%%EOF The drug combination with no compatibility data were left unchecked. L. Trissel, D. Gilbert, J. Martinez, M. Kim. What Is The Difference Between Potassium Chloride And Klor Con? Your email address will not be published. 2020;44:8087. Potassium Has 2+ years experience. WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. endstream endobj startxref A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. 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. The magnesium was piggybacked onto the other saline IV with the potassium. Compatibility Hypokalemia - EMCrit Project and Lpez-Cabezas et al. Physical Compatibility: Physically compatible. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. In this scenario, oral doses of potassium may be scheduled and the potassium level can be checked intermittently. There were no interactions between Effervescent Potassium / Chloride and potassium phosphate & sodium phosphorus. Beckmans Clinical Chemistry Analyzer Synchron CX5 Delta. Commonly used for severe hypokalemia or DKA. 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. S.E. S.R. 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 main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). Updated: Feb 27, 2020 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. Hunt-Fugate AK, Hennessey CK, Kazarian CM. Chemical Stability: Chemically stable. If you have persistently low blood magnesium levels, this could lead to low potassium and calcium levels. 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. An official website of the United States government. Profound shock with questionable absorption. Compatibility Maddox, K. Viswanathan, J.L. This study guide will help you focus your time on what's most important. Table 3. Articles published from 1990 to 2017 in English, Spanish and French were included. Beta-agonists (albuterol, terbutaline, epinephrine including endogenous epinephrine surges from stress). F. Flamein, L. Storme, A. Maiguy-Foinard, M. Perez, B. Dcaudin, M. Masse. %PDF-1.5 % M. Maqueda-Palau, E. Prez-Juan, M.J. Arvalo-Rubert, S.M. the difference between oral and IV magnesium MPotassium The citrate will be converted into bicarbonate, thereby improving the acidosis. However, they may be better tolerated with less emesis. For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. MCompatibility 2980 0 obj <>stream Disclaimer. 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. 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. Repletion of magnesium is often necessary to successfully replete the potassium. According to the Linus Pauling Institute, all adults over the age of 19 require 4,700 milligrams of potassium per day. Structured summary of the results of the reference search. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. Walker, S. Varrin, D. Yannicelli, S. Law. 9/gY'=@5y!h6{[T e- vVfbd' I&*_5u(_*h10x8C5C%4z1vE{_e"l|Yh/ c%`=DDz}Qu3lB1o]wK-a!3 {'']9x`B#_;)">I>Mb? The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population. Summary of physical and chemical compatibilities. Magnesium Sulfate Potassium citrate is equally effective as KCl for the repletion of potassium. If the renal function is adequate and stable (e.g., GFR is >30 ml/min and the patient is not oliguric), then it's unlikely that oral potassium will cause hyperkalemia. I sat upright and called for the nurse. IV or IM. 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. Potassium chloride is inexpensively available and is rarely used in the laboratory. FOIA Both increase serum potassium. Compatibility Potassium Pharm Technol Hosp Pharm, 2 (2017), pp. Fosinopril Serious Alternative (1) eprosartan and potassium phosphates, IV, both raise serum potassium. Accessibility Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. Chemical Stability: Chemically stable. 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). Es usted profesional sanitario apto para prescribir o dispensar medicamentos? Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 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. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. None of the included studies followed all the methodological requirements. 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. Tests were run in triplicate only in 26% of the cases. and MgSO4 be mixed together RELATED: What Does Potassium Chloride React With? It is important to recognize that compatibility is not just So, potassium uptake is 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. Compatibilit de lactylcystine injectable lors de son administration en Y avec dautres mdicaments usuels. Nieforth KA, Shea BF, Souney PF, Scavone JM. Magnesium And Potassium 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. ICH Harmonised Tripartite Guideline Q1A(R2): Stability testing of new drug substances and products, international conference on harmonisation (ICH), 6 February 2003. J Cardiovasc Electrophysiol. WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. S. Manrique-Rodrguez, A.C. Snchez-Galindo, C.M. 1 shows the selection process. Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Clinical context where potassium is likely to fall further (e.g. 2) as conditioned compatibility (I/C), that is, that the combination had been studied at a concentration different from the standard one. allnurses is a Nursing Career & Support site for Nurses and Students. Webcompatibility prior to coadministration. Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. The drugs used in the review are routinely used in the ICU setting are often administered by continuous infusion. 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 WebMany people may need magnesium supplements. This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. Potassium is flowing into the cells just fine. Potassium is flowing into the cells just fine. It can be made by treating potassium hydroxide (or other potassium bases) with hydrochloric acid: KOH + HCl + H2O. The IV was shut off. IV Compatibility 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. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. Compatibilidad fsica del bicarbonato sdico con frmacos de uso frecuente en la unidad de cuidados intensivos. Infusions of sodium chloride and magnesium sulfate were present in 0. L. Trissel, C. Saenz, D. Ingram, K. Williams, J. Retzinger. The rest is in bones and cells. Physical Compatibility: Physically compatible. magnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. HHS Vulnerability Disclosure, Help IV or IM. Deg C have been investigated. Web1. 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. Intravenous D. Brossard, V. Chedru-Legros, S. Crauste-Manciet, S. Fleury-Souverain, F. Lagarce, P. Odou. Am J Heal Syst Pharm, 58 (2001), pp. Standardization of infusion solutions to reduce the risk of incompatibility. Just out of curiosity, what order did the MD write for them in? Our patients hate those because they're enormous pills. Boxes with diagonal lines show compatibility with physiological serum only. Akkerman, H. Zhang, R.E. Careful consideration of the above etiologies combined with the clinical context will usually provide an explanation for the hypokalemia. It is consistent with the gray boxes specified as I/C as shown in Fig. Summary of the quality criteria of the papers published. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. La revisin sistemtica incluy 29 artculos (27 originales y 2 revisiones). and Lpez-Cabezas et al.5,7 were used as a reference point. 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). 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. Are you a health professional able to prescribe or dispense drugs? The IV was shut off. Summary of the quality criteria of the papers published. 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. WebC = Compatible; may be mixed via Y-site. Storage: Room temperature of 22 C. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. 321 0 obj <>/Filter/FlateDecode/ID[<375F2B8E29F4DA448F0196983DC39AD5>]/Index[273 101]/Info 272 0 R/Length 178/Prev 592955/Root 274 0 R/Size 374/Type/XRef/W[1 3 1]>>stream RELATED: What Does Potassium Chloride React With? 1287-1292. Ann Pharm Franaises, 69 (2011), pp. EKG changes (especially QT prolongation). Carasso, R.A. Kennedy. I have tremendous respect for ED nurses but this comment just seemsfranklynot well thought outmaybe more time to think was needed! (ii) Article quality was analyzed according to the stability studies practice guidelines. 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 On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. 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. %%EOF 2192-2196. Intravenous (2) Even in severely hypokalemic patients, aggressive IV potassium administration can be dangerous (more on this below). to drip potassium and magnesium with the Iv B. Moriyama, S.A. Henning, H. Jin, M. Kolf, N.N. Isn't this an ED Nursing thread? Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. Iv Amors Cerd. consider target potassium level (more) Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Therefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Can Potassium And Magnesium Be Given Iv Together? Especially useful in patients with metabolic alkalosis (since potassium chloride will increase the serum chloride level). ]g0i9FAA,at 0 Y-Site Intravenous Drugs Compatibility To keep this page small and fast, questions & discussion about this post can be found on another page here. The data obtained by the reviews conducted by Kanji et al. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. Gormley, M.S. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). DKA or re-feeding syndrome). The research was published in the journal Neurotypical and was released online on December 4, 2013. For patients with acute or worsening renal failure, potassium is likely to rise over time. Guidelines for the practical stability studies of anticancer drugs: a European consensus conference. 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. Magnesium Sulfate 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. 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. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. solutions. Am J Health Syst Pharm, 62 (2005), pp. 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. The patient had one patent iv site. Magnesium Sulfate Ideally, you give mag first, although it's not critical to do so. 2643-2647.