Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Ideally, you give mag first, although it's not critical to do so. Stability of meropenem in saline and dextrose solutions and compatibility with potassium chloride. Then get the mag started. Renal tubular acidosis types I or II (see table below). and transmitted securely. The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. EKG changes (especially QT prolongation). Errors in the administration of drugs in ICUs are due to several factors: the use of high-risk drugs (vasoactive drugs, inotropes, sedatives, etc.) Round IV supplementation to the nearest 7.5 or 15 mmol increment 1.6-2.3 mg/dL Phosphate-potassium packet (PHOS-NAK powder) 2 (two) packets every 4 hours while awake x 3 dosesB Phosphate-potassium packet (PHOS-NAK The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Combinations of physical and chemically compatible drugs with concentrations below the reference mark. (c) Expedient treatment of hypomagnesemia may reduce the risk of Torsade de pointes. Published data may report both compatibility and stability; however, most evaluate compatibility alone. Until we have new and better compatibility studies that shed some light on this issue, this review can be an easy-to-read update on the evidence available on the compatibility of the drugs most commonly used at the ICU setting. Compatibility of drugs administered as 67% of the studies assessed gas formation, and only 12 measured pH changes in time. However, 93% guaranteed correct reproducibility. Start another line and run them both if you are worried about running them together. It can be made by treating potassium hydroxide (or other potassium bases) with hydrochloric acid: KOH + HCl + H2O. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 The goal of this review is to gather the information published on the physical and chemical compatibility of the most commonly used drugs at an ICU when infused through the same line via a Y-site. Time is required for potassium to enter the cells. Visual compatibility of clonidine with selected drugs. Boxes with diagonal lines show compatibility with physiological serum only. Only 6 studies assessed the chemical stability of the mixes being high-resolution liquid chromatography the method used in 5 studies to measure the concentration of the active ingredients of the mix. QT prolongation). Reference: International Journal of Pharmaceutical Compounding. Potassium can be infused in saline (unless a line is contraindicated) rather than in glucose solutions in critical states, as glucose can lower serum potassium levels. Use serum magnesium values to guide continued dosage. May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). Stability of milrinone lactate in the presence 29 critical care drugs and 4 i.v. Martn, A. Alonso, I. Gutirrez, J. lvarez, F. Becerril. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Iv The compatibility of these is shown in Fig. eplerenone and potassium. Overall, we found information on 82 new drug combinations from 27 different references including combinations of 3 beta-lactam antibiotics (ceftazidime, meropenem, and piperacillin-tazobactam) widely used at the ICU setting. @Z-!/^0B"oxC(cbS8v^zjx?N3Ggf&;V7Jmm *ZDkQ}:TpE
E[$c. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: RELATED: What Does Potassium Chloride React With? Dotted boxes show that the mix is compatible with glycosylated serum only. Can Potassium And Magnesium Be Given Iv Together? 2960 0 obj
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Repletion of magnesium is often necessary to successfully replete the potassium. Please enable it to take advantage of the complete set of features! Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Es usted profesional sanitario apto para prescribir o dispensar medicamentos? Complicated early prosthetic aortic valve infective endocarditis, Description of the methodology used (includes number and frequency of observations and study conditions), Description of diluents of all study drugs, Description of the material of the study recipients. FOIA Bethesda, MD 20894, Web Policies government site. The drug combination with no compatibility data were left unchecked. A target potassium of >3 mM may be reasonable in most patients with severe renal failure (in the absence of digoxin or myocardial ischemia). Magnesium Sulfate WebIV Drug Compatibility Chart A Alteplase (Activase, rTPA) Amiodarone (Cordarone) Argatroban Atropine Calcium chloride Diltiazem (Cardizem) Dobutamine (Dobutrex) Dopamine Epinephrine (Adrenalin) Esmolol (Brevibloc) Furosemide (Lasix) Heparin Insulin (regular) Lidocaine (Xylocaine) Lorazepam (Ativan) Magnesium Sulfate Potassium 0
J Antimicrob Chemother, 51 (2003), pp. Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. 2020;44:8087. %]-tm@$`m~!Z$Z5vxU^9^W8`=DmU LSJzXAnPEkXV`*7dAv4Q4
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=AYYXwf/WI F0Z[z%:}KbU8 Regarding the dates of publication, 8 papers were published between 1990 and 1999, 10 between 2000 and 2009, and the remaining 11 papers were published between 2010 and 2017. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Compatibility For example, diabetic ketoacidosis causes potassium to shift out of the cells. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. Amors Cerd. However, information on drug compatibility is scarce and, on many occasions, difficult to interpret due to the different concentrations used, the lack of information on the assessment techniques used or the suspicious technical quality of the sources. When started up again the Iv with the magnesium had blown. 562-565. The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. Serum hyperkalemia is dangerous. If you have any questions or comments, please dont hesitate to contact us. DKA or re-feeding syndrome). Making sure that the use of drugs is safe is one of the main commitments made by healthcare providers with their patients. It takes 3-4 hours for the Mg2+ in kidney and heart cells to exchange with the Mg2+ in plasma, meaning that you should give the mag first so it has time to start moving into the cells so that it is more likely to be effective in blocking potassium excretion. Select a second drug the same way (limited to 2 drugs) 3. Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. N. Baririan, H. Chanteux, E. Viaene, H. Servais, P.M. Tulkens. As far as the magnesium goes we don't piggyback it most of the time. Its goal is to contribute to the safe administration of drugs to patients who can face the consequences of greater severity due to their frailty. It's usually best to be conservative in the absence of any specific factors which increase the risk of arrhythmia (see risk stratification above). WebC = Compatible; may be mixed via Y-site. Can you piggyback critical meds like IV Potassium I have never worked in a ED but why wouldn't you want to do it right for the patient the first timefast isn't always the bestjust like placing every IV start in the AC for a patient being admitted!!! Patients with hypokalemia often have a large. The rest is in bones and cells. The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. Magnesium depletion is very common in patients with hypokalemia. The effect of nimodipine, fentanyl and remifentanil intravenous products on the stability of propofol emulsions. sharing sensitive information, make sure youre on a federal WebIv Medication Solution Compatibility Chart For Nurses Uploaded by: run.rebel.run April 2020 PDF Bookmark Download This document was uploaded by user and they confirmed that they have the permission to share it. Avoid drug incompatibilities: clinical context in neonatal intensive care unit (NICU). Hunt-Fugate AK, Hennessey CK, Kazarian CM. Larger, modern studies have shown that the safest potassium range in patients with myocardial infarction may be 3.5-4.5 mM. Secondary to another electrolyte abnormality: Polyuria with increased distal delivery of sodium and water to the tubule: Potassium wasting diuretics (e.g. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. Hypokalemia - EMCrit Project Magnesium repletion is also useful because it will reduce the risk of Torsade de pointes in these patients. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. Repletion of magnesium is often necessary to successfully replete the potassium. Intravenous Table 2. This involves clinical judgement based on consideration of two factors: total body potassium deficit and renal function. The IV was shut off. For example, even though the pH is a critical factor in the stability of drugs in solution, it was only verified in 12 of the 27 papers. Forty-four drugs used in continuous perfusion at the ICU setting were selected including a solution for parenteral nutrition with and without lipids and 3 beta-lactam antibiotics. J Cardiovasc Electrophysiol. K. Nemec, E. Germ, M. Schulz-Siegmund, A. Ortner. Ideally, this shouldn't be run through a single peripheral IV line (to prevent vein sclerosis). WebThe compatibility and stability of 80 mmol/L potassium chloride and 16 mmol/L magnesium sulfate in 0.9% sodium chloride injection and in 5% dextrose injection solutions at 22 deg C have been studied by means of a Beckman Clinical Chemistry Analyzer Synchron CX5 Delta. Am J Health Syst Pharm, 67 (2010), pp. and MgSO4 be mixed together Patients being resuscitated from DKA will generally tend to drop their potassium levels over time. Failure to treat the magnesium deficiency will make it difficult or impossible to fix the hypokalemia (hypomagnesemia causes renal potassium-wasting, so the patient will keep on spilling potassium until their magnesium level is repleted). Physical Compatibility: Physically compatible. Are you a health professional able to prescribe or dispense drugs? Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. The magnesium administration, which is concomitant with potassium, aids in tissue replenishment of potassium. Low magnesium levels usually don't cause symptoms. SRJ is a prestige metric based on the idea that not all citations are the same. COMPATIBILITY Before However, they may be better tolerated with less emesis. Specializes in Critical Care. Has anyone else? Amors Cerd, M.J. Arvalo Rubert, M. Maqueda Palau. Torsades de pointes may be the most classic. This means that different drugs are delivered using the same route of administration, which increases the risks involved when mixing incompatible drugs. 2. Vasoactive drugs, analgesics, and sedatives are among the most widely used therapeutic groups and are usually administered in continuous infusion. All information on compatibility found for a certain molecule about a different concentration interval is shown in Table 2. We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Search for and click on a drug 2. Sodium-wasting nephropathy (e.g. J.T. Unable to load your collection due to an error, Unable to load your delegates due to an error. EMCrit is a trademark of Metasin LLC. The research was published in the journal Neurotypical and was released online on December 4, 2013. Epub 2011 Aug 4. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. Critically ill patients often have limited venous accesses. This review focused on analyzing the physical and chemical compatibility of the IV drugs most commonly used through Y-site infusion in the ICU setting and summarizing the information obtained in a double-entry chart. Potassium is flowing into the cells just fine. Studies conducted to assess the stability of the mix: (a) transparency: for visible particles, observation with a matt black panel, automatic particle count or turbidimetry; for subvisible particles, use of optic microscopy, spectrophotometry or turbidimetry; (b) change in color: visual inspection or spectrophotometry; (c) gas formation: visual inspection; (d) pH; and (e) chemical stability: measurement of the variation of the concentration of the 2 drugs. C. Bardin, A. Astier, A. Vulto, G. Sewell, J. Vigneron, R. Trittler. Compatibility Web17. The concentrations used as a reference are the ones standardized in our center7 for these drugs and are consistent with the ones commonly used in most ICUs (Table 1). consider target potassium level (more) When started up again the Iv with the magnesium had blown. Use serum magnesium values to guide continued dosage. Int J Pharm Compd. Am J Health Syst Pharm, 65 (2008), pp. Physical Compatibility: Physically compatible. To respond to Larry777 I have never worked in a. Disclaimer. J.R. Chalmers, M.B. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 It takes 3-4 hours for the Mg2+ in kidney and heart cells to exchange with the Mg2+ in plasma, meaning that you should give the mag first so it has time to start moving into the cells so that it is more likely to be effective in blocking potassium excretion. Webcompatibility prior to coadministration. 2002 Jan-Feb;6(1):62-5. Y-Site Intravenous Drugs Compatibility To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. Therefore, the potassium deficit may be even, The vast majority of potassium in the body is located intracellularly. Ongoing fall in potassium likely (e.g., DKA or refeeding syndrome). Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. The magnesium was piggybacked onto the other saline IV with the potassium. Stability of Milrinone Lactate 200 micrograms/mL in 5% Dextrose Injection and 0.9% Sodium Chloride Injection. Just out of curiosity, what order did the MD write for them in? This means that we only have data available for 50.3% of all the possible combinations suggested. Targeting a potassium level >3.5 mM seems reasonable for most patients. Webimportant to recognize that compatibility reflects only the physical interactions such as formation of a precipitate and does not necessarily address stability or pharmacologic activity of the products. Potassium chloride is inexpensively available and is rarely used in the laboratory.
Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Failure to check and replete magnesium levels. and Lpez-Cabezas et al.5,7 were used as a reference point. ICH Harmonised Tripartite Guideline Q1A(R2): Stability testing of new drug substances and products, international conference on harmonisation (ICH), 6 February 2003. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. M
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