Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. Hunt-Fugate AK, Hennessey CK, Kazarian CM. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net. The antidepressant is a form of azoteantidepressants. S. Manrique-Rodrguez, A.C. Snchez-Galindo, C.M. Visual compatibility of neuromuscular blocking agents with various injectable drugs during simulated Y-site injection. K of 3 mEq/L may correlate with a potassium deficit of 100-200 mEq. Summary of physical and chemical compatibilities. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Web17. Epub 2011 Aug 4. Our members represent more than 60 professional nursing specialties. J.A. F. Flamein, L. Storme, A. Maiguy-Foinard, M. Perez, B. Dcaudin, M. Masse. Am J Health Syst Pharm, 67 (2010), pp. 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. 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. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 504-506. (2) Even in severely hypokalemic patients, aggressive IV potassium administration can be dangerous (more on this below). Amors-Cerd, B. Ribas-Nicolau. For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. According to the systematic review conducted by Moyen et al. J.T. 2643-2647. K of 2 mEq/L may correlate with a potassium deficit of 400-600 mEq. Martn, A. Alonso, I. Gutirrez, J. lvarez, F. Becerril. Select a second drug the same way (limited to 2 drugs) 3. Search focused on drug combinations on which these authors had no information or had not looked for information. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Commonly used rate for routine potassium repletion. Reference: P.R. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Please enable it to take advantage of the complete set of features! Low magnesium levels usually don't cause symptoms. For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. No visible haze or particulate formation, color change, or gas evolution. A total of 140 drugs are known to interact with Effervecent Pot potassium / Choride. In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. Your email address will not be published. Bookshelf Copyright 2009-. Low magnesium levels usually don't cause symptoms. Since 1997, allnurses is trusted by nurses around the globe. 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 Ideally, this shouldn't be run through a single peripheral IV line (to prevent vein sclerosis). 516-520. Similarly, turbidimetry or microscopymore accurate techniques than visual observation for the detection of particles and changes in colorare underused. 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. 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. Start another line and run them both if you are worried about running them together. The drug combination with no compatibility data were left unchecked. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite Avoid drug incompatibilities: clinical context in neonatal intensive care unit (NICU). Summary of the quality criteria of the papers published. J.R. Chalmers, M.B. Potassium chloride is inexpensively available and is rarely used in the laboratory. Figure 2. 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. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. It is important to recognize that compatibility is not just Physical Compatibility: Physically compatible. 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. Antimicrob Agents Chemother, 45 (2001), pp. Search for and click on a drug 2. Magnesium can be repleted rapidly (faster than 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.) The concentrations used as a reference are the ones standardized in our center7 for these drugs and are consistent with the ones commonly used in most ICUs (Table 1). A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. Articles published from 1990 to 2017 in English, Spanish and French were included. It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. It is important to recognize that compatibility is not just Ann Pharm Franaises, 69 (2011), pp. P. Merino, M.C. Despite this, the number of drug combinations studied is still insufficient. Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 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 Potassium chloride is inexpensively available and is rarely used in the laboratory. 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 magnesium was piggybacked onto the other saline IV with the potassium. EMCrit is a trademark of Metasin LLC. Select a second drug the same way (limited to 2 drugs) 3. 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. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. 2. All works go through a rigorous selection process. In my time there we have still never used IV potassium and opt for PO k-dur instead. J Cardiovasc Electrophysiol. Am J Heal Syst Pharm, 58 (2001), pp. 9/gY'=@5y!h6{[T e- vVfbd' I&*_5u(_*h10x8C5C%4z1vE{_e"l|Yh/ c%`=DDz}Qu3lB1o]wK-a!3 {'']9x`B#_;)">I>Mb? If you have any questions or comments, please dont hesitate to contact us. 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. WebC = Compatible; may be mixed via Y-site. Specializes in MPH Student Fall/14, Emergency, Research. Foushee, L.M. %%EOF May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). Number of tests run (at least in triplicate). 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. ;}9fUe ][n, 77"^tSg7~Yk^m_m_m_mMT Zbqx| j The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. What Are The Benefits Of Exercising Daily. The mix of incompatible drugs is a medication error that can have serious consequences for the patient such as therapeutic failures, micro-embolism or toxicity.4, The Y-site infusion of 2 drugs requires both drugs to be physically compatible.5 This coadministration occurs when mixing drugs in a 1:1 ratio and in the absence of visible signs of incompatibility like precipitation or change in color. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). 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. Physicochemical compatibility of commonly used analgesics and sedatives in the intensive care medicine. 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. ?6)J@quAD`)Xww"){-y:=%q&D2I)z*&4F0,)K52fb1e`R6K*E}Xlf*h4aZ-_4 Has 10 years experience. hSMxv? Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). 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. 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. Physical compatibility of milrinone lactate injection with intravenous drugs commonly used in the pediatric intensive care unit. 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. 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 Fig. Physical compatibility studies are the most common of all because they are easy to conduct. Incompatibility between calcium and sulfate ions in solutions for injection. M5-5.3 mM. Potassium citrate be useful in patients with nonanion-gap metabolic acidosis (NAGMA). Use serum magnesium values to guide continued dosage. RELATED: What Does Potassium Chloride React With? Time is required for potassium to enter the cells. Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. Ideally, you give mag first, although it's not critical to do so. Chemical Stability: Chemically stable. RELATED: What Does Potassium Chloride React With? Commonly used for severe hypokalemia or DKA. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: Aldosterone and renin levels should ideally be measured after correction of potassium, because otherwise hypokalemia may suppress the aldosterone level. 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. 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). QT prolongation). The anti-depressant is an antipsychotic derivative of antihystericicineineine. May fuse with the T-wave to produce a prolonged QT interval (technically a Q-T-U interval). 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. 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. Warren, F.C. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given. Hecq, B. Bihin, J. Jamart, L. Galanti. This means that different drugs are delivered using the same route of administration, which increases the risks involved when mixing incompatible drugs. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. and SEMICYUC, Copyright 2023. 1968-1969. Just out of curiosity, what order did the MD write for them in? Patients with hypokalemia often have a large. Specializes in Medical-Surgical/Float Pool/Stepdown. 2980 0 obj <>stream Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). M2 drug combinations at a time, which is highly not advisable. Standardizing the concentration of infusion solutions is one of the most useful measures to prevent medication errors in the ICU setting, especially in high-risk drugs due to their potential to cause severe damage and because they have the highest incidence of medication errors. Gormley, M.S. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. However, they may be better tolerated with less emesis. J Antimicrob Chemother, 51 (2003), pp. 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. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex.
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