Intravenous containers

The kidney is unable to adjust to abrupt changes in sodium intake in patients with severe CKD. Therefore, patients should be advised to refrain from adding salt to their diet, but should not restrict sodium intake. Changes in sodium intake should occur slowly over a period of several days to allow adequate time for the kidney to adjust urinary sodium content. Sodium restriction produces a negative sodium balance, which causes fluid excretion to restore sodium balance. The resulting volume contraction can decrease perfusion of the kidney and hasten the decline in GFR. Saline-containing intravenous (IV) solutions should be used cautiously in patients with CKD because the salt load may precipitate volume overload. 

The rapid movement in the global phthalates market away from using plasticisers 2-ethylhexanol (2-EH) and diethylhexyl phthalate (DEHP) in favour of alternative products was underscored recently when BASF revealed plans to close its 2-EH and DEHP plants in Germany. The restructuring in Europe will have no effect on BASF s plasticiser portfolio in Nafta and Asia, however, where the company will continue to offer 2-EH and DEHP. About 70% of the plasticiser maiket volume is phthalates, and plasticisers make up about 60% of the plastic additives maiket. PVC accounts for 80-90% of global plasticiser consumption. In October 2003, California added DEHP to the state s list of more than 750 chemicals known to cause birth defects or reproductive harm. Previous studies had shown that the chemical can leach from plastic bags that contain intravenous fluids, blood, tube feedings or other medical treatment, and thereby enter the bodies of patients. 

Blood glucose should be monitored in patients with diabetes mellitus who receive glucose-containing intravenous immunoglobulin (484). 

Developmental Effects. Studies in human infants indicate that only certain children are affected by aluminum. Excessive aluminum accumulation and encephalopathy may occur in premature infants with reduced renal function given dialysis with aluminum-containing intravenous fluid (Polinsky and Gruskin 1984 Sedman et al. 1985). Bone disease has also been reported in infants with renal failure who were treated orally with aluminum hydroxide (Andreoli et al. 1984). 

Droperidol Droperidol has pH-dependent incompatibility with many drugs. It is not compatible with nafcillin sodium, fluorouracil, folic acid, frusemide, heparin, methotrexate, or barbiturates. Droperidol should not be stored in PVC bags containing intravenous infusions, although some solutions appear to be stable.157... 

Containers for blood products Disposable syringes Irrigating solution containers Intravenous infusion fluid containers Administration sets Polyvinyl chloride Polycarbonate, polyethylene, polypropylene Polyethylene, polypropylene, polyvinyl chloride Polyethylene, polypropylene, polyvinyl chloride Nylon (spike), polyvinyl chloride (tubing),... 

In several studies, intravenous amifostine (910 mg/m ) preserved glomerular filtration rate when it was co-administered with cisplatin-containing regimens (213). Even after two cycles containing intravenous cisplatin 50 mg/m plus intravenous ifosfamide and etoposide or paclitaxel, glomerular filtration rate can fall by more than 30%, but concomitant use of amifostine prevented this. Even lower dosages of intravenous amifostine (for example 740 mg/m ) may be effective (220,221). 

Bicarbonate-containing intravenous fluid therapy Massive blood transfusion (sodium citrate overload) Antacids and cation-exchange resins in dialysis patients High-dose carbenicillin or penicillin (associated with hypokalemia)... 

EXPOSURE ROUTES Ingestion (food, drinking water) use of hemodialysis tubing polyvinylchloride bags containing intravenous solutions occupational exposure not absorbed through skin. 

Administer glucose-containing intravenous fluids, and give concentrated glucose bolus (pp 19 and 450) if the patient is hypoglycemic. 

Koletzko B, Goulet O. Fish oil containing intravenous lipid emulsions in parenteral nutrition-associated cholestatic Uver disease. Curr Opin Clin Nutr Metab Care 2010 13(3) 321-6. 

In solutions (intravenous solutions) the yellow discolouration is more manifest. An intermediate in the reaction is a furan derivate (5-hydroxymethylfurfural) that is toxic (see Sect. 13.6.4). In glucose containing intravenous solutions the Pharmacopoeia specifies a limit test for this impurity. 

The resuspended and formulated Fraction II precipitate normally contains some aggregated IgG and trace substances that can cause hypotensive reactions in patients, such as the enzyme prekail ikrein activator (186). These features restrict this type of product to intramuscular adininistration. Further processing is required if products suitable for intravenous adininistration are required. Processes used for this purpose include treatment at pH 4 with the enzyme pepsin [9001-75-6] being added if necessary (131,184), or further purification by ion-exchange chromatography (44). These and other methods have been fiiUy reviewed (45,185,187,188). Intravenous immunoglobulin products are usually suppHed in the freeze-dried state but a product stable in the solution state is also available (189). 

Oral LD q levels have been deterrnined in the mouse at 470 mg/kg (21) and the guinea pig at 7750 mg/kg (22). Several other studies (23—25) have shown that large quantities of both synthetic and natural glycerol can be adniinistered orally to experimental animals and humans without the appearance of adverse effects. Intravenous adniinistration of solutions containing 5% glycerol to animals and humans has been found to cause no toxic or otherwise undesirable effects (26). 

NPH Isophane Human Insulin Suspension. NPH isophane insulin, also called Humulin N, Insulatard NPH Human, or Novolin N is an intermediate-acting form of human insulin produced by recombinant DNA techniques. Mixtures Humulin 70/30 and Novolin 70/30 contain 70% NPH isophane and 30% regular, whereas Humulin 50/50 contains 50% NPH isophane and 50% regular. It is adrninistered subcutaneously and should not be given intravenously. Absorption is delayed because the insulin is conjugated with protamine in a complex of reduced isoelectric solubiUty. Therapeutically, this preparation is probably comparable to purified porcine NPH insulin. However, human NPH insulin may have a slightly shorter duration of action than comparable purified porcine products. 

Commercially available containers for use with parenteral products include single-dose ampuls that are heat sealed and opened by snapping at the point of least diameter, vials for multidose use, and botdes and pHable bags that are used for large volumes such as needed in intravenous infusions. Container size can vary from 1 mL to 1 L. Generally volumes up to 100 mL are available as ampuls or vials. 

USP XXII specifies that sodium iodide contains 99—101.5% Nal, calculated on an anhydrous basis (4). It is used iaterchangeably with potassium iodide as a therapeutic agent, except where sodium ion is contraindicated (see Potassium compounds). Intravenous sodium iodide formulations have been used for a variety of diseases, from thyroid deficiency to neuralgia (see Thyroid and antithyroid preparations). However, these solutions are no longer listed ia the XFXUII (4), iadicatiag that their therapeutic value has not been satisfactorily demonstrated. 

Amphotericin B. Amphotericin B (3), an important polyene antibiotic, is administered almost exclusively via the intravenous route and is therefore discussed in more detail under the systemic antimycotics. The vaginal tablets contain 50 mg amphotericin B, and 100 mg tetracycline base per tablet (see also Antibiotics, tetracyclines). The tablets for oral use contain 50 mg amphotericin B, 250 mg tetracycline base, and 125 mg sodium hexametaphosphate. A combination ointment contains 1 mg fludrocortisone acetate, 2.5 mg neomycin, 0.25 mg gramicidin, and 1 g plastibase in addition to 30 mg amphotericin B (see also Antibiotics, peptides). 

For late-stage disease, in which the central nervous system is impHcated, the compound of choice until recently was melarsoprol (94, Mel B, Arsobal [494-79-1]) for T. b. gambiense or T. b. rhodesiense. The dmg, adrninistered intravenously, is a solution containing a combination of BAT,... 

Alimentary biotin deficiency is rare. It may, however, occur in patients on long-term parenteral nutrition lacking biotin or in persons who frequently consume raw egg white. Raw egg white contains a biotin-binding glycoprotein, called avidin, which renders biotin biologically unavailable. Pharmacological doses of the vitamin (1-10 mg/d) are then used to treat deficiency symptoms. There are no reports of toxicity for daily oral doses up to 200 mg and daily intravenous doses of up to 20 mg [2]. 

Do not mix dopamine with other drug , especially sodium bicarbonate or odier alkaline intravenous (IV) solutions. Check with the hospital pharmacist before adding a second drug to an IV solution containing this drug. 

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