Specializes in Trauma/ED. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. eplerenone and potassium. 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 For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. ?6)J@quAD`)Xww"){-y:=%q&D2I)z*&4F0,)K52fb1e`R6K*E}Xlf*h4aZ-_4 Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review, Compatibilidad de los frmacos administrados en Y en las unidades de cuidados intensivos: revisin sistemtica. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Marta Prat Dot: data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. Chemical Stability: Chemically stable. If you have any questions or comments, please dont hesitate to contact us. 2940 0 obj <> endobj WebMany people may need magnesium supplements. Please cite this article as: Castells Lao G, Rodrguez Reyes M, Roura Turet J, Prat Dot M, Soy Muner D, Lpez Cabezas C. Compatibilidad de los frmacos administrados en Y en las unidades de cuidados intensivos: revisin sistemtica. Compatibilit du pantoprazole injectable lors dadministration en Y. Unauthorized use of these marks is strictly prohibited. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. I wondered that too, but it's pretty common practice to run things in one at a time on stable patients because if they have an adverse reaction, you can be pretty certain which medication they're reacting to. Published Nov 18, 2013. CiteScore measures average citations received per document published. None of the papers studied met all of the quality criteria established in this review. Potassium citrate is equally effective as KCl for the repletion of potassium. Potassium chloride is inexpensively available and is rarely used in the laboratory. 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. Physical Compatibility: Physically compatible. Start another line and run them both if you are worried about running them together. Compatibilit de lactylcystine injectable lors de son administration en Y avec dautres mdicaments usuels. and MgSO4 be mixed together Amors Cerd, M.J. Arvalo Rubert, M. Maqueda Palau. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. hSMxv? Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Structured summary of the results of the reference search. (iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. Renal tubular acidosis types I or II (see table below). On the contrary, 81% of the studies followed the recommendation of taking samples at time 0, although only 10 obtained a sample in 5 different times. Y-Site Intravenous Drugs Compatibility and Lpez-Cabezas et al.5,7 were used as a reference point. This may be the, For patients with ongoing gastric fluid loss, initiation of a proton pump inhibitor may minimize electrolyte derangements being caused by this. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. and MgSO4 be mixed together (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). Intravenous Iv mag or k+ which do I hang first The magnesium was piggybacked onto the other saline IV with the potassium. None of the included studies followed all the methodological requirements. Boxes were named with a C if the mix was compatible, with an I if incompatible and with I/C if stability depended on special conditions. (1) IV potassium should never be given as a bolus. 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 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. This means that different drugs are delivered using the same route of administration, which increases the risks involved when mixing incompatible drugs. Slow-release microencapsulated (wax-matrix) KCl formulations are suboptimal if an immediate effect is desired. 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. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Web1. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. This means prior confirmation is needed that no significant change has occurred in the concentration of either one of the drugs present in the mix.6. hN-X!hU1N-O7 ":9.y>FC&~vs&"(UVy]D9-W1a=-xZ,~weU/Q4yXf'au?,FIQ Int J Pharm Compd. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. (ii) Article quality was analyzed according to the stability studies practice guidelines. there is an average 1.7 errors/day associated with the process of drug administration in the ICU setting.1 On the other hand, the data reported by Merino et al. the difference between oral and IV magnesium Added to the risk of complications associated to the administration of 2 incompatible molecules, this lack of information can make the nurse have to look for new venous accesses to administer the drugs separately whichincreases the risk of infectious or thromboembolic complications. Also, in this case, I'd want to correct the hypomagnesemia prior to administering the K+, since as I mentioned above, the low K+ may be refractory to treatment in the presence of hypomagnesemia. Low magnesium levels usually don't cause symptoms. 3 Articles; This review was conducted following quality criteria based on the opinion of experts and following clinical practice guidelines811: Study reproducibility: description of active ingredient and diluent, study conditions and methodology. All works go through a rigorous selection process. Commonly used for severe hypokalemia or DKA. Repletion of magnesium is often necessary to successfully replete the potassium. Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). Due to their clinical approach and lack of methodology to determine physical and chemical stability, case studies were discarded. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Potassium This means that we only have data available for 50.3% of all the possible combinations suggested. Ningn estudio cumpli todos los criterios de calidad establecidos, aunque el 93% garantizaba una correcta reproducibilidad. Although it is an important advance with regard to safety, the use of intelligent infusion pumps has been associated with an important number or medication errors due to programming issues.3, The combination of these risk factors increases the chances of making mistakes in the most vulnerable patients due to their severity. Infusion of potassium at a rate of 40-60 mEq/hr is reasonable if the patient is extremely unstable (with the judgement that the inability to provide insulin is a life-threatening problem). Low magnesium levels usually don't cause symptoms. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Mmmm, sort ofintracellular Mg2+ modulates the transport of K+ *OUT* of cells by blocking secretion of K+, so if there is a deficiency of intracellular Mg2+, then more K+ is secreted by the distal renal tubule. A systematic search on Medline, Stabilis, Handbook on Injectable Drugs, and Micromedex databases was conducted for the identification of original papers, review articles and meta-analyses on the physical and chemical compatibility of drugs. Compatibility of drugs administered as For instance, Flamein et al.14 studied this problem in neonatal ICUs; Knudsen et al.15 shed light on the compatibility of analgesics and sedatives. Tests were run in triplicate only in 26% of the cases. phosphates. (3) Profound shock plus severe hypokalemia (unclear whether potassium would be adequately absorbed from the gut). Has 10 years experience. Visual compatibility of neuromuscular blocking agents with various injectable drugs during simulated Y-site injection. Specializes in MPH Student Fall/14, Emergency, Research. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Am J Heal Syst Pharm, 58 (2001), pp. WebMagnesium Sulphate Mannitol Metronidazole Midazolam Labetalol Gentamicin Glucose 4%, Sodium Chloride 0.18% Glucose 5% Glyceryl Trinitrate (GTN) Heparin (Sodium) Potassium Chloride Potassium Phosphate Propofol Remifentanil Milrinone Morphine Noradrenaline Omeprazole Thiopental Vancomycin (b) Treatment of hypomagnesemia may be required to effectively treat hypokalemia. sharing sensitive information, make sure youre on a federal Recopilar la informacin publicada sobre estabilidad de los frmacos usados en el paciente crtico, evaluar la calidad de los datos publicados y generar una tabla de compatibilidad con informacin actualizada. Required fields are marked *. Iv mag or k+ which do I hang first Compatibility screening of Precedex during simulated Y-site administration with other drugs. Use serum magnesium values to guide continued dosage. Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. QT prolongation, which may predict risk of arrhythmia. About UsWelcome to TheFitnessManual, your number one source for all things related to Fitness. Maddox, K. Viswanathan, J.L. Are you a health professional able to prescribe or dispense drugs? 161LP-166LP. Stability and compatibility study of cefepime in comparison with ceftazidime for potential administration by continuous infusion under conditions pertinent to ambulatory treatment of cystic fibrosis patients and to administration in intensive care units. Thus, most of the total body potassium deficit represents deficient, The intracellular nature of the potassium deficit means that IV potassium must be administered. However, they may be better tolerated with less emesis. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. So, potassium uptake is not affected, and secretion is increased. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Web17. 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. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). 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. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 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!!! Magnesium repletion is also useful because it will reduce the risk of Torsade de pointes in these patients. For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. Visual compatibility of clonidine with selected drugs. 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. Table 3. 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. Updated: Feb 27, 2020 The IV was shut off. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Carasso, R.A. Kennedy. Has 10 years experience. There were no interactions between Effervescent Potassium / Chloride and potassium phosphate & sodium phosphorus. WebThe primary endpoint of the study (change in serum magnesium level after 6 to 24 hours) was greater with IV therapy than any dose of oral therapy (mean change 0.24 mg/dL vs. 0.05-0.11 mg/dL, p=0.003). Careers. An official website of the United States government. Militello. No visible haze or particulate formation, color change, or gas evolution. Hypokalemia - EMCrit Project Avoid or use alternate Drug. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. J.R. Chalmers, M.B. Former authors have published reviews of these characteristics. Compatibility consider target potassium level (more) Combinations of physical and chemically compatible drugs with concentrations below the reference mark. Rapid administration may cause serum levels to be elevated (even though there is a total-body potassium deficit!). Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite FOIA 2 shows we could not find any information on the physical and chemical compatibility of all the combinations suggested; for instance, in the case of flumazenil and piperacillin-tazobactam we could only determine stability with 4 drugs and in both cases the 39 remaining combinations remained with no information. When started up again the Iv with the magnesium had blown. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). Larger, modern studies have shown that the safest potassium range in patients with myocardial infarction may be 3.5-4.5 mM. J.A. So, potassium uptake is Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 Commonly used rate for routine potassium repletion. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Reference: Bethesda, MD 20894, Web Policies Furthermore, serum hyperkalemia may cause poor retention of potassium (as it will tend to encourage potassium excretion in the urine). 0 If the etiology of hypokalemia remains elusive, the following approach may be helpful: This be calculated based on spot urine potassium and creatinine levels (using a calculator found. Fernndez-Llamazares, M.M. Number of tests run (at least in triplicate). Amors Cerd. Fig. Magnesium And Potassium Our patients hate those because they're enormous pills. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. RELATED: What Does Potassium Chloride React With? It's usually best to be conservative in the absence of any specific factors which increase the risk of arrhythmia (see risk stratification above). Web1. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. Intravenous and MgSO4 be mixed together M