Dextrose and Sorbitol as Diluents for Continuous Intravenous Heparin Infusion

Chessells, Judith M.; Braithwaite, Tessa A.; Chamberlain, Douglas

doi:10.1136/bmj.2.5805.81

Cited by 8 publications

(4 citation statements)

References 9 publications

(8 reference statements)

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“…While the procedure of Yin detected a moderate loss of anticoagulant activity, the thrombin time remained unchanged throughout the experiment. Chessells et al (1972) using a within-patient cross-over trial to compare 5 % dextrose and 5 % sorbitol as diluents for heparin, demonstrated no detectable loss of heparin activity in either solution. The in vivo study of Chessells et al may not prove or disprove the results of the in vitro studies, because of accumulative anticoagulant activity in the body, which may obviate the in vitro determination, and because of its in vivo metabolism which is relatively unknown (Genton, 1974).…”

Section: Discussionmentioning

confidence: 98%

Anticoagulant activity of heparin in intravenous fluids.

Okuno¹,

Nelson²

1975

J Clin Pathol

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Section: Discussionmentioning

confidence: 98%

Anticoagulant activity of heparin in intravenous fluids.

Okuno¹,

Nelson²

1975

J Clin Pathol

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“…745 0L one hour and the levels of activity then remained constant throughout the rest of the 24-hour period of observation. This could account for the fact that the assays of Chessells et al (1972) failed to show any marked differences in plasma heparin level between three and 12 hours. Our results may also explain the clinical observations of O'Riordan and MacGowan (1970).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent report of a within-patient cross-over trial comparing dextrose 5% (pH 3 8-4 5) and sorbitol 5 % (pH 6-2) as diluents for heparin, Chessells, Braithwaite, and Chamberlain (1972) found little variation in plasma herapin levels at three hours and 12 hours, although there was wider variation in the partial thromboplastin time with kaolin (PTTK) over this period.…”

Section: Discussionmentioning

confidence: 99%

Intravenous infusions of heparin and penicillins

Jacobs¹,

Kletter²,

Superstine³

et al. 1973

J Clin Pathol

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syNopsis The chemical stability and anticoagulant activity of heparin (20 U/ml) were studied in five intravenous fluids at room temperature. Heparin remained stable and active for 24 hours in normal saline, but there was a rapid inactivation of 40 to 55 % in solutions containing dextrose or lactate, as measured by chemical and biological methods.High concentrations of benzylpenicillin, ampicillin, or methicillin had no effect on heparin activity in normal saline or dextrose 5%: nor was the stability of the penicillins in these fluids affected to any marked extent by the presence of heparin. Ampicillin was, however, found to be unstable in dextrose 5 %, and it would be preferable for it not to be added to dextrose infusions. It is concluded that heparin may be given intravenously in normal saline with benzylpenicillin, ampicillin, or methicillin but several other antibiotics were found to be unsuitable for concurrent infusion with heparin.

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“…Some authors have reported significant inactivation of heparin in D5W solutions (61,62). However, several other investigators have found heparin stable in both dextrose and saline solutions (63)(64)(65)(66)(67)(68)(69). Thus, it has been shown that heparin did not lose activity in 5% dextrose over 24 h within the pH range of 2-9 (63,65,67,69).…”

Section: And L Hndersjomentioning

confidence: 99%

Incompatibility and Stability Problems Associated With Intravenous Admixtures: A Survey

Lundgren

Landersjö²

1980

J Clin Pharm Ther

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In intravenous therapy the use of infusion fluids as vehicles or carriers for other parenteral drugs is now common. The extent of use of this drug administration method has been illustrated in many papers (1-8). A report from the early sixties shows that one or more drugs were added to about 10% of the infusion fluids administered (9). In the late sixties, however, the frequency of intravenous prescriptions containing additives had increased and figures of between 50 and 907; have been reported in several papers (2, 4, 5, 8). Reports over the last 5 years indicate that drugs are now less frequently administered as additives.The drugs added to infusion fluids are mainly antibiotics, electrolytes, heparin, vitamins and, to a lesser extent, several other drugs such as aminophylline and corticosteroids. Some of these drugs, for example, electrolytes, are available as sterile stock solutions designed for use as additives in infusion fluids. Usually, however, neither infusion fluids nor injections are formulated to be diluted or mixed with further drugs. The practice of adding drugs to large volume parenteral solutions may therefore result in incompatibility or stability problems.Several authors have reviewed the literature concerning addition of drugs to large volume solutions and provided references, tables and recommendations to reduce the occurrence of problems (10-16). There have been many studies on such incompatibilities; however, the literature in this area is often inconsistent and does not reflect clinically applicable situations. Several stated incompatibilities, reported in compatibility charts, are based on single observations. The influence of pH, the concentration of the drug and other factors have not been evaluated. Some are based only on the observation that no visible change has taken place in the admixture within a stated time.In some papers (6,17-27) the prediction ofcompatibility and stability ofdrugs added to infusion fluids was based on relevant physico-chemical principles. This more theoretical approach has allowed quantitative approximations to be made from kinetic data. Such a technique may be the best way to attack incompatibility problems. The success of this approach, however, depends on the available physicochemical information on the drug *Apoteksbolaget AB, (National Corporation of Swedish Pharmacies,) 105 14 Stockholm, Sweden. 29. Lebmnnn, H. (1959) uber pH-Werte von Infusionslosungen. dsterreichische Apotheker-Zeitung, 13, 30. Vogt. H. P Cklche, C. (1961) pH-Studien an den gebrauchlichsten Infusionslosungen, inbesondere die Ennittlung ihrer Pufferkapazitiit im Vergleich mit der des Blutes. Mitteilirngen der Deutschen Pharmaceutischen Gesellschaft. 31,97-107. 3 I . Cklche, G. (1966) Uber die Bedeutung de pH und Puferwertes von lnfusionslosungen fur Kombinationen mit weiteren Anneistoffen. Krankenhausact. 39.80-86. 32. hndgrm, P. P hndasj6, L. (1970) Studieson the stability and compatibility of drugs in infusion fluids. 1. pH and buffer capacity of infusion fluids. Acta Pharmacewica Sue...

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Dextrose and Sorbitol as Diluents for Continuous Intravenous Heparin Infusion

Cited by 8 publications

References 9 publications

Anticoagulant activity of heparin in intravenous fluids.

Anticoagulant activity of heparin in intravenous fluids.

Intravenous infusions of heparin and penicillins

Incompatibility and Stability Problems Associated With Intravenous Admixtures: A Survey

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