropriate amount and type of solution have been infused in the vein once at a rate not exceeding 10-40 milliequivalents per hour.
• For prevention of hypokalemia, 10-20 milliequivalents have been taken by mouth once daily in equally divided doses, using formulations that include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution, or powder for dissolution mixed with an appropriate volume of water or juice. 10-40 milliequivalents of potassium chloride for injection diluted in an appropriate amount and type of solution have been infused in the vein once at a rate not exceeding 40 milliequivalents per hour.
• For rheumatoid arthritis, 6,000 milligrams of potassium chloride dissolved in grape juice and taken by mouth for 28 consecutive days with normal medications has been used.
• For dentin hypersensitivity, toothpastes, solutions, gels, and mouth rinses that have been used have included 1-15% KNO₃ and/or 30% potassium oxalate solution.
• For infusions, the maximum recommended concentration is 60 milliequivalents of potassium per liter of intravenous (infused in the vein) fluid. Potassium chloride solutions should be infused slowly (up to 20 milliequivalents per hour) to avoid venous irritation and pain. Monitoring the serum potassium concentration is recommended.
• For dehydration, 34 millimoles per liter of potassium chloride, at an infusion rate of 250-333 milliliters per hour, has been used.

Children (under 18 years old)

• Potassium chloride by mouth should be taken with food and/or a full glass of water to prevent gastrointestinal irritation. Dissolvable potassium chloride tablets, powder, or concentrated solutions may be mixed with 3-8 ounces of water.
• For treatment of hypokalemia, 2-5 milliequivalents taken by mouth in equally divided doses, using age-appropriate oral dosage formulations, have been used. 0.5-1 milliequivalents per kilogram per dose (with a maximum dose of 30 milliequivalents) of potassium chloride for injection diluted in an appropriate amount and type of solution to has been infused in the vein once at a rate not exceeding 0.3-0.5 milliequivalents per kilogram per hour. Monitoring the serum potassium concentration is recommended.
• For prevention of hypokalemia, 1-2 milliequivalents have been taken by mouth in equally divided doses, using age-appropriate oral dosage formulations.
• For kwashiorkor, 4.7-7.7 millimoles of potassium per kilogram of body weight has been taken by mouth.

References

1. Büssemaker E, Hillebrand U, Hausberg M, et al. Pathogenesis of hypertension: interactions among sodium, potassium, and aldosterone. Am J Kidney Dis. 2010 Jun;55(6):1111-20. View Abstract
2. D'Elia L, Barba G, Cappuccio FP, et al. Potassium intake, stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol. 2011 Mar 8;57(10):1210-9. View Abstract
3. Fenton TR, Lyon AW, Eliasziw M, et al. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res. 2009 Nov;24(11):1835-40. View Abstract
4. Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004 Sep;14(3):235-9. View Abstract
5. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev. 2002;(1):CD002847. View Abstract
6. Hoffman RS. Thallium toxicity and the role of Prussian blue in therapy. Toxicol Rev. 2003;22(1):29-40. View Abstract
7. Jones G, Riley MD, Whiting S. Association between urinary potassium, urinary sodium, current diet, and bone density in prepubertal children. Am J Clin Nutr. 2001 Apr;73(4):839-44. View Abstract
8. Kim Y, Hahn S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev. 2001;(2):CD002847. View Abstract
9. Macdonald HM, New SA, Fraser WD, et al. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr. 2005 Apr;81(4):923-33. View Abstract
10. Manary MJ, Brewster DR. Potassium supplementation in kwashiorkor. J Pediatr Gastroenterol Nutr. 1997 Feb;24(2):194-201. View Abstract
11. McCarty MF. Scavenging of peroxynitrite-derived radicals by flavonoids may support endothelial NO synthase activity, contributing to the vascular protection associated with high fruit and vegetable intakes. Med Hypotheses. 2008;70(1):170-81. View Abstract
12. Myers VH, Champagne CM. Nutritional effects on blood pressure. Curr Opin Lipidol. 2007 Feb;18(1):20-4. View Abstract
13. Poulsen S, Errboe M, Lescay Mevil Y, et al. Potassium containing toothpastes for dentine hypersensitivity. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001476. View Abstract
14. Rastmanesh R, Abargouei AS, Shadman Z, et al. A pilot study of potassium supplementation in the treatment of hypokalemic patients with rheumatoid arthritis: a randomized, double-blinded, placebo-controlled trial. J Pain. 2008 Aug;9(8):722-31. View Abstract
15. Rochon PA, Gill SS, Litner J, et al. A systematic review of the evidence for hypodermoclysis to treat dehydration in older people. J Gerontol A Biol Sci Med Sci. 1997 May;52(3):M169-76. View Abstract