In the clinical treatment of animal diseases, infusion therapy is to use a certain device to deliver glucose injection, physiological saline, etc. (some are also dissolved with drugs) into the body through veins to replenish body fluids and achieve the purpose of treatment. Infusion therapy seems to be very simple, but it is an important clinical subject and occupies an extremely important position in clinical treatment.
Intravenous infusion is one of the most widely used, most important, most basic and most complex technical measures to maintain the stability of the body's fluid state.
Different liquids should be selected according to different diseases, pathological processes such as water, electrolyte, acid-base balance disorders of the body, and nutritional status of the body. content.
The degree of mastery of the relevant knowledge of infusion therapy by the licensed veterinarian directly affects the clinical individual treatment effect.
First, the concept of incompatibility.
When a drug is not effective, it is necessary to choose other drugs for reasonable compatibility. But not all compatibility is reasonable. Some compatibility weakens the therapeutic effect of the drug and leads to treatment failure; The ability to tolerate it can also cause adverse reactions.
Incompatibility refers to the physical changes, chemical reactions and pharmacological changes of two or more drugs together before entering the body, which changes the properties of the drugs and makes the drugs less effective, ineffective or more toxic. Only by correctly grasping the pharmacological effects of drugs can we avoid the occurrence of incompatibility in clinical medication.
2. Key points for infusion drug compatibility:
1 Drugs that
can only be compatible with normal saline:
1) Sodium bicarbonate
Sodium bicarbonate is an acid-base balance adjusting drug with a large degree of dissociation and can provide more bicarbonate ions (HCO3-), while the pH of 5% or 10% glucose injection is 3.2-6.5, which is acidic and can be The bicarbonate ion is decomposed to form water and carbon dioxide, which makes the drug ineffective and cannot neutralize the body's excess acid. The presence of sodium ions in normal saline can relieve the dissociation of sodium bicarbonate, and the compatibility of sodium bicarbonate and sodium chloride is more stable. Clinically, sodium bicarbonate is usually diluted with normal saline for intravenous administration.
2) Amoxicillin
sodium for injection is composed of sodium salt, which is unstable in glucose solution. Precipitation may occur in solutions with pH below 6.5, but it is easily soluble and stable in saline (pH 6.5-7.0). When used, it should be dissolved in normal saline and used now.
3) Furosemide (furosemide)
Furosemide injection is a sodium salt injection with higher alkalinity, that is, a sterile aqueous solution made of furosemide plus sodium hydroxide and sodium chloride. When furosemide injection is compatible with glucose injection, sodium hydroxide and hydrochloric acid in the mixed liquid will neutralize, and the pH value will change. The commonly used clinical furosemide injection is compatible with normal saline, and the pH value does not change much, which does not affect the stability of furosemide. This medicine is strictly prohibited to be combined with glucose injection.
4)
Procaine Procaine is a short-acting ester local anesthetic. When preparing procaine injection, it should be diluted with normal saline instead of glucose injection. Because glucose can reduce the local anesthesia effect of this drug, 2 drugs that are not suitable for compatibility with normal saline:
1) Water-soluble vitamins
Water-soluble vitamins are a group of vitamins that can be dissolved in water, including B vitamins and ascorbic acid (vitamin C). The components of coenzyme or prosthetic group are involved in the metabolism of water-soluble vitamin water solution in vivo, and the stable pH value is in the range of 5.6-6.1. Water-soluble vitamins and strong electrolytes produce the same ion effect, potential neutralization and salting-out effect, which increase the insoluble particles in the solution and increase the incidence of adverse reactions. Therefore, water-soluble vitamins cannot be added to normal saline containing electrolytes, but can be added to electrolyte-free glucose injections.
2) Immunoglobulins
cannot be diluted with normal saline, and sodium chloride may cause immunoglobulins to salt out and precipitate. Immune globulin can be dissolved in water for injection to the specified volume for direct intravenous infusion or diluted 1-2 times with 5% glucose injection for intravenous infusion.
3) Norepinephrine
should be diluted with 5% glucose injection or 5% glucose and sodium chloride injection, and should not be diluted with normal saline.
4) Mannitol
should avoid compatibility with inorganic salt drugs (such as sodium chloride, potassium chloride, etc.) to avoid crystallization of mannitol.
3
Drugs that can only be compatible with glucose injection
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norepinephrine can not be used as a solution for intravenous infusion of norepinephrine, because norepinephrine has a catechol structure in its molecular structure, and its properties are unstable. It is easily oxidized and deteriorated in the air or exposed to sunlight, resulting in red norepinephrine red; it accelerates oxidation under alkaline conditions, and is also prone to oxidation under neutral and acidic conditions, but it is relatively stable under alkaline conditions and slightly acidic. The stability is the best.
Norepinephrine should be diluted with acidic 5% dextrose injection or 5% dextrose and sodium chloride injection by intravenous drip.
4 Drugs that are not
compatible with glucose injection The
following drugs should not be compatible with 5% glucose injection, because the efficacy and stability of the drug may be reduced.
1) Furosemide
According to the above, furosemide injection is forbidden to be compatible with glucose injection. The commonly used clinical furosemide injection is compatible with normal saline, and the pH value does not change much, which does not affect the stability of furosemide.
2) Penicillin
The optimum pH value of penicillin sodium is 6.0-6.5, the pH value of 10% glucose injection is 3.2-5.5, and the pH value of 5% glucose injection is 3.2-6.5. Penicillins all contain lactam rings in their structures, and this The ring is easily decomposed in acidic or alkaline environments, resulting in drug failure. Therefore, 5% glucose injection and 10% glucose injection should not be used as the solvent for penicillin G, and sodium chloride injection (pH value 4.5-7.0) is often used as the solvent. It is formed in the form of a salt and is unstable in glucose solutions; precipitation may occur in solutions below pH 6.5. Soluble and stable in normal saline.
4)
Sulfadiazine Sodium Sulfadiazine Sodium Injection is a sterile aqueous solution of sulfadiazine plus sodium hydroxide, and its pH value is 9.5-11.0. If it is added to glucose injection (pH value 3.2-6.5) for instillation, the former is alkaline , The latter is weakly acidic. After mixing the two, sulfonamide crystals are easily precipitated, which can cause embolism when entering the blood.
Therefore, sulfadiazine sodium is strictly prohibited to be used in combination with glucose injection. Commonly used sterile water for injection or normal saline diluted into a 5% solution, slow intravenous injection, intravenous drip concentration ≤ 1%.
In a word, the compatibility of infusion drugs should be simplified, the types of drugs added should be strictly controlled, and the combination of multiple drugs should be input in small package solutions as far as possible. When two or more drugs are mixed, attention should be paid to the incompatibility, and after preparation, observe whether the liquid has changes such as discoloration, precipitation, and turbidity.
The preparation of powder medicine should be shaken sufficiently to make the medicine completely dissolved before use.
https://www.arshinepharma.com/info/incompatibility-of-several-drugs-commonly-used-76216226.html
