Physico‐chemical stability of Plasma‐Lyte 148 ® and Plasma‐Lyte 148 ® + 5% Glucose with eight common intravenous medications

Abstract

Background

Plasma‐Lyte 148 ^® is a balanced, crystalloid intravenous (IV) fluid which is both calcium‐free and isotonic. It prevents the hyperchloraemic metabolic acidosis and iatrogenic hyponatraemia seen with use of 0.9% sodium chloride and hypotonic solutions respectively. However, data on compatibility with commonly used drugs is lacking.

Aim

To investigate the stability of Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose with eight commonly used therapeutic agents when compared with 5% Glucose and 0.9% Sodium Chloride as diluents. We aimed to provide vital data which may facilitate the introduction of what appears to be a safer and more economic fluid.

Method

Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose were mixed with morphine, midazolam, fentanyl, ketamine, clonidine, aminophylline, salbutamol and furosemide at set concentrations. Comparisons were made to 0.9% Sodium Chloride and 5% Glucose fluid controls. Six repeats of each IV fluid and drug admixture were analysed through high performance liquid chromatography (HPLC), at three time points: 0, 2 and 24 hours. A concentration change of < 5% was defined as chemically stable. Physical stability was assessed by observation of precipitate formation or colour change. pH changes were measured using a Fisherbrand Hydrus 300 pH meter.

Results

Relative to starting concentration, all drugs except midazolam were stable to +/‐ 3%. All examined therapeutic agents were chemically stable at 2 and 24 hours relative to control solutions. No precipitate formed in any of the samples. All Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose drug admixtures remained in a safe, peripheral administration pH range of 5‐9 and were closer to the pH of blood than standard fluid‐drug admixtures.

Conclusion

Morphine, fentanyl, ketamine, salbutamol, aminophylline, and clonidine are stable for 24 hours when mixed with Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^®+5% Glucose for administration at concentrations equivalent to those found at a typical Y site with maintenance fluid. Furosemide is stable at lower concentrations than those seen at a Y‐site, but midazolam displayed instability.

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