By using a Beckman clinical chemistry Analyzer, 9% sodium chloride injection and 5% dextrose injection solutions at 22. 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. Gens Castells Lao: 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. The lack of information on the safe mix of 2 drugs creates problems in the daily work of ICU nursing teams. This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. Thus, if this allegedly compatible mix is performed in physiological serum, a loss of concentration of amiodarone can occur with the corresponding risk of lack of therapeutic response. An official website of the United States government. 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. Does Magnesium React With Potassium Chloride? HHS Vulnerability Disclosure, Help 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. Compatibility screening of Precedex during simulated Y-site administration with other drugs. 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). Pharm Technol Hosp Pharm, 2 (2017), pp. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. Specializes in Critical Care. DKA or re-feeding syndrome). Well, while I'm not sure I agree with the other RN's verbiage, she is correct that hypomagnesemia can make hypokalemia refractory to treatment, so hanging the mag first would be the correct action, as far as I know. Are you a health professional able to prescribe or dispense drugs? Making sure that the use of drugs is safe is one of the main commitments made by healthcare providers with their patients. To keep this page small and fast, questions & discussion about this post can be found on another page here. Am J Health Syst Pharm, 62 (2005), pp. According to the systematic review conducted by Moyen et al. K of 2 mEq/L may correlate with a potassium deficit of 400-600 mEq. (iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. consider target potassium level (more) K of 3 mEq/L may correlate with a potassium deficit of 100-200 mEq. Profound shock with questionable absorption. Targeting a potassium level >3.5 mM seems reasonable for most patients. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. UAiM 0g `%u?J[ +sC e#)7p:iQZ>`} d/ J;#A- 0 IJp C%tu0t}vN0{3):UVww A;{ ?M=]\:Zk-=%]%Q`l L. Trissel, D. Gilbert, J. Martinez, M. Kim. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. 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 Am J Health Syst Pharm, 67 (2010), pp. Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. M. Maqueda-Palau, E. Prez-Juan, M.J. Arvalo-Rubert, S.M. The citrate will be converted into bicarbonate, thereby improving the acidosis. This means that we only have data available for 50.3% of all the possible combinations suggested. The magnesium was piggybacked onto the other saline IV with the potassium. 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. 1968-1969. The reviews published by Kanji et al. When started up again the Iv with the magnesium had blown. If the urine creatinine level isn't known, then the urine potassium concentration can be used as a rough surrogate (with a cutoff of >>15-19 mM indicating renal potassium wasting). Calvo-Calvo, . Carrillo-lvarez, M. Sanjurjo-Sez. As Fig. 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. Another highly recommended measure for the safe administration of drugs is having reliable information available on drug compatibility when administering common drugs in critically ill patients. The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. Start another line and run them both if you are worried about running them together. The rest is in bones and cells. 2) as conditioned compatibility (I/C), that is, that the combination had been studied at a concentration different from the standard one. 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. Web17. 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. Web1. May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). Repletion of magnesium is often necessary to successfully replete the potassium. Only about 2% of the total Mg2+ in the body is in the plasma. What Are The Best Exercises For A Flat Tummy? Use serum magnesium values to guide continued dosage. This conversion is an acid-base neutralization reaction. The infusions were stable for 24 hours at 22 deg C. The results from both diluents showed an average of +/-5% fluctuations in concentration. Amors Cerd. For patients with hypokalemia and hypomagnesemia, rapid correction of hypomagnesemia is safe and may quickly decrease the risk of arrhythmia. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. The site is secure. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net. It is important to recognize that compatibility is not just Vasoactive drugs, analgesics, and sedatives are among the most widely used therapeutic groups and are usually administered in continuous infusion. K. Nemec, E. Germ, M. Schulz-Siegmund, A. Ortner. In my time there we have still never used IV potassium and opt for PO k-dur instead. Report DMCA Overview Just out of curiosity, what order did the MD write for them in? 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. Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: 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. 71-78. QT prolongation, which may predict risk of arrhythmia. Patients being resuscitated from DKA will generally tend to drop their potassium levels over time. Times elapsed while taking the samples in the stability analysis: a 5-time sample time period is recommended including a sample time of 0. The presence of any factors which may cause shifting of potassium in or out of the cells. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net uptake to improve potassium levels, it's sort of like cells are scooping up potassium with a bowl, except those with low magnesium are scooping them up with a colander. Vomiting or large-volume gastric suction. Nieforth KA, Shea BF, Souney PF, Scavone JM. Has 2+ years experience. Physical compatibility of calcium gluconate and magnesium sulfate injections. Warren, F.C. UCI de hospitales espaoles e internacionales. Save me from this ICU'ish intracellular speak :-). Storage: Room temperature of 22 C. An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). Use serum magnesium values to guide continued dosage. solutions. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Potassium chloride is inexpensively available and is rarely used in the laboratory. Compatibilidad fsica del bicarbonato sdico con frmacos de uso frecuente en la unidad de cuidados intensivos. 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. San Francisco General or Highland Hospital. Avoid or use alternate Drug. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. Eur J Hosp Pharm Sci Pract, 21 (2014), pp. 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. 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. J.D. Militello. Compatibilidad fsica de la amiodarona en perfusin continua. A fractional excretion of potassium >9.3% suggests renal potassium wasting (with sensitivity of 81% and specificity of 86%). For example, diabetic ketoacidosis causes potassium to shift out of the cells. J Cardiovasc Electrophysiol. 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. Forest. %%EOF The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 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. 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. 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. Inverted T-wave followed by prominent U-wave may create a biphasic down-up morphology. Our patients hate those because they're enormous pills. $MMT=window.$MMT||{};$MMT.cmd=$MMT.cmd||[];$MMT.cmd.push(function(){$MMT.display.slots.push(["e023039a-a41d-404b-ba77-d0a561240f4b"]);}). The most problematic combinations regarding incompatibility are drugs whose stability is closely linked to the pH interval; this is the case with sodium bicarbonate, furosemide or pantoprazole. In the absence of the above factors, hypokalemia is well tolerated (and can be treated gradually). 1287-1292. Recently I had a patient that needed both iv k and iv mag. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. %%EOF 651-658. 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.