Making sure that the use of drugs is safe is one of the main commitments made by healthcare providers with their patients. magnesium and potassium solutions in the Intravenous reduces energy levels and raises the possibility of electrocardiographic fibrillation. hb``b``g```1c@@,&a|sR9TzxYeK Commonly used rate for routine potassium repletion. Sociedad Espaola de Medicina Intensiva, Crtica y Unidades Coronarias, rea del Medicamento. Boxes with diagonal lines show compatibility with physiological serum only. Please enable it to take advantage of the complete set of features! Other possibilities include atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. Using high-dose IV potassium is rarely necessary. 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. I wondered that too, but it's pretty common practice to run things in one at a time on stable patients because if they have an adverse reaction, you can be pretty certain which medication they're reacting to. For patients with oliguria or renal insufficiency, closer monitoring is required to avoid overshoot hyperkalemia. Index Medicus / MEDLINE / EMBASE / Excerpta Medica / SCOPUS / MEDES / Science Citation Index Expanded, Journal of Citation Reports, The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. Both increase serum potassium. J Cardiovasc Electrophysiol. Select a second drug the same way (limited to 2 drugs) 3. (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). 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. Guidelines for the practical stability studies of anticancer drugs: a European consensus conference. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. The reviews published by Kanji et al. 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 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. Use Alternative Drug. consider target potassium level (more) Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. 1159-1160. The effect of nimodipine, fentanyl and remifentanil intravenous products on the stability of propofol emulsions. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. 2020;44:8087. It is important to recognize that compatibility is not just Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. If you have any questions or comments, please dont hesitate to contact us. All information on compatibility found for a certain molecule about a different concentration interval is shown in Table 2. 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. The magnesium administration, which is concomitant with potassium, aids in tissue replenishment of potassium. Unauthorized use of these marks is strictly prohibited. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). Avoiding common flaws in stability and compatibility studies of injectable drugs. The lack of information on the safe mix of 2 drugs creates problems in the daily work of ICU nursing teams. Potassium is flowing into the cells just fine. 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. Save me from this ICU'ish intracellular speak :-). There were no interactions between Effervescent Potassium / Chloride and potassium phosphate & sodium phosphorus. The stability of remifentanil hydrochloride and propofol mixtures in polypropylene syringes and polyvinylchloride bags at 22. @Z-!/^0B"oxC(cbS8v^zjx?N3Ggf&;V7Jmm *ZDkQ}:TpE E[$c. Am J Health Syst Pharm, 62 (2005), pp. WebMany people may need magnesium supplements. SRJ is a prestige metric based on the idea that not all citations are the same. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. Magnesium depletion is very common in patients with hypokalemia. 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 Bethesda, MD 20894, Web Policies S.E. Standardization of infusion solutions to reduce the risk of incompatibility. %%EOF Has 10 years experience. The frequency of monitoring electrolytes depends on clinical acuity and renal function (similar to the monitoring of oral repletion above). Potassium chloride is inexpensively available and is rarely used in the laboratory. ME`3J_9`cX2!E[X\ZK-zgAQTT"AMKhj\.'1aq1|@1B9[kz]K/3c2jp{?OVL1 1-612-816-8773. In the context of an ICU patient with no obvious GI potassium losses, persistent/recurrent hypokalemia implies renal potassium wasting. Aldosterone and renin levels should ideally be measured after correction of potassium, because otherwise hypokalemia may suppress the aldosterone level. Our review is based on the previous work done by Kanji et al.5 in Canada and Lpez-Cabezas.7 in Spain. May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). Chemical stability studies, however, are not because they require more sophisticated analytical techniques to determine the initial and final concentration of drugs. To respond to Larry777 I have never worked in a. Visual compatibility of diltiazem injection with various diluents and medications during simulated Y-site injection. WebMany people may need magnesium supplements. For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. Slow-release microencapsulated (wax-matrix) KCl formulations are suboptimal if an immediate effect is desired. Repeat electrolytes if doubt exists about their validity (e.g., inconsistent with clinical context & EKG). L. Knudsen, S. Eisend, N. Haake, T. Kunze. Careers. Former authors have published reviews of these characteristics. (2) Markedly elevated cell counts (leukocytes take up potassium while the blood is awaiting analysis). The .gov means its official. 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. Avoid or Use Alternate Drug. Webcompatibility prior to coadministration. 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. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Compatibility of drugs administered as Y-site infusion in intensive care units: A http://dx.doi.org/10.1016/j.medin.2012.11.002, http://dx.doi.org/10.1016/j.medin.2016.01.011, http://dx.doi.org/10.1016/j.enfi.2010.09.004, http://dx.doi.org/10.1016/j.enfcli.2010.06.002, http://dx.doi.org/10.1128/aac.45.9.2643-2647.2001, http://dx.doi.org/10.1177/106002809603000303, http://dx.doi.org/10.1093/ajhp/54.19.2192, http://dx.doi.org/10.1097/00000539-200006000-00037, http://dx.doi.org/10.1016/0952-8180(96)00043-8, Impact of vaccination on admissions to an intensive care unit for COVID-19 in a third-level hospital, Delirium in COVID-19. 2940 0 obj <> endobj 71-78. The compatibility of these is shown in Fig. J.A. Secondary to another electrolyte abnormality: Polyuria with increased distal delivery of sodium and water to the tubule: Potassium wasting diuretics (e.g. Combinations of physical and chemically compatible drugs with concentrations below the reference mark. Web1. 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. Updated: Feb 27, 2020 In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). Am J Health Syst Pharm, 65 (2008), pp. Choosing a specialty can be a daunting task and we made it easier. Physical Compatibility: Physically compatible. Physical compatibility studies are the most common of all because they are easy to conduct. Avoid or use alternate Drug. Available from: C. Lpez-Cabezas, D. Soy, L. Guerrero, G. Molas, H. Anglada, J. Ribas. Low magnesium levels usually don't cause symptoms. IV or IM. )J23~v1aYz qL4p}t%& IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given. Therefore, the potassium deficit may be even, The vast majority of potassium in the body is located intracellularly. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. PMC B. Ribas Nicolau, E. Prez Juan, S.M. 651-658. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. On the other hand, in many cases, the quality of the studies published so far can be better. Physical Compatibility: Physically compatible. 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. However, this does not necessarily mean there are no interactions. WebMany people may need magnesium supplements. Ann Pharm Franaises, 69 (2011), pp. This involves clinical judgement based on consideration of two factors: total body potassium deficit and renal function. 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. Larger, modern studies have shown that the safest potassium range in patients with myocardial infarction may be 3.5-4.5 mM. Gormley, M.S. As far as the magnesium goes we don't piggyback it most of the time. The presence of any factors which may cause shifting of potassium in or out of the cells. Has 10 years experience. Careful consideration of the above etiologies combined with the clinical context will usually provide an explanation for the hypokalemia. hN-X!hU1N-O7 ":9.y>FC&~vs&"(UVy]D9-W1a=-xZ,~weU/Q4yXf'au?,FIQ WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. Am J Health Syst Pharm, 72 (2015), pp. Summary of the quality criteria of the papers published. Compatibility of remifentanil hydrochloride with selected drugs during simulated Y-site administration. K of 2 mEq/L may correlate with a potassium deficit of 400-600 mEq. Bobek, M.A. QT prolongation, which may predict risk of arrhythmia. Deg C have been investigated. It is important to recognize that compatibility is not just 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. The IV was shut off. (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. 2192-2196. Repletion of magnesium is often necessary to successfully replete the potassium. Thank you you for your response to that ? Storage: Room temperature of 22 C. Report DMCA Overview Time is required for potassium to enter the cells. 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. L. Trissel, D. Gilbert, J. Martinez, M. Kim. However, 93% guaranteed correct reproducibility. Patients admitted to intensive care units (ICU) often require the IV administration of several drugs. Ningn estudio cumpli todos los criterios de calidad establecidos, aunque el 93% garantizaba una correcta reproducibilidad. Visual compatibility of clonidine with selected drugs. H. Pr, V. Chass, J.-M. Forest, P. Hildgen. 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. ]g0i9FAA,at 0 The years of publication of the studies went from the1990s until December 2017 and the languages included were English, Spanish, and French. 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. Reference: Federal government websites often end in .gov or .mil. government site. But, I'd be curious to hear the OP's rationale as well. According to Lexicomp, these are compatible, and there are no warnings against infusing concomitantly - is there any reason you couldn't run them together? Beckmans Clinical Chemistry Analyzer Synchron CX5 Delta. The magnesium level is the most important contributing factor, for several reasons: (a) Hypomagnesemia is common (most patients with hypokalemia have hypomagnesemia as well).(. Can Magnesium And Potassium Run Together? After the reference search, 2 independent reviewers assessed the quality of the studies using a peer-review process. Physical compatibility of magnesium sulfate and sodium bicarbonate in a pharmacy-compounded hemofiltration solution. $MMT=window.$MMT||{};$MMT.cmd=$MMT.cmd||[];$MMT.cmd.push(function(){$MMT.display.slots.push(["bf84ea07-bd33-4824-bab3-02410772e6f3"]);}). Am J Health Syst Pharm, 54 (1997), pp. 3 Articles; Nieforth KA, Shea BF, Souney PF, Scavone JM. WebIntravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation J Cardiovasc Electrophysiol. Stability of cyclosporine with magnesium sulfate in 5% dextrose injection. If you are author or own the copyright of this book, please report to us by using this DMCA report form. 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. The infusions were stable for 24 hours at 22 deg C. The results from both diluents showed an average of +/-5% fluctuations in concentration. Advanced diagnostic testing: Begin by checking urine potassium, creatinine, sodium, and chloride. Compatibilidad fsica del bicarbonato sdico con frmacos de uso frecuente en la unidad de cuidados intensivos. The reference search process for each drug was conducted concurrently by 2 independent researchers. 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. Furthermore, serum hyperkalemia may cause poor retention of potassium (as it will tend to encourage potassium excretion in the urine). there is an average 1.7 errors/day associated with the process of drug administration in the ICU setting.1 On the other hand, the data reported by Merino et al. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. 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. Our hospital stopped using IV potassium because we had too many sentinel events involving their use. Has 2+ years experience. M3 mM may be reasonable in most patients with severe renal failure (in the absence of digoxin or myocardial ischemia). K. Nemec, E. Germ, M. Schulz-Siegmund, A. Ortner. Cardiac arrest due to hypokalemia (e.g. 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. So, potassium uptake is Nevertheless, the drugs and concentrations selected are the most widely used in the adult ICUs of most hospitals. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. Despite this, the number of drug combinations studied is still insufficient. Infusions of sodium chloride and magnesium sulfate were present in 0. None of the included studies followed all the methodological requirements. The magnesium was piggybacked onto the other saline IV with the potassium. #1) Familial form with onset <20 years old. Targeting a potassium level >3.5 mM seems reasonable for most patients. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient. Table 1. This may be the, For patients with ongoing gastric fluid loss, initiation of a proton pump inhibitor may minimize electrolyte derangements being caused by this. Would you like email updates of new search results? 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. RELATED: What Does Potassium Chloride React With? Foushee, L.M. v]"^{ ?5iLuQaU.f.1&fU\G;*=Wxtz6IF/5:Z55el6hCAj|]r8-]TOa.0-DEllb uCcP|v&,g'6x"n|gM,pQY}f}Q~ 1rZW_1aQ& i'yJ<8hBI0f`~Cc]l;So8>(P|;7d>XQ&@K;ra`HNi11,o_N*k2'R>!^7& fMnfclfMq1X< 'jjJU**;&2QTmN.bJVB}} q|=yxxEdjgauNX 6cVV I"r|NiaUvzY]Oy K#0@'YVio|{G@ ;|'mYV? 8600 Rockville Pike The antidepressant is a form of azoteantidepressants. solutions. Copyright 2009-. 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. C, compatible; I, incompatible; I/C, compatible in special conditions. Clarivate Analytics, Journal Citation Reports 2021. 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. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. Compatibilidad visual y fsica de la furosemida en mezclas intravenosas para perfusin continua. Webcompatibility prior to coadministration.