According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. thiazides, loop diuretics, acetazolamide, mannitol). The authors declared no conflicts of interest whatsoever. consider target potassium level (more) Am J Heal Syst Pharm, 58 (2001), pp. Boxes were named with a C if the mix was compatible, with an I if incompatible and with I/C if stability depended on special conditions. Advanced diagnostic testing: Begin by checking urine potassium, creatinine, sodium, and chloride. 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. 2643-2647. Were dedicated to providing you with the very best information about all kinds of subjects related to Fitness and nutrition, with an emphasis on improving your lifestyle and helping you become healthier.Founded in 2021 by Marie June, TheFitnessManual has come a long way from its beginnings. MeSH and transmitted securely. The rest is in bones and cells. (3) Profound shock plus severe hypokalemia (unclear whether potassium would be adequately absorbed from the gut). Forest. Medicina Intensiva is the journal of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICIUC), and has become the reference publication in Spanish in its field. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. 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. This can be run either through a central line, or split into two 10 mEq/hr infusions through two. When started up again the Iv with the magnesium had blown. For example, diabetic ketoacidosis causes potassium to shift out of the cells. There is no inhibition of potassium uptake. Especially useful in patients with metabolic alkalosis (since potassium chloride will increase the serum chloride level). /`p M. Maqueda-Palau, E. Prez-Juan, M.J. Arvalo-Rubert, S.M. In the context of an ICU patient with no obvious GI potassium losses, persistent/recurrent hypokalemia implies renal potassium wasting. 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. Create well-written care plans that meets your patient's health goals. 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. Storage: Room temperature of 22 C. 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. RELATED: What Does Potassium Chloride React With? May fuse with the T-wave to produce a prolonged QT interval (technically a Q-T-U interval). 373 0 obj <>stream 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. In my time there we have still never used IV potassium and opt for PO k-dur instead. 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 J Cardiovasc Electrophysiol. 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. The anti-depressant is an antipsychotic derivative of antihystericicineineine. J Cardiovasc Electrophysiol. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. D. Brossard, V. Chedru-Legros, S. Crauste-Manciet, S. Fleury-Souverain, F. Lagarce, P. Odou. See. Am J Health Syst Pharm, 52 (1995), pp. Use serum magnesium values to guide continued dosage. consider target potassium level (more) Am J Hosp Pharm, 40 (1983), pp. Am J Health Syst Pharm, 72 (2015), pp. Pharm Technol Hosp Pharm, 2 (2017), pp. An official website of the United States government. 1287-1292. Avoid drug incompatibilities: clinical context in neonatal intensive care unit (NICU). Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. Low magnesium levels usually don't cause symptoms. 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. None of the samples seemed to have visible precipitation or changed in color or clarity. Potassium is flowing into the cells just fine. 79-84. EKG changes due to hypokalemia (e.g. Inverted T-wave followed by prominent U-wave may create a biphasic down-up morphology. This involves clinical judgement based on consideration of two factors: total body potassium deficit and renal function. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. The magnesium was piggybacked onto the other saline IV with the potassium. 651-658. Table 2. Repletion of magnesium is often necessary to successfully replete the potassium. J.T. Use Alternative Drug. K of 2 mEq/L may correlate with a potassium deficit of 400-600 mEq. Is Potassium Phosphate Compatible With Potassium Chloride? The results on this section are summarized in Table 3. F. Flamein, L. Storme, A. Maiguy-Foinard, M. Perez, B. Dcaudin, M. Masse. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. Other methods were used in 16 studies (59%) to see subvisible particles. Specializes in MPH Student Fall/14, Emergency, Research. So, potassium uptake is 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!!! 67% of the studies assessed gas formation, and only 12 measured pH changes in time. The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. Please enable it to take advantage of the complete set of features! Bethesda, MD 20894, Web Policies 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. A total of 48 papers were identified. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite Your email address will not be published. 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. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. Fig. Thank you you for your response to that ? Int J Pharm Compd. 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. J.R. Chalmers, M.B. 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. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Am J Health Syst Pharm, 54 (1997), pp. 3 Articles; J Pharm Pract Res, 32 (2002), pp. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net. 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. J.A. It is important to recognize that compatibility is not just RELATED: What Does Potassium Chloride React With? Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. Sheesh! (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). Despite this, the number of drug combinations studied is still insufficient. The reviews published by Kanji et al. Foushee, L.M. Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. Propofol compatibility with other intravenous drug products-two new methods of evaluating IV emulsion compatibility. 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. Report DMCA Overview Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Physical compatibility of milrinone lactate injection with intravenous drugs commonly used in the pediatric intensive care unit. 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%. Table 3. Marta Prat Dot: data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. The adverse drug is anaade to serotonins risk of an adverse effect. Published data may report both compatibility and stability; however, most evaluate compatibility alone. allnurses is a Nursing Career & Support site for Nurses and Students. Search for and click on a drug 2. Since 1997, allnurses is trusted by nurses around the globe. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Web17. Nieforth KA, Shea BF, Souney PF, Scavone JM. A target potassium of >3 mM may be reasonable in most patients with severe renal failure (in the absence of digoxin or myocardial ischemia). 2020;44:8087. Compatibility of propofol, fentanyl, and vecuronium mixtures designed for potential use in anesthesia and patient transport. Has 6+ years experience. 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. 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). Ongoing fall in potassium likely (e.g., DKA or refeeding syndrome). DKA with adequate renal function: >5-5.3 mM. Ann Pharm Franaises, 69 (2011), pp. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. 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. Gormley, M.S. Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. C, compatible; I, incompatible; I/C, compatible in special conditions. Beckmans Clinical Chemistry Analyzer Synchron CX5 Delta. So, potassium uptake is The site is secure. 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). L. Trissel, C. Saenz, D. Ingram, K. Williams, J. Retzinger. Patients being resuscitated from DKA will generally tend to drop their potassium levels over time. Compatibilidad visual y fsica de la furosemida en mezclas intravenosas para perfusin continua. Save my name, email, and website in this browser for the next time I comment. Clarivate Analytics, Journal Citation Reports 2021. The magnesium was piggybacked onto the other saline IV with the potassium. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available Carasso, R.A. Kennedy. Walker, S. Varrin, D. Yannicelli, S. Law. Stewart, F.W. Chemical Stability: Chemically stable. The reference search process for each drug was conducted concurrently by 2 independent researchers. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. Complicated early prosthetic aortic valve infective endocarditis, Description of the methodology used (includes number and frequency of observations and study conditions), Description of diluents of all study drugs, Description of the material of the study recipients. Your email address will not be published. Careful consideration of the above etiologies combined with the clinical context will usually provide an explanation for the hypokalemia. Potassium chloride is inexpensively available and is rarely used in the laboratory. 0 307-309, Copyright 2018. It would be good to have greater uniformity in the quality standards of this type of studies. Due to their clinical approach and lack of methodology to determine physical and chemical stability, case studies were discarded. WebMany people may need magnesium supplements. Am J Health Syst Pharm, 54 (1997), pp. Physical compatibility of magnesium sulfate and sodium bicarbonate in a pharmacy-compounded hemofiltration solution. Summary of physical and chemical compatibilities. 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 Compatibilit de lactylcystine injectable lors de son administration en Y avec dautres mdicaments usuels. 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. It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. According to Lexicomp, these are compatible, and there are no warnings against infusing concomitantly - is there any reason you couldn't run them together? To keep this page small and fast, questions & discussion about this post can be found on another page here. Study drugs and concentrations used as reference for the bibliographic search. Specializes in NICU, PICU, Transport, L&D, Hospice. The infusions were stable for 24 hours at 22 deg C. The results from both diluents showed an average of +/-5% fluctuations in concentration. Compatibilit du pantoprazole injectable lors dadministration en Y. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. In the absence of renal dysfunction, it's often useful to target a high-normal potassium level. EKG changes (especially QT prolongation). Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. La tabla final aporta datos de compatibilidad fisicoqumica de 475 de las 945 combinaciones posibles (50,3%), de las cuales 366 (77,1%) son compatibles y 80 (16,8%) son incompatibles. (2) Even in severely hypokalemic patients, aggressive IV potassium administration can be dangerous (more on this below). 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. Physicochemical compatibility of commonly used analgesics and sedatives in the intensive care medicine. 2192-2196. EMCrit is a trademark of Metasin LLC. As Fig. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). 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). Magnesium can be repleted rapidly (faster than potassium). Unable to load your collection due to an error, Unable to load your delegates due to an error. %PDF-1.6 % When Marie June first started out, her passion for Fitness & Nutrition drove her to begin a team of writers that shared the same passion to help their readers lead a healthier lifestyle.We hope you enjoy our articles as much as we enjoy offering them to you. Table 1. Want to Download the Episode?Right Click Here and Choose Save-As. 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. 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. 562-565. Ideally, you give mag first, although it's not critical to do so. 8600 Rockville Pike %%EOF 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. IV or IM. 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. 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. This means that we only have data available for 50.3% of all the possible combinations suggested. Int J Pharm Compd. S.R. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. VT, VF, or asystole), Recurrent malignant arrhythmias with a pulse, Severe hypokalemia plus {DKA or overdose of beta-blocker/calcium channel blocker}, http://traffic.libsyn.com/ibccpodcast/IBCC_EP_67_-_Hypokalemia.mp3. Profound shock with questionable absorption. Targeting a potassium level >3.5 mM seems reasonable for most patients. About UsWelcome to TheFitnessManual, your number one source for all things related to Fitness. 2. Ningn estudio cumpli todos los criterios de calidad establecidos, aunque el 93% garantizaba una correcta reproducibilidad. 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. Search for and click on a drug 2. Fosinopril Serious Alternative (1) eprosartan and potassium phosphates, IV, both raise serum potassium. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. Physical compatibility of calcium gluconate and magnesium sulfate injections. Repletion of magnesium is often necessary to successfully replete the potassium. The IV was shut off. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient. As far as the magnesium goes we don't piggyback it most of the time. Web17. phosphates. This conversion is an acid-base neutralization reaction. 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. 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. IV or IM. I hung the potassium 1 st because it would take the less time. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: 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. 2002 Jan-Feb;6(1):62-5. Summary of the quality criteria of the papers published. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. In this scenario, oral doses of potassium may be scheduled and the potassium level can be checked intermittently.