what will actually happen?

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what will actually happen if amiodarone dilute with normal saline 0.9?

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I don't understand your question.

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Amiodarone isn't compatible with NS. Generally that means there is research to say it either effects how the medication devolves within solution leading to such things as decreased efficacy or precipitates. Amiodarone should also be used in non-PVC bags if you're infusing longer than 2 hours.

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what will actually happen if amiodarone dilute with normal saline 0.9?
.

The patient will explode.

Don't laugh. It happens.

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Amiodarone isn't compatible with NS. Generally that means there is research to say it either effects how the medication devolves within solution leading to such things as decreased efficacy or precipitates. Amiodarone should also be used in non-PVC bags if you're infusing longer than 2 hours.

thanx.we've been taught so..and the using of non-PVC bags if more than 2 hours is new to me.Thanx a lot.I've seen Amiodarone 150mg diluted in 50cc N.Saline over 0.9% and run over 10 minutes during my clinical.Being curious,I asked more than 5 staffs workin in ED and they give me the same answer.Can be diluted in N.saline.I just wont believe it.

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The patient will explode.

Don't laugh. It happens.

I'm not laughing at it.Seriously.:nono:

I will find the phatophysiology based on 'Patient will explode'

I just wonder how and why.. thank you :)

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Specializes in Infusion Nursing, Home Health Infusion.

You can have these incompatibilities in general

1 Physical ..this is when you could see physical changes such as in a precipitate or turbidity in the solution...and color change..things of that nature

2 Chemical You may not see anything but the drug may not work at all or as well..it may inactivate the therapeutic effect that is desired and even create a different agrnt that may be toxic. (think back to chemistry)

3 Therapeutic This is when unfavorable or undesirable reactions occur in the patient b/c as a result of incompatible medications being administered. This can include any routes

The following medications have a known hx of incomaptabilit issues to name a few: Dilantin,Valium,Electrolyte additives(ie calcium) Flagyl,the antifungals such as amphotericin ,TPN and PPN solutions,propofol,and other fat based drugs

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thanx.we've been taught so..and the using of non-PVC bags if more than 2 hours is new to me.Thanx a lot.I've seen Amiodarone 150mg diluted in 50cc N.Saline over 0.9% and run over 10 minutes during my clinical.Being curious,I asked more than 5 staffs workin in ED and they give me the same answer.Can be diluted in N.saline.I just wont believe it.

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.

* Direct IV:

Diluent: Administer undiluted. May also be diluted in 20-30 mL of D5W or 0.9% NaCl.

Concentration: 50 mg/mL.

* Rate:

Administer IV push.

* Intermittent Infusion:

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.

* Rate:

Infuse over 10 min. Do not administer IV push.

* Continuous Infusion:

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 1-6 mg/mL (concentrations >2 mg/mL must be administered via central venous catheter).

http://www.drugguide.com/ddo/ub?

Despite that, I believe it is a fairly common practice.

Let's 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."

http://www.drugguide.com/ddo/ub/view/Davis-Drug-Guide/51261/11/enoxaparin?q=lovenox

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.

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Specializes in Emergency, Med/Surg, Vascular Access.

Medscape says amiodarone is compatible in NS for 24 hrs.

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Specializes in Emergency/Trauma/Critical Care Nursing.

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.

• Direct IV:

Diluent: Administer undiluted. May also be diluted in 20–30 mL of D5W or 0.9% NaCl.

Concentration: 50 mg/mL.

• Rate:

Administer IV push.

• Intermittent Infusion:

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.

• Rate:

Infuse over 10 min. Do not administer IV push.

• Continuous Infusion:

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 1–6 mg/mL (concentrations >2 mg/mL must be administered via central venous catheter).

http://www.drugguide.com/ddo/ub?

Despite that, I believe it is a fairly common practice.

Let’s 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."

http://www.drugguide.com/ddo/ub/view/Davis-Drug-Guide/51261/11/enoxaparin?q=lovenox

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

BeLLaRN

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