Factors affecting the concentration of electrolyte infusions prepared from stock solutions.
BACKGROUND
Wide variation in the concentrations of electrolyte infusions prepared from stock solutions has previously been reported. Layering of viscous stock electrolyte solutions in their diluent can lead to high concentrations being delivered during the infusion, resulting in potentially very serious medication errors which have caused deaths.


OBJECTIVE
To determine the safest way of preparing homogenous electrolyte solutions for parenteral infusion.


METHODS
The study examined how the concentration of potassium and magnesium varied during infusions after concentrated stock solutions had been diluted to 400&emsp14;mmol/l with 0.9% sodium chloride. It also examined the use of syringes compared to polyvinyl chloride (PVC) bags, agitating vigorously with a 'vortex' mixer compared to inversion, and the influence of allowing the infusions to stand for 24&emsp14;h before administration. The study was conducted in November 2009. Results It was found that, in general, the concentrations of potassium and magnesium solutions are less variable if they are prepared in PVC bags rather than syringes. Vigorous mixing of concentrated stock solutions with diluent and allowing preparations to stand for 24&emsp14;h also improved the homogeneity of the infusions. However, even with meticulous preparation, some infusions deviated from the expected concentration by more than 10%.


CONCLUSIONS
It is recommended that electrolyte infusions are prepared and provided by the pharmaceutical industry in prefilled syringes or bags. Given the likely cost of these products, an alternative would be to prepare infusions in pharmacy in advance, using PVC bags rather than syringes, and that they should be agitated vigorously with a 'vortex' mixer.
Donaldson
Thomas M
TM
School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Mani
Vaithianadan
V
Wheeler
Daniel W
DW
D004349:Drug Packaging / Q000379:methods; D004356:Drug Storage / Q000379:methods; D004573:Electrolytes / Q000008:administration & dosage* / Q000737:chemistry; D006801:Humans; D007263:Infusions, Parenteral; D008278:Magnesium Sulfate / Q000737:chemistry*; D008508:Medication Errors / Q000517:prevention & control; D004364:Pharmaceutical Preparations / Q000737:chemistry*; D011143:Polyvinyl Chloride; D011189:Potassium Chloride / Q000737:chemistry*; D012996:Solutions / Q000592:standards; D013997:Time Factors
D004573:Electrolytes; D004364:Pharmaceutical Preparations; D012996:Solutions; D011189:Potassium Chloride; D008278:Magnesium Sulfate; D011143:Polyvinyl Chloride