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Standardization of infusion solutions to reduce the risk of incompatibility. Is Potassium Phosphate Compatible With Potassium Chloride? A chart was created with all the possible combinations of the drugs of interest. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. 273 0 obj <> endobj Vomiting or large-volume gastric suction. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 magnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. To respond to Larry777 I have never worked in a. J Cardiovasc Electrophysiol. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Elsevier Espaa, S.L.U. The site is secure. Our research goal was to investigate three combinations of potassium, calcium, and magnesium, in the event of a subsequent trial, to determine the relationships nature. Magnesium depletion is very common in patients with hypokalemia. Web1. An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). Larger, modern studies have shown that the safest potassium range in patients with myocardial infarction may be 3.5-4.5 mM. Bethesda, MD 20894, Web Policies A total of 48 papers were identified. 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. B. Moriyama, S.A. Henning, H. Jin, M. Kolf, N.N. Infusions remained stable at 22 degrees C. For 24 hours. S. Kanji, J. Lam, C. Johanson, A. Singh, R. Goddard, J. Fairbairn. Just out of curiosity, what order did the MD write for them in? and Lpez-Cabezas et al. An ED nurse can't have an understanding of fluid and electrolyte balance? According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. Please enable it to take advantage of the complete set of features! Report DMCA Overview Use serum magnesium values to guide continued dosage. Online databases like Stabilis 4.0 are very useful to look for information on drug compatibility. 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. Low magnesium levels usually don't cause symptoms. v]"^{ ?5iLuQaU.f.1&fU\G;*=Wxtz6IF/5:Z55el6hCAj|]r8-]TOa.0-DEllb uCcP|v&,g'6x"n|gM,pQY}f}Q~ 1rZW_1aQ& i'yJ<8hBI0f`~Cc]l;So8>(P|;7d>XQ&@K;ra`HNi11,o_N*k2'R>!^7& fMnfclfMq1X< 'jjJU**;&2QTmN.bJVB}} q|=yxxEdjgauNX 6cVV I"r|NiaUvzY]Oy K#0@'YVio|{G@ ;|'mYV? Summary of physical and chemical compatibilities. @'c[: pg6~ 0No2J:xWk^`+0Hg| 0BPo>E`3J_9`cX2!E[X\ZK-zgAQTT"AMKhj\.'1aq1|@1B9[kz]K/3c2jp{?OVL1 Has 10 years experience. According to Lexicomp, these are compatible, and there are no warnings against infusing concomitantly - is there any reason you couldn't run them together? consider target potassium level (more) A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. None of the papers studied met all of the quality criteria established in this review. Es usted profesional sanitario apto para prescribir o dispensar medicamentos? The transtubular potassium gradient (TTKG) is no longer recommended. As Fig. Other methods were used in 16 studies (59%) to see subvisible particles. endstream endobj 2944 0 obj <>stream WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. 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. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Summary of the quality criteria of the papers published. 2. Potassium chloride is inexpensively available and is rarely used in the laboratory. Potassium chloride is sold as a generic drug, but the following brand names are also available: Klor-Con M, K-Tab, Khlor Con, and Micro K. Keep in mind that these are more expensive than generic potassium chlorides because they are brand drugs. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. H. Pr, V. Chass, J.-M. Forest, P. Hildgen. Storage: Room temperature of 22 C. The reference search process for each drug was conducted concurrently by 2 independent researchers. Bobek, M.A. May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). Renal tubular acidosis types I or II (see table below). Avoid or use alternate Drug. The antidepressant is a form of azoteantidepressants. Amors Cerd, M.J. Arvalo Rubert, M. Maqueda Palau. EMCrit is a trademark of Metasin LLC. Compatibilit de lactylcystine injectable lors de son administration en Y avec dautres mdicaments usuels. 321 0 obj <>/Filter/FlateDecode/ID[<375F2B8E29F4DA448F0196983DC39AD5>]/Index[273 101]/Info 272 0 R/Length 178/Prev 592955/Root 274 0 R/Size 374/Type/XRef/W[1 3 1]>>stream Potassium chloride is inexpensively available and is rarely used in the laboratory. 8600 Rockville Pike Potassium citrate be useful in patients with nonanion-gap metabolic acidosis (NAGMA). Table 2. Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. None of the included studies followed all the methodological requirements. Chemical Stability: Chemically stable. 79-84. Storage: Room temperature of 22 C. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. If the renal function is adequate and stable (e.g., GFR is >30 ml/min and the patient is not oliguric), then it's unlikely that oral potassium will cause hyperkalemia. 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. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Times elapsed while taking the samples in the stability analysis: a 5-time sample time period is recommended including a sample time of 0. sharing sensitive information, make sure youre on a federal Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. 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 stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. 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. Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. However, 93% guaranteed correct reproducibility. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Unauthorized use of these marks is strictly prohibited. Militello. I sat upright and called for the nurse. Physical compatibility of calcium gluconate and magnesium sulfate injections. (c) Expedient treatment of hypomagnesemia may reduce the risk of Torsade de pointes. J Cardiovasc Electrophysiol. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. 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. Web17. hb``b``g```1c@@,&a|sR9TzxYeK (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. Time is required for potassium to enter the cells. When started up again the Iv with the magnesium had blown. 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 ?6)J@quAD`)Xww"){-y:=%q&D2I)z*&4F0,)K52fb1e`R6K*E}Xlf*h4aZ-_4 Physical Compatibility: Physically compatible. 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. 2. Published Nov 18, 2013. Number of tests run (at least in triplicate). In my time there we have still never used IV potassium and opt for PO k-dur instead. Chemical Stability: Chemically stable. If you have any questions or comments, please dont hesitate to contact us. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. 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!!! The systematic review included 29 studies (27 originals, 2 reviews). Report DMCA Overview Can Potassium And Magnesium Be Given Iv Together? Isn't this an ED Nursing thread? Torsades de pointes may be the most classic. Guidelines for the practical stability studies of anticancer drugs: a European consensus conference. However, this, Start with 20 mEq potassium IV over 2-3 minutes, Start with 20 mEq potassium IV over 10-20 minutes (infusion rate of 60-120 mEq/hr). Bookshelf If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. J Antimicrob Chemother, 51 (2003), pp. Rehak, R.L. 2960 0 obj <>/Filter/FlateDecode/ID[<9C0431B6ABCE6D4C97FFF3C0974F0366>]/Index[2940 41]/Info 2939 0 R/Length 104/Prev 123650/Root 2941 0 R/Size 2981/Type/XRef/W[1 3 1]>>stream Especially useful in patients with metabolic alkalosis (since potassium chloride will increase the serum chloride level). Serum hyperkalemia is dangerous. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. 71-78. Physical compatibility of milrinone lactate injection with intravenous drugs commonly used in the pediatric intensive care unit. 307-309, Copyright 2018. Am J Health Syst Pharm, 52 (1995), pp. In the absence of renal dysfunction, it's often useful to target a high-normal potassium level. (2) Markedly elevated cell counts (leukocytes take up potassium while the blood is awaiting analysis). Compatibility of propofol injectable emulsion with selected drugs during simulated Y-site administration. 1998 Mar-Apr;2(2):168169. The effect of nimodipine, fentanyl and remifentanil intravenous products on the stability of propofol emulsions. For example, diabetic ketoacidosis causes potassium to shift out of the cells. 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. DKA with adequate renal function: >5-5.3 mM. May be useful in the following situations: (1) Patients with severe volume overload who require. In the ICU setting and given the huge amount of IV drugs administered and the patients limited number of routes of administration, this safety is sometimes compromised due to the risks involved when co-administering incompatible drugs in especially vulnerable patients. Does Magnesium React With Potassium Chloride? Profound shock with questionable absorption. J Cardiovasc Electrophysiol. (ii) Article quality was analyzed according to the stability studies practice guidelines. What Are The Benefits Of Exercising Daily. %%EOF 2643-2647. Ideally, you give mag first, although it's not critical to do so. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. National Library of Medicine Nonanion-gap metabolic acidosis (look for RTA-1 or RTA-2), Metabolic alkalosis (may cause hypokalemia, but can also result. For example: In a patient with normal renal function and K = 3 mM (estimated deficiency of ~100-200 mEq), a dose of 40 mEq KCl could be given q8hr with daily measurement of electrolytes. 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. 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. Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. Sodium-wasting nephropathy (e.g. Table 3. Traditionally, the target has been >4 mM in efforts to reduce the risk of arrhythmia. Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. Foushee, L.M. Figure 2. I sat upright and called for the nurse. endstream endobj startxref 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. Chemical Stability: Chemically stable. Another way would be to allow potassium to burn in the presence of chlorine gas, which is also a very exothermic reaction: K + Cl 2 KCl, or 2 K+ MCl or CKl. 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. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. The search strategy consisted of using multiple terms describing the information of interest to combine them with the Boolean operator OR followed by refine search using the AND operator. Amors-Cerd, B. Ribas-Nicolau. For patients with oliguria or renal insufficiency, closer monitoring is required to avoid overshoot hyperkalemia. Epub 2011 Aug 4. The magnesium administration, which is concomitant with potassium, aids in tissue replenishment of potassium. It can be made by treating potassium hydroxide (or other potassium bases) with hydrochloric acid: KOH + HCl + H2O. Search for and click on a drug 2. Start another line and run them both if you are worried about running them together. 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. Save me from this ICU'ish intracellular speak :-). The magnesium was piggybacked onto the other saline IV with the potassium. Beta-agonists (albuterol, terbutaline, epinephrine including endogenous epinephrine surges from stress). IV or IM. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. E. Prez Juan, M. Maqueda Palau, M. Arvalo Rubert, B. Ribas Nicolau, S.M. Study drugs and concentrations used as reference for the bibliographic search. Hunt-Fugate AK, Hennessey CK, Kazarian CM. 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. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. There is no inhibition of potassium uptake. post-ATN or post-obstructive). 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. Use serum magnesium values to guide continued dosage. and Lpez-Cabezas et al.5,7 were used as a reference point. Table 1. Carmen Lpez Cabezas: 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. Potassium is flowing into the cells just fine. Slow-release microencapsulated (wax-matrix) KCl formulations are suboptimal if an immediate effect is desired. PMC Want to Download the Episode?Right Click Here and Choose Save-As. Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. However, they may be better tolerated with less emesis. Furosemide, for example, requires a basic pH to guarantee the stability of the molecule in solution, which is why the mix with acid drugs (pH<4) causes turbidity and precipitation.12. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Create well-written care plans that meets your patient's health goals.