magnesium and potassium iv compatibility magnesium and potassium iv compatibility

Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Low magnesium levels usually don't cause symptoms. I have tremendous respect for ED nurses but this comment just seemsfranklynot well thought outmaybe more time to think was needed! B. Ribas Nicolau, E. Prez Juan, S.M. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Am J Health Syst Pharm, 62 (2005), pp. Avoid drug incompatibilities: clinical context in neonatal intensive care unit (NICU). It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. Similarly, turbidimetry or microscopymore accurate techniques than visual observation for the detection of particles and changes in colorare underused. To respond to Larry777 I have never worked in a. and SEMICYUC, Copyright 2023. Before The resulting salt can then be reconstituted by recrystallization. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Only about 2% of the total Mg2+ in the body is in the plasma. (iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. May fuse with the T-wave to produce a prolonged QT interval (technically a Q-T-U interval). S. Manrique-Rodrguez, A.C. Snchez-Galindo, C.M. The magnesium level is the most important contributing factor, for several reasons: (a) Hypomagnesemia is common (most patients with hypokalemia have hypomagnesemia as well).(. 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. The systematic review included 29 studies (27 originals, 2 reviews). Potassium citrate be useful in patients with nonanion-gap metabolic acidosis (NAGMA). An official website of the United States government. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. Potassium is flowing into the cells just fine. Reference: Excessive use of intravenous potassium repletion, when enteral potassium would be a safer and easier strategy. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Reference: sharing sensitive information, make sure youre on a federal PMC /`p often administered in low doses due to their high drug strength, requiring dilution and a prior assessment to their administration. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). 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. L. Trissel, D. Gilbert, J. Martinez, M. Kim. Webcompatibility prior to coadministration. There were no interactions between Effervescent Potassium / Chloride and potassium phosphate & sodium phosphorus. ?6)J@quAD`)Xww"){-y:=%q&D2I)z*&4F0,)K52fb1e`R6K*E}Xlf*h4aZ-_4 Patients being resuscitated from DKA will generally tend to drop their potassium levels over time. Guidelines for the practical stability studies of anticancer drugs: a European consensus conference. Fernndez-Llamazares, M.M. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient. B. Moriyama, S.A. Henning, H. Jin, M. Kolf, N.N. Renal tubular acidosis types I or II (see table below). This study guide will help you focus your time on what's most important. 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. 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. Careful consideration of the above etiologies combined with the clinical context will usually provide an explanation for the hypokalemia. Eur J Hosp Pharm Sci Pract, 21 (2014), pp. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. The IV was shut off. 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. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. provided compatibility information on 393 out of 945 possible combinations.5,7 After completing the systematic review, new stability data for 82 drug combinations were added. 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. 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. 373 0 obj <>stream Use serum magnesium values to guide continued dosage. EKG changes (especially QT prolongation). Published data may report both compatibility and stability; however, most evaluate compatibility alone. Specializes in Medical-Surgical/Float Pool/Stepdown. S. Tollec, K. Touzin, E. Pelletier, J.M. K. Nemec, E. Germ, M. Schulz-Siegmund, A. Ortner. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. %PDF-1.6 % (3) Profound shock plus severe hypokalemia (unclear whether potassium would be adequately absorbed from the gut). S.E. 2. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. San Francisco General or Highland Hospital. in a study conducted among Spanish hospital ICUs are a little better (1.13 medication errors for every 100 patients/day).2 Even so, medication errors are common in ICUs and require care from healthcare providers to minimize them. 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 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). According to the systematic review conducted by Moyen et al. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. 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. In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Patients with hypokalemia often have a large. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Despite this, the number of drug combinations studied is still insufficient. 1159-1160. Also, to assess the quality of the information published and generate a compatibility chart with reliable and updated information to improve safety in the administration of drugs to critically ill patients. None of the included studies followed all the methodological requirements. Am J Health Syst Pharm, 52 (1995), pp. Ideally, this shouldn't be run through a single peripheral IV line (to prevent vein sclerosis). 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. However, 93% of the papers described the conditions and methodology of the study with enough detail to guarantee its reproducibility. Bookshelf 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. Especially useful in patients with metabolic alkalosis (since potassium chloride will increase the serum chloride level). Failure to check and replete magnesium levels. E. Prez Juan, M. Maqueda Palau, M. Arvalo Rubert, B. Ribas Nicolau, S.M. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. The effect of nimodipine, fentanyl and remifentanil intravenous products on the stability of propofol emulsions. Physical compatibility of milrinone lactate injection with intravenous drugs commonly used in the pediatric intensive care unit. Storage: Room temperature of 22 C. N. Baririan, H. Chanteux, E. Viaene, H. Servais, P.M. Tulkens. 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. 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. This conversion is an acid-base neutralization reaction. 504-506. Low magnesium levels usually don't cause symptoms. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. Former authors have published reviews of these characteristics. %PDF-1.5 % Hypokalemia itself isn't immediately life-threatening here, but hypokalemia impedes the ability to provide. As far as the magnesium goes we don't piggyback it most of the time. Compatibility screening of Precedex during simulated Y-site administration with other drugs. Over the last few years, several experts have published guidelines for the design of drug stability studies.811 We can only hope that this will improve the overall quality of this type of studies in the future. 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. An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. J Cardiovasc Electrophysiol. This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. UAiM 0g `%u?J[ +sC e#)7p:iQZ>`} d/ J;#A- 0 IJp C%tu0t}vN0{3):UVww A;{ ?M=]\:Zk-=%]%Q`l Martn, A. Alonso, I. Gutirrez, J. lvarez, F. Becerril. N. Beauregard, N. Bertrand, A. Dufour, O. Blaizel, G. Leclair. Magnesium can be repleted rapidly (faster than potassium). Summary of physical and chemical compatibilities. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: In the absence of the above factors, hypokalemia is well tolerated (and can be treated gradually). consider target potassium level (more) Methodological guidelines for stability studies of hospital pharmaceutical preparations. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. Can Potassium And Magnesium Be Given Iv Together? 79-84. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). Just out of curiosity, what order did the MD write for them in? The drugs used in the review are routinely used in the ICU setting are often administered by continuous infusion. EMCrit is a trademark of Metasin LLC. Physical compatibility of calcium gluconate and magnesium sulfate injections. consider target potassium level (more) 1287-1292. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given. Web1. Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. 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 ;}9fUe ][n, 77"^tSg7~Yk^m_m_m_mMT Zbqx| j Study drugs and concentrations used as reference for the bibliographic search. Also, the information provided is in regard to 2 drug combinations, and incompatibilities may be present with>2 drug combinations at a time, which is highly not advisable. However, they may be better tolerated with less emesis. If you are author or own the copyright of this book, please report to us by using this DMCA report form. The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. La revisin sistemtica incluy 29 artculos (27 originales y 2 revisiones). 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. Walker, S. Varrin, D. Yannicelli, S. Law. endstream endobj 2944 0 obj <>stream The IV was shut off. C. Bardin, A. Astier, A. Vulto, G. Sewell, J. Vigneron, R. Trittler. Study drugs and concentrations used as reference for the bibliographic search. Commonly used rate for routine potassium repletion. Repletion of magnesium is often necessary to successfully replete the potassium. Am J Health Syst Pharm, 65 (2008), pp. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available Start another line and run them both if you are worried about running them together. Nieforth KA, Shea BF, Souney PF, Scavone JM. 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. It is important to recognize that compatibility is not just Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Chemical Stability: Chemically stable. However, this does not necessarily mean there are no interactions. 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. Patients admitted to intensive care units (ICU) often require the IV administration of several drugs. Pharm Technol Hosp Pharm, 2 (2017), pp. Articles published from 1990 to 2017 in English, Spanish and French were included. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. Nonanion-gap metabolic acidosis (look for RTA-1 or RTA-2), Metabolic alkalosis (may cause hypokalemia, but can also result. Bethesda, MD 20894, Web Policies 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. J Cardiovasc Electrophysiol. 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. Tests were run in triplicate only in 26% of the cases. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. Can You Give Po And Iv Potassium Together? 2643-2647. 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. Both increase serum potassium. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. The https:// ensures that you are connecting to the Standardization of infusion solutions to reduce the risk of incompatibility. SRJ is a prestige metric based on the idea that not all citations are the same. Targeting a potassium level >3.5 mM seems reasonable for most patients. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. The patient had one patent iv site. Potassium chloride is inexpensively available and is rarely used in the laboratory. and Lpez-Cabezas et al. The compatibility of these is shown in Fig. It would be good to have greater uniformity in the quality standards of this type of studies. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. Summary of physical and chemical compatibilities. Number of tests run (at least in triplicate). WebC = Compatible; may be mixed via Y-site. 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. We therefore expect that combinations of these cations would reduce blood pressure. 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. 71-78. S.R. The rest is in bones and cells. Aggressive repletion of mild hypokalemia in patients with renal failure (. Gormley, M.S. Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Bobek, M.A. 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. 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 Compatibility of propofol injectable emulsion with selected drugs during simulated Y-site administration. What Is The Difference Between Potassium Chloride And Klor Con? Es usted profesional sanitario apto para prescribir o dispensar medicamentos? The magnesium was piggybacked onto the other saline IV with the potassium. It is consistent with the gray boxes specified as I/C as shown in Fig. The 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. As far as the magnesium goes we don't piggyback it most of the time. Deg C have been investigated. @'c[: pg6~ 0No2J:xWk^`+0Hg| 0BPo>E`3J_9`cX2!E[X\ZK-zgAQTT"AMKhj\.'1aq1|@1B9[kz]K/3c2jp{?OVL1 161LP-166LP. The new findings revealed 29 compatible combinations, 27 incompatible combinations, and 26 compatible combinations in specific conditions. The magnesium was piggybacked onto the other saline IV with the potassium. By using a Beckman clinical chemistry Analyzer, 9% sodium chloride injection and 5% dextrose injection solutions at 22. From the 1st of January 2022 onwards, it will be mandatory to submit the conflict of interest of each author with the second submission of the manuscript (see instructions for authors). Figure 2. 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 years of publication of the studies went from the1990s until December 2017 and the languages included were English, Spanish, and French. Lineberger. 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.