magnesium and potassium iv compatibility

UCI de hospitales espaoles e internacionales. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. Compatibilidad fsica de la amiodarona en perfusin continua. Table 3. Walker, S. Varrin, D. Yannicelli, S. Law. In this sense, we could not find data on all drug combinations regarding the high concentrations used in the ICU setting (Table 1); however, in some cases, we did obtain information on lower concentrations than the ones reported in this review. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. Stability of Milrinone Lactate 200 micrograms/mL in 5% Dextrose Injection and 0.9% Sodium Chloride Injection. When started up again the Iv with the magnesium had blown. The authors declared no conflicts of interest whatsoever. Would you like email updates of new search results? Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. PMC 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 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. Nonanion-gap metabolic acidosis (look for RTA-1 or RTA-2), Metabolic alkalosis (may cause hypokalemia, but can also result. 273 0 obj <> endobj J.A. hmo6 IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. 2940 0 obj <> endobj Stewart, F.W. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. Furthermore, serum hyperkalemia may cause poor retention of potassium (as it will tend to encourage potassium excretion in the urine). Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. After the reference search, 2 independent reviewers assessed the quality of the studies using a peer-review process. Compatibility of drugs administered as Y-site infusion in intensive care units: A http://dx.doi.org/10.1016/j.medin.2012.11.002, http://dx.doi.org/10.1016/j.medin.2016.01.011, http://dx.doi.org/10.1016/j.enfi.2010.09.004, http://dx.doi.org/10.1016/j.enfcli.2010.06.002, http://dx.doi.org/10.1128/aac.45.9.2643-2647.2001, http://dx.doi.org/10.1177/106002809603000303, http://dx.doi.org/10.1093/ajhp/54.19.2192, http://dx.doi.org/10.1097/00000539-200006000-00037, http://dx.doi.org/10.1016/0952-8180(96)00043-8, Impact of vaccination on admissions to an intensive care unit for COVID-19 in a third-level hospital, Delirium in COVID-19. Reference: Montse Rodrguez Reyes: study design and idea, data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. Choosing a specialty can be a daunting task and we made it easier. If you have any questions or comments, please dont hesitate to contact us. According to the systematic review conducted by Moyen et al. Chemical Stability: Chemically stable. A chart was created with all the possible combinations of the drugs of interest. QT prolongation, which may predict risk of arrhythmia. The magnesium was piggybacked onto the other saline IV with the potassium. Use serum magnesium values to guide continued dosage. 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. (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). HWr8}W|MT9'emv2}r-EZvnP%"@NdtpY{wpvtz\4/?>*FGM1@FISbr7rB]sYLwu4&ijm /&)]yZY 40HsWc32ffg0aF+my=.V"[&&p~vk'T cX0;?~3!Lc56@q]uS~ >9"TyrUm@<08XD)j]oX(X4] vo7#%1TFFBiJ$z(Eo` l@Ih The presence of adjuvants in the pharmaceutical formulation, the concentration and exposure to extreme temperatures or luminosity are other factors associated with drug incompatibility.13 There are times when a given drug combination can be stable in a certain diluent and incompatible in another; for instance, dopamine is only compatible with amiodarone when both are dissolved in glycosylated serum at 5% because the latter in unstable in saline solutions at 0.9%. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). Infusions of sodium chloride and magnesium sulfate were present in 0. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. This means that different drugs are delivered using the same route of administration, which increases the risks involved when mixing incompatible drugs. Beckmans Clinical Chemistry Analyzer Synchron CX5 Delta. Judit Roura Turet: data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. Compatibilidad visual y fsica de la furosemida en mezclas intravenosas para perfusin continua. Avoid or Use Alternate Drug. 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. By using a Beckman clinical chemistry Analyzer, 9% sodium chloride injection and 5% dextrose injection solutions at 22. Web1. Failure to check and replete magnesium levels. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. Am J Health Syst Pharm, 65 (2008), pp. Epub 2011 Aug 4. 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. RELATED: What Does Potassium Chloride React With? EKG changes (especially QT prolongation). Report DMCA Overview (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). Rate of 20 mEq/hr for severe hypokalemia or DKA (either via a central line, or split into two simultaneous infusions of 10 mEq/hr in two peripheral lines). Compatibilitat fisicoqumica de frmacs administrats en perfusi contnua en les unitats de cures intensives. Propofol compatibility with other intravenous drug products-two new methods of evaluating IV emulsion compatibility. None of the samples appeared to form visible precipitation or to change in color or clarity. Due to their clinical approach and lack of methodology to determine physical and chemical stability, case studies were discarded. 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. Renal tubular acidosis types I or II (see table below). A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. MeSH 8600 Rockville Pike Avoiding common flaws in stability and compatibility studies of injectable drugs. IV or IM. Clinical context where potassium is likely to fall further (e.g. 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. P.R. L. Knudsen, S. Eisend, N. Haake, T. Kunze. Patients admitted to intensive care units (ICU) often require the IV administration of several drugs. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. RELATED: What Does Potassium Chloride React With? Potassium administration by intravenous route should only be used if the oral or enteral route is not available or does not have the required serum potassium increase in a clinically acceptable time. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. Visual compatibility of diltiazem injection with various diluents and medications during simulated Y-site injection. Has 2+ years experience. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Then get the mag started. Especially useful in patients with metabolic alkalosis (since potassium chloride will increase the serum chloride level). Mullins, K. Yaughn. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Stability of ranitidine hydrochloride at dilute concentration in intravenous infusion fluids at room temperature. Hypokalemia itself isn't immediately life-threatening here, but hypokalemia impedes the ability to provide. None of the samples seemed to have visible precipitation or changed in color or clarity. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. 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. Both increase serum potassium. EKG changes due to hypokalemia (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. I had not heard this before and am unable to find any information on this. Akkerman, H. Zhang, R.E. Commonly used for severe hypokalemia or DKA. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. 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. I have tremendous respect for ED nurses but this comment just seemsfranklynot well thought outmaybe more time to think was needed! As far as the magnesium goes we don't piggyback it most of the time. thiazides, loop diuretics, acetazolamide, mannitol). Am J Health Syst Pharm, 54 (1997), pp. Martn, A. Alonso, I. Gutirrez, J. lvarez, F. Becerril. 1-612-816-8773. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. %]-tm@$`m~!Z$Z5vxU^9^W8`=DmU LSJzXAnPEkXV`*7dAv4Q4 2,B9M~_ ,0-]v =AYYXwf/WI F0Z[z%:}KbU8 Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. Potassium citrate be useful in patients with nonanion-gap metabolic acidosis (NAGMA). However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. Summary of the quality criteria of the papers published. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available 2. 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 Inverted T-wave followed by prominent U-wave may create a biphasic down-up morphology. 1159-1160. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net. However, the personnel administering the drugs finds charts much more useful because they can quickly look at the information they need at a given time. Lineberger. 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. 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. $MMT=window.$MMT||{};$MMT.cmd=$MMT.cmd||[];$MMT.cmd.push(function(){$MMT.display.slots.push(["e023039a-a41d-404b-ba77-d0a561240f4b"]);}). On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. Updated: Feb 27, 2020 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. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. 651-658. Physical and Chemical Stability of Morphine Sulfate 5mg/mL and 50mg/mL Packaged in Plastic Syringes. Before (3) Safer (oral potassium is overall more idiot-proof than IV potassium). Use serum magnesium values to guide continued dosage. 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. J Cardiovasc Electrophysiol. J Cardiovasc Electrophysiol. Low magnesium = decreased potassium uptake which results in more of the potassium you gave being excreted. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. K of 3 mEq/L may correlate with a potassium deficit of 100-200 mEq. J Antimicrob Chemother, 51 (2003), pp. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Summary of physical and chemical compatibilities. Maddox, K. Viswanathan, J.L. Specializes in Trauma/ED. 221-231. I hung the potassium 1 st because it would take the less time. Unable to load your collection due to an error, Unable to load your delegates due to an error. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient. 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). However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. Web17. (3) Profound shock plus severe hypokalemia (unclear whether potassium would be adequately absorbed from the gut). Is Potassium Phosphate Compatible With Potassium Chloride? Errores de medicacin en los servicios de medicina intensiva espaoles. Other methods were used in 16 studies (59%) to see subvisible particles. Magnesium can be repleted rapidly (faster than potassium). Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Magnesium depletion is very common in patients with hypokalemia. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. Since 1997, allnurses is trusted by nurses around the globe. 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. No visible haze or particulate formation, color change, or gas evolution. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. hb```l\ cg`a" D@M70I?@C Z|`d>!-Uu>]ppX=+c(rJT'c9V{L7M{{]ua;DVo"6e\W:qcf/f3%dayw-LrO{.p*zvTSf1xpSIC a. A target potassium of >3 mM may be reasonable in most patients with severe renal failure (in the absence of digoxin or myocardial ischemia). If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. 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 Even if we took all the possible combinations suggested into consideration and added the new data found, we would still have zero information on the physical and chemical compatibility of 470 combinations. Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. 2. I sat upright and called for the nurse. Secondary to another electrolyte abnormality: Polyuria with increased distal delivery of sodium and water to the tubule: Potassium wasting diuretics (e.g. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). DKA or re-feeding syndrome). It is important to recognize that compatibility is not just Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. Our hospital stopped using IV potassium because we had too many sentinel events involving their use.