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? Is Potassium Phosphate Compatible With Potassium Chloride? Potassium is flowing into the cells just fine. This study guide will help you focus your time on what's most important. 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. Warren, F.C. 307-309, Copyright 2018. Bookshelf Cardiac arrest due to hypokalemia (e.g. Am J Hosp Pharm, 40 (1983), pp. The data obtained by the reviews conducted by Kanji et al. I hung the potassium 1 st because it would take the less time. Am J Health Syst Pharm, 54 (1997), pp. WebMany people may need magnesium supplements. P.R. Careers. Propofol compatibility with other intravenous drug products-two new methods of evaluating IV emulsion compatibility. ;}9fUe
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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. 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. Stewart, F.W. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. The systematic review included 29 studies (27 originals, 2 reviews). 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. Repletion of magnesium is often necessary to successfully replete the potassium. 2002 Jan-Feb;6(1):62-5. Potassium citrate be useful in patients with nonanion-gap metabolic acidosis (NAGMA). Just out of curiosity, what order did the MD write for them in? The anti-depressant is an antipsychotic derivative of antihystericicineineine. See. The .gov means its official. Mstream
QT prolongation, which may predict risk of arrhythmia. (3) Profound shock plus severe hypokalemia (unclear whether potassium would be adequately absorbed from the gut). Eur J Hosp Pharm Sci Pract, 21 (2014), pp. Rehak, R.L. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. 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. WebC = Compatible; may be mixed via Y-site. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. The compatibility of these is shown in Fig. Our patients hate those because they're enormous pills. Akkerman, H. Zhang, R.E. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. In my time there we have still never used IV potassium and opt for PO k-dur instead. What Is The Difference Between Potassium Chloride And Klor Con? Bethesda, MD 20894, Web Policies This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. Compatibilidad fsica del bicarbonato sdico con frmacos de uso frecuente en la unidad de cuidados intensivos. Methodological guidelines for stability studies of hospital pharmaceutical preparations. solutions. S. Manrique-Rodrguez, A.C. Snchez-Galindo, C.M. Summary of the quality criteria of the papers published. Mullins, K. Yaughn. Forest. This means that we only have data available for 50.3% of all the possible combinations suggested. Visual compatibility of clonidine with selected drugs. Webcompatibility prior to coadministration. Errores de medicacin en los servicios de medicina intensiva espaoles. Walker, S. Varrin, D. Yannicelli, S. Law. Reference: 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. Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. 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. J Antimicrob Chemother, 51 (2003), pp. 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. hb``b``g```1c@@,&a|sR9TzxYeK 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. May be useful in the following situations: (1) Patients with severe volume overload who require. Web1. 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. Webcompatibility prior to coadministration. Save my name, email, and website in this browser for the next time I comment. Fox. 2980 0 obj
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L. Knudsen, S. Eisend, N. Haake, T. Kunze. 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 The magnesium was piggybacked onto the other saline IV with the potassium. 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. F. Flamein, L. Storme, A. Maiguy-Foinard, M. Perez, B. Dcaudin, M. Masse. (3) Safer (oral potassium is overall more idiot-proof than IV potassium). Carasso, R.A. Kennedy. Beckmans Clinical Chemistry Analyzer Synchron CX5 Delta. 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. 79-84. Aldosterone and renin levels should ideally be measured after correction of potassium, because otherwise hypokalemia may suppress the aldosterone level. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. Ann Pharm Franaises, 69 (2011), pp. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). Stability of ranitidine hydrochloride at dilute concentration in intravenous infusion fluids at room temperature. @Z-!/^0B"oxC(cbS8v^zjx?N3Ggf&;V7Jmm *ZDkQ}:TpE
E[$c. Tests were run in triplicate only in 26% of the cases. Storage: Room temperature of 22 C. 9/gY'=@5y!h6{[T e- vVfbd' I&*_5u(_*h10x8C5C%4z1vE{_e"l|Yh/
c%`=DDz}Qu3lB1o]wK-a!3 {'']9x`B#_;)">I>Mb? 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. 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). thiazides, loop diuretics, acetazolamide, mannitol). Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. 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. 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. For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. Inverted T-wave followed by prominent U-wave may create a biphasic down-up morphology. Potassium chloride is inexpensively available and is rarely used in the laboratory. It is important to recognize that compatibility is not just )J23~v1aYz qL4p}t%& As Fig. Only about 2% of the total Mg2+ in the body is in the plasma. Martn, A. Alonso, I. Gutirrez, J. lvarez, F. Becerril. 67% of the studies assessed gas formation, and only 12 measured pH changes in time. 373 0 obj
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and SEMICYUC, Copyright 2023. Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. Foushee, L.M. But, I'd be curious to hear the OP's rationale as well. Create well-written care plans that meets your patient's health goals. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. 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. Specializes in Medical-Surgical/Float Pool/Stepdown. Select a second drug the same way (limited to 2 drugs) 3. Failure to check and replete magnesium levels. So, potassium uptake is By using a Beckman clinical chemistry Analyzer, 9% sodium chloride injection and 5% dextrose injection solutions at 22. 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. Specializes in Critical Care. Am J Health Syst Pharm, 62 (2005), pp. There is no inhibition of potassium uptake. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. A total of 48 papers were identified. and Lpez-Cabezas et al.5,7 were used as a reference point. Physical Compatibility: Physically compatible. J Cardiovasc Electrophysiol. Added to the risk of complications associated to the administration of 2 incompatible molecules, this lack of information can make the nurse have to look for new venous accesses to administer the drugs separately whichincreases the risk of infectious or thromboembolic complications. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite Danner. hSMxv? Has anyone else? (2) Patients with persistent renal potassium wasting, with inadequate response to potassium supplementation alone. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. 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. Stability of milrinone lactate in the presence 29 critical care drugs and 4 i.v. I have tremendous respect for ED nurses but this comment just seemsfranklynot well thought outmaybe more time to think was needed! Can You Give Po And Iv Potassium Together? RELATED: What Does Potassium Chloride React With? 71-78. Critically ill patients often have limited venous accesses. This is particularly true in oliguric renal failure, wherein there is little risk that the patient will suddenly develop worsening hypokalemia. Incompatibility between calcium and sulfate ions in solutions for injection. J.T. I sat upright and called for the nurse. and Lpez-Cabezas et al. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. As far as the magnesium goes we don't piggyback it most of the time. IV or IM. In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). endstream
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Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. Unauthorized use of these marks is strictly prohibited. (1) Delayed sample analysis (cells absorb potassium while the blood tube is sitting around). The reference search process for each drug was conducted concurrently by 2 independent researchers. Avoid or use alternate Drug. 2192-2196. Has 2+ years experience. Therefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). 0
It is important to recognize that compatibility is not just None of the samples appeared to form visible precipitation or to change in color or clarity. UAiM 0g `%u?J[ +sC
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J;#A- 0 IJp C%tu0t}vN0{3):UVww A;{ ?M=]\:Zk-=%]%Q`l Published data may report both compatibility and stability; however, most evaluate compatibility alone. As far as the magnesium goes we don't piggyback it most of the time. Ideally, this shouldn't be run through a single peripheral IV line (to prevent vein sclerosis). 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. This involves clinical judgement based on consideration of two factors: total body potassium deficit and renal function. J.R. Chalmers, M.B. May fuse with the T-wave to produce a prolonged QT interval (technically a Q-T-U interval). 8600 Rockville Pike Former authors have published reviews of these characteristics. 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). The adverse drug is anaade to serotonins risk of an adverse effect. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population. Clinical review: medication errors in critical care. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). Your email address will not be published. Magnesium repletion is also useful because it will reduce the risk of Torsade de pointes in these patients. Militello. Lineberger. 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. 2. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. 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 None of the samples seemed to have visible precipitation or changed in color or clarity. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. Infusions remained stable at 22 degrees C. For 24 hours. The research was published in the journal Neurotypical and was released online on December 4, 2013. The drugs used in the review are routinely used in the ICU setting are often administered by continuous infusion. The rest is in bones and cells. Bobek, M.A. Int J Pharm Compd. May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). 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. 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%). 483-486. %PDF-1.5
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WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. Compatibility screening of Precedex during simulated Y-site administration with other drugs. Your email address will not be published. Antimicrob Agents Chemother, 45 (2001), pp. 0
Low magnesium = decreased potassium uptake which results in more of the potassium you gave being excreted. 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. Repletion of magnesium is often necessary to successfully replete the potassium. Errors in the administration of drugs in ICUs are due to several factors: the use of high-risk drugs (vasoactive drugs, inotropes, sedatives, etc.) B. Moriyama, S.A. Henning, H. Jin, M. Kolf, N.N. Clarivate Analytics, Journal Citation Reports 2021. 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. Renal tubular acidosis types I or II (see table below). Furthermore, serum hyperkalemia may cause poor retention of potassium (as it will tend to encourage potassium excretion in the urine). Compatibilit de lactylcystine injectable lors de son administration en Y avec dautres mdicaments usuels. L. Trissel, C. Saenz, D. Ingram, K. Williams, J. Retzinger. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. Since 1997, allnurses is trusted by nurses around the globe. 161LP-166LP. J Pharm Pract Res, 32 (2002), pp. All information on compatibility found for a certain molecule about a different concentration interval is shown in Table 2. I had not heard this before and am unable to find any information on this. This site represents our opinions only. 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. Isert, D. Lee, D. Naidoo, M.L. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). IV or IM. (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). ICH Harmonised Tripartite Guideline Q1A(R2): Stability testing of new drug substances and products, international conference on harmonisation (ICH), 6 February 2003. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. SRJ is a prestige metric based on the idea that not all citations are the same. So, potassium uptake is not affected, and secretion is increased. hbbd```b`` =wK"`RL Qn dX1DMZBAXD$
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Figure 2. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. 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. Epub 2011 Aug 4. WebC = Compatible; may be mixed via Y-site. When started up again the Iv with the magnesium had blown. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Report DMCA Overview Choosing a specialty can be a daunting task and we made it easier. Down-titrate the rate rapidly as the EKG improves and the patient stabilizes. In this scenario, oral doses of potassium may be scheduled and the potassium level can be checked intermittently. The relationship between potassium level and total-body potassium deficit is. Avoiding common flaws in stability and compatibility studies of injectable drugs. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. Use Alternative Drug. Our members represent more than 60 professional nursing specialties. Potassium chloride is inexpensively available and is rarely used in the laboratory. Physical compatibility of magnesium sulfate and sodium bicarbonate in a pharmacy-compounded hemofiltration solution. 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. 516-520. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Published Nov 18, 2013. 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. On the other hand, in many cases, the quality of the studies published so far can be better. Webmagnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. Stability of Milrinone Lactate 200 micrograms/mL in 5% Dextrose Injection and 0.9% Sodium Chloride Injection. Summary of physical and chemical compatibilities. International Journal of Pharmaceutical Compounding. Potassium citrate is equally effective as KCl for the repletion of potassium. 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. 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). Summary of the quality criteria of the papers published. J.A. 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. Despite this, the number of drug combinations studied is still insufficient. 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. EKG changes (especially QT prolongation). 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. M2 drug combinations at a time, which is highly not advisable. Fosinopril Serious Alternative (1) eprosartan and potassium phosphates, IV, both raise serum potassium. No visible haze or particulate formation, color change, or gas evolution. Online databases like Stabilis 4.0 are very useful to look for information on drug compatibility. ?6)J@quAD`)Xww"){-y:=%q&D2I)z*&4F0,)K52fb1e`R6K*E}Xlf*h4aZ-_4 It's usually best to be conservative in the absence of any specific factors which increase the risk of arrhythmia (see risk stratification above). Advanced diagnostic testing: Begin by checking urine potassium, creatinine, sodium, and chloride. 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).
Nonanion-gap metabolic acidosis (look for RTA-1 or RTA-2), Metabolic alkalosis (may cause hypokalemia, but can also result. hN-X!hU1N-O7 ":9.y>FC&~vs&"(UVy]D9-W1a=-xZ,~weU/Q4yXf'au?,FIQ Has 6+ years experience. S. Kanji, J. Lam, C. Johanson, A. Singh, R. Goddard, J. Fairbairn. Web17. 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. The magnesium administration, which is concomitant with potassium, aids in tissue replenishment of potassium. Rapid administration may cause serum levels to be elevated (even though there is a total-body potassium deficit!).