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. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. 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. 9/gY'=@5y!h6{[T e- vVfbd' I&*_5u(_*h10x8C5C%4z1vE{_e"l|Yh/
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;|'mYV? 2002 Jan-Feb;6(1):62-5. May fuse with the T-wave to produce a prolonged QT interval (technically a Q-T-U interval). WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. Ann Pharm Franaises, 69 (2011), pp. Perfusions at drug concentrations that exceed the usual ones are often used in the critically ill patient. Fox. Potassium is flowing into the cells just fine. F. Flamein, L. Storme, A. Maiguy-Foinard, M. Perez, B. Dcaudin, M. Masse. Amors Cerd, M.J. Arvalo Rubert, M. Maqueda Palau. Both increase serum potassium. 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. On the other hand, in many cases, the quality of the studies published so far can be better. ]g0i9FAA,at 0
Are you a health professional able to prescribe or dispense drugs? Profound shock with questionable absorption. See. The IV was shut off. 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. What Is The Difference Between Potassium Chloride And Klor Con? Am J Health Syst Pharm, 54 (1997), pp. Sheesh! Specializes in Med nurse in med-surg., float, HH, and PDN. 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. Amors-Cerd, B. Ribas-Nicolau. 321 0 obj
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Report DMCA Overview CiteScore measures average citations received per document published. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Reference: Published data may report both compatibility and stability; however, most evaluate compatibility alone. P. Merino, M.C. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 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. 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 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. After the reference search, 2 independent reviewers assessed the quality of the studies using a peer-review process. 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). 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. The resulting salt can then be reconstituted by recrystallization. Regarding the dates of publication, 8 papers were published between 1990 and 1999, 10 between 2000 and 2009, and the remaining 11 papers were published between 2010 and 2017. 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. The lack of information on the safe mix of 2 drugs creates problems in the daily work of ICU nursing teams. often administered in low doses due to their high drug strength, requiring dilution and a prior assessment to their administration. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). Reference: The .gov means its official. Tests were run in triplicate only in 26% of the cases. Commonly used rate for routine potassium repletion. So, potassium uptake is not affected, and secretion is increased. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. Chemical Stability: Chemically stable. 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. Dilution: Potassium chloride concentrate is compatible with the majority of commonly used intravenous infusion fluids. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. valuation visuelle de la compatibilit physique de la naloxone avec dautres mdicaments intraveineux usuels. This means that we only have data available for 50.3% of all the possible combinations suggested. Renal tubular acidosis types I or II (see table below). Chemical Stability: Chemically stable. 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. and Lpez-Cabezas et al.5,7 were used as a reference point. Clinical context where potassium is likely to fall further (e.g. 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. 1998 Mar-Apr;2(2):168169. 1648-1654. Web17. Physical compatibility of calcium gluconate and magnesium sulfate injections. Use serum magnesium values to guide continued dosage. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Potassium citrate is equally effective as KCl for the repletion of potassium. Aldosterone and renin levels should ideally be measured after correction of potassium, because otherwise hypokalemia may suppress the aldosterone level. Methodological guidelines for stability studies of hospital pharmaceutical preparations.
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. official website and that any information you provide is encrypted Select a second drug the same way (limited to 2 drugs) 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. 2643-2647. K of 2 mEq/L may correlate with a potassium deficit of 400-600 mEq. 562-565. In the absence of renal dysfunction, it's often useful to target a high-normal potassium level. For example, diabetic ketoacidosis causes potassium to shift out of the cells. (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). @'c[: pg6~ 0No2J:xWk^`+0Hg| 0BPo>E`3J_9`cX2!E[X\ZK-zgAQTT"AMKhj\.'1aq1|@1B9[kz]K/3c2jp{?OVL1 B. Moriyama, S.A. Henning, H. Jin, M. Kolf, N.N. Infusions remained stable at 22 degrees C. For 24 hours. 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. 516-520. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. 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. According to the systematic review conducted by Moyen et al. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. S.R. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 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). Search for and click on a drug 2. 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. Using high-dose IV potassium is rarely necessary. P.R. hbbd```b`` =wK"`RL Qn dX1DMZBAXD$
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Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Compatibility of propofol, fentanyl, and vecuronium mixtures designed for potential use in anesthesia and patient transport. In the absence of the above factors, hypokalemia is well tolerated (and can be treated gradually). So, potassium uptake is 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. WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. 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. Careers. Patients with hypokalemia often have a large. 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. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Ongoing fall in potassium likely (e.g., DKA or refeeding syndrome). Federal government websites often end in .gov or .mil. $MMT=window.$MMT||{};$MMT.cmd=$MMT.cmd||[];$MMT.cmd.push(function(){$MMT.display.slots.push(["e023039a-a41d-404b-ba77-d0a561240f4b"]);}). Low magnesium levels usually don't cause symptoms. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. 67% of the studies assessed gas formation, and only 12 measured pH changes in time. J Pharm Pract Res, 32 (2002), pp. If you are author or own the copyright of this book, please report to us by using this DMCA report form. 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. Making sure that the use of drugs is safe is one of the main commitments made by healthcare providers with their patients. 2,816 Posts. I have tremendous respect for ED nurses but this comment just seemsfranklynot well thought outmaybe more time to think was needed! Bethesda, MD 20894, Web Policies It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. Has 10 years experience. Summary of physical and chemical compatibilities. J.A. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. The systematic review included 29 studies (27 originals, 2 reviews). (3) Safer (oral potassium is overall more idiot-proof than IV potassium). Avoid or use alternate Drug. 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. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net. Nonanion-gap metabolic acidosis (look for RTA-1 or RTA-2), Metabolic alkalosis (may cause hypokalemia, but can also result. DKA or re-feeding syndrome). EMCrit is a trademark of Metasin LLC. 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. None of the samples appeared to form visible precipitation or to change in color or clarity. QT prolongation, which may predict risk of arrhythmia. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. 2. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Potassium chloride is inexpensively available and is rarely used in the laboratory. L. Trissel, C. Saenz, D. Ingram, K. Williams, J. Retzinger. Am J Hosp Pharm, 40 (1983), pp. Avoid drug incompatibilities: clinical context in neonatal intensive care unit (NICU). The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 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. Our members represent more than 60 professional nursing specialties. @Z-!/^0B"oxC(cbS8v^zjx?N3Ggf&;V7Jmm *ZDkQ}:TpE
E[$c. C, compatible; I, incompatible; I/C, compatible in special conditions. L. Knudsen, S. Eisend, N. Haake, T. Kunze. All works go through a rigorous selection process. 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. So, potassium uptake is 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. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). 273 0 obj
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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. Visual compatibility of diltiazem injection with various diluents and medications during simulated Y-site injection. Epub 2011 Aug 4. Excessive use of intravenous potassium repletion, when enteral potassium would be a safer and easier strategy. So, potassium uptake is 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. #2) Acquired form associated with hyperthyroidism, typically in Asian and Mexican men. Your email address will not be published. Webcompatibility prior to coadministration. The compatibility of these is shown in Fig. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. Specializes in Trauma/ED. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. 2980 0 obj
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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. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. solutions. Has 10 years experience. 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 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. Danner. The drugs used in the review are routinely used in the ICU setting are often administered by continuous infusion. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. However, they may be better tolerated with less emesis. Potassium chloride is inexpensively available and is rarely used in the laboratory. Mullins, K. Yaughn. WebC = Compatible; may be mixed via Y-site. Magnesium depletion is very common in patients with hypokalemia. None of the papers studied met all of the quality criteria established in this review. But, I'd be curious to hear the OP's rationale as well. Select a second drug the same way (limited to 2 drugs) 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. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available Dotted boxes show that the mix is compatible with glycosylated serum only. Deg C have been investigated. Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. If you have any questions or comments, please dont hesitate to contact us. Then get the mag started. This conversion is an acid-base neutralization reaction. When started up again the Iv with the magnesium had blown. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Se proporciona una actualizacin de las compatibilidades entre los frmacos habitualmente empleados en las UCI, con la intencin de contribuir a la administracin segura de medicamentos en pacientes crticos. I sat upright and called for the nurse. Recently I had a patient that needed both iv k and iv mag. 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. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. Stability of milrinone lactate in the presence 29 critical care drugs and 4 i.v. 504-506. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Low magnesium = decreased potassium uptake which results in more of the potassium you gave being excreted. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. K of 3 mEq/L may correlate with a potassium deficit of 100-200 mEq. hmo6 WebC = Compatible; may be mixed via Y-site. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. Our patients hate those because they're enormous pills. Table 2. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population. Regarding the trials conducted to assess the stability of the samples, all studies assessed transparency while 93% of studies reported a change in color through visual inspection. The relationship between potassium level and total-body potassium deficit is. Please enable it to take advantage of the complete set of features! Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. The magnesium was piggybacked onto the other saline IV with the potassium. Search for and click on a drug 2. Specializes in Critical Care. Secondary to another electrolyte abnormality: Polyuria with increased distal delivery of sodium and water to the tubule: Potassium wasting diuretics (e.g. Therefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. 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. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Use serum magnesium values to guide continued dosage. Calvo-Calvo, . Carrillo-lvarez, M. Sanjurjo-Sez. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. The reference search process for each drug was conducted concurrently by 2 independent researchers. Study drugs and concentrations used as reference for the bibliographic search. M Kill Me Tomorrow, Let Me Live Tonight Analysis,
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