Quality Control of Compounded Crystalloid Fluids for Intravenous Delivery to Horses

Abstract

BackgroundPeriodic lack of availability and high cost of commercially produced isotonic fluids for intravenous (IV) use in horses have increasingly led to use of home‐made or commercially compound fluids by veterinarians. Data regarding the quality control and safety of compounded fluids would be of benefit to equine veterinarians.ObjectivesTo compare electrolyte concentrations, sterility, and endotoxin contamination of commercially available fluids to 2 forms of compounded isotonic crystalloid fluids intended for IV use in horses.MethodsProspective study. Two methods of preparing compounded crystalloids formulated to replicate commercial Plasma‐Lyte A (Abbott, Chicago, IL) were compared. One formulation was prepared by a hand‐mixed method involving chlorinated drinking water commonly employed by equine practitioners, and the other was prepared by means of ingredients obtained from a commercial compounding pharmacy. The variables for comparison were electrolyte concentrations, sterility, and presence of endotoxin contamination.ResultsElectrolyte concentrations were consistent within each product but different between types of fluids (P < 0.0001). Hand‐mixed fluids had significantly more bacterial contamination compared to commercial Plasma‐Lyte A (P = 0.0014). One of the hand‐mixed fluid samples had detectable endotoxin contamination.Conclusions and Clinical ImportanceChlorinated drinking water is not an acceptable source of water to compound isotonic fluids for IV administration. Equine practitioners should be aware of this risk and obtain the informed consent of their clients.

Outcome and complications in horses administered sterile or non‐sterile fluids intravenously

“…As an example, when more critical examination was pursued in a study comparing two catheter types, 61% of veins had local perivascular swelling, hematomas or both and ultrasonographic assessment revealed moderate to severe venous pathology in 5.4% of catheterized veins . Although JUG fluids likely had a greater risk of contamination with bacteria and endotoxin, neither of which are found in commercial fluids, introduction of these agents would more likely produce systemic effects (eg, fever, tachycardia, tachypnea, and sweating) rather than localized inflammation or sepsis. Consequently, the mechanism(s) by which custom‐made, non‐sterile fluids might have contributed to an increased risk of jugular vein complications was not fully elucidated in either our or previous studies …”

Current Concepts in Fluid Therapy in Horses

“…Commercially available fluids are produced in appropriate clean environments and guaranteed to be non-pyrogenic and endotoxin-free, features that cannot be achieved during homemade mixing of potable water, regardless of the source. A recent study compared bacterial and endotoxin contamination in hand mixed non-sterile IV fluids made from chlorinated drinking water and chemical grade electrolytes, compounded IV fluids made from distilled, filtered, irradiated water and filtered electrolyte solution and subsequently autoclaved, and commercially available balanced polyionic fluids (Plasma-Lyte A 1 ) ( 33 ). This study showed a significant increase and unacceptable level of bacterial contamination in hand-mixed fluids (7/8) compared to compounded (1/8) and commercial (0/8) fluids.…”

Highlights of recent clinically relevant papers

“…This study by C.B. Magnusson and colleagues at the University of Wisconsin‐Madison, USA, investigated quality control and safety of compounded crystalloid fluids for intravenous (i.v.)…”