what will actually happen? - page 2
what will actually happen if amiodarone dilute with normal saline 0.9?... Read More
- 0Nov 5, '12 by Christy1019Quote from hherrn
It absolutely can be diluted with NS. That is how to administer your IVP dose in a code.
Maintenance doses need to be mixed in D5w.
The question is whether the initial loading dose of 150 mg can be mixed in 100 ml ns, as it often is.
According to Davis: No.
Diluent: Administer undiluted. May also be diluted in 2030 mL of D5W or 0.9% NaCl.
Concentration: 50 mg/mL.
Administer IV push.
Diluent: Dilute 150 mg of amiodarone in 100 mL of D5W. Infusion stable for 2 hr in PVC bag, or use pre-mixed bags.
Concentration: 1.5 mg/mL.
Infuse over 10 min. Do not administer IV push.
Diluent: Dilute 900 mg (18 mL) of amiodarone in 500 mL of D5W. Infusion stable for 24 hr in glass or polyolefin bottle.
Concentration: 1.8 mg/mL. Concentration may range from 16 mg/mL (concentrations >2 mg/mL must be administered via central venous catheter).
Despite that, I believe it is a fairly common practice.
Lets say you are working a code, and getting drugs ready. Patient is a 10 kg baby. In anticipation of needing Amiodarone, you draw up 50 mg in 30 ml ns, and have at the ready for 10 minutes. 1.66mg/ml. (while this is not how I would draw it up, it would be within the guidelines.)
In the next bed, is a more stable guy getting a maintenance gtt, starting with a loading dose. 150 mg in 100 ml ns. 1.5mg/ml.
Similar concentrations for similar duration. The baby gets Amiodarone diluted with normal saline.
It is not always clear why a manufacturer makes certain recommendations. Lovenox in love handles for example: " Alternate injection sites daily between the left and right anterolateral and left and right posterolateral abdominal wall."
This makes no logical sense. Why not anterior abdomen? When I asked a Lovenox rep about this, I was told that since the initial studies were done using the sides, that was the recommendation. Absolutely no pharmacologic reason to do it.
I love this response. I once asked our ER pharmacist about thiamine after a resident ordered an abnormally high dose (I believe our standard is 100mg ivp and 1mg folic acid ivp) for our Etoh pts, and he said that it didn't really matter because noone ever could determine a "correct therapeutic dose" so the guy developing it just picked 100mg b/c he liked that number lol. Even asked another pharmacist who confirmed the same story LOL