Magnes chloride and potassium metal reactions are generally described as a single displacement reaction. Isert, D. Lee, D. Naidoo, M.L. Clinical context where potassium is likely to fall further (e.g. The stability data reported in this review cannot be generalized to other drug combinations or concentrations different from the ones described. Only about 2% of the total Mg2+ in the body is in the plasma. (The main driver of hypokalemia due to gastric fluid loss is the metabolic alkalosis, so avoiding loss of gastric acid will prevent this.). Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. This involves clinical judgement based on consideration of two factors: total body potassium deficit and renal function. The frequency of monitoring electrolytes depends on clinical acuity and renal function (similar to the monitoring of oral repletion above). 651-658. 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 Bobek, M.A. Start another line and run them both if you are worried about running them together. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. The rest is in bones and cells. Torsades de pointes may be the most classic. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. Amors Cerd, M.J. Arvalo Rubert, M. Maqueda Palau. Want to Download the Episode?Right Click Here and Choose Save-As. Use serum magnesium values to guide continued dosage. 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. International Journal of Pharmaceutical Compounding. 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. Administer IV dose over 2 to 3 hours for mild or moderate hypophosphatemia and over 6 to 8 hours for severe hypophosphatemia 18. (iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. Published data may report both compatibility and stability; however, most evaluate compatibility alone. Serum hyperkalemia is dangerous. Save my name, email, and website in this browser for the next time I comment. According to Lexicomp, these are compatible, and there are no warnings against infusing concomitantly - is there any reason you couldn't run them together? Magnesium Sulfate J Cardiovasc Electrophysiol. The IV was shut off. A chance of incompatibility exists whenever any medication is combined or added to an IV fluid. As far as the magnesium goes we don't piggyback it most of the time. An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). Practical aspects of a frequent association, Comparison of the clinical characteristics and mortality in acute respiratory distress syndrome due to COVID-19 versus due to Influenza A-H1N1pdm09, Descriptive analysis of SARS-CoV-2 pandemia impact on pediatric intensive care unit admissions. Recopilar la informacin publicada sobre estabilidad de los frmacos usados en el paciente crtico, evaluar la calidad de los datos publicados y generar una tabla de compatibilidad con informacin actualizada. L. Knudsen, S. Eisend, N. Haake, T. Kunze. 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. A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. Antimicrob Agents Chemother, 45 (2001), pp. IV or IM. 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. Epub 2011 Aug 4. Can you piggyback critical meds like IV Potassium However, 93% of the papers described the conditions and methodology of the study with enough detail to guarantee its reproducibility. Aggressive repletion of mild hypokalemia in patients with renal failure (. Can you piggyback critical meds like IV Potassium As far as the magnesium goes we don't piggyback it most of the time. 562-565. to drip potassium and magnesium with the Our patients hate those because they're enormous pills. On the contrary, 81% of the studies followed the recommendation of taking samples at time 0, although only 10 obtained a sample in 5 different times. Web1. Fosinopril Serious Alternative (1) eprosartan and potassium phosphates, IV, both raise serum potassium. or not to mix compatibilities of When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. Compatibility of drugs administered as (3) Safer (oral potassium is overall more idiot-proof than IV potassium). The anti-depressant is an antipsychotic derivative of antihystericicineineine. Stewart, F.W. 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. 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. the difference between oral and IV magnesium Unable to load your collection due to an error, Unable to load your delegates due to an error. From the 1st of January 2022 onwards, it will be mandatory to submit the conflict of interest of each author with the second submission of the manuscript (see instructions for authors). Specializes in MPH Student Fall/14, Emergency, Research. Am J Health Syst Pharm, 54 (1997), pp. Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. The magnesium was piggybacked onto the other saline IV with the potassium. N. Baririan, H. Chanteux, E. Viaene, H. Servais, P.M. Tulkens. Compatibility of drugs administered as RELATED: What Does Potassium Chloride React With? WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). 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. Calvo-Calvo, . Carrillo-lvarez, M. Sanjurjo-Sez. 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. Intravenous Ongoing fall in potassium likely (e.g., DKA or refeeding syndrome). Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. 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. Web1. Another factor is the prescription of doses in different units of measurement or the high number of drugs used with each patient. 67% of the studies assessed gas formation, and only 12 measured pH changes in time. %PDF-1.5 % Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. As Fig. 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. 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. IV magnesium may be the fastest way to reduce the risk of arrhythmia (because magnesium can be given rapidly). The relationship between potassium level and total-body potassium deficit is. The infusions were stable for 24 hours at 22 deg C. The results from both diluents showed an average of +/-5% fluctuations in concentration. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. WebTherefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Amors-Cerd, B. Ribas-Nicolau. It can be made by treating potassium hydroxide (or other potassium bases) with hydrochloric acid: KOH + HCl + H2O. The presence of any factors which may cause shifting of potassium in or out of the cells. Servicio de Farmacia, Hospital Clnic de Barcelona, Barcelona, Spain, Results of physical and chemical compatibility. For example, diabetic ketoacidosis causes potassium to shift out of the cells. The magnesium was piggybacked onto the other saline IV with the potassium. Summary of physical and chemical compatibilities. 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. Out of the 29 papers included in the review, 4 were written in Spanish, 3 in French, and 22 in English. IV Compatibility 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 Similarly, turbidimetry or microscopymore accurate techniques than visual observation for the detection of particles and changes in colorare underused.