why should dobutamine,dopa, or NE be combined with dextrose 5%?

[ketap]

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hi, i need to ask why should we always combine dobutamine,dopamine,NE with Dextrose 5% only? some book said that it is to prevent oxidation or because it will inactive those drugs but i don't understand how?what kind of oxidation?..i've checked some books ( stoelting's pharm. in anesthetic practice, pharmacology for anesth) but can't find any answer about it..

is there any one can give me some clue? thx u so much,friends 🙂

best regards,
Ketap

 

[deleted59964]

not sure why, but have made them in N/S for ICU patients getting lots of volume of D5W and hyponatraemia ... works fine in N/S

 

[jetproppilot]

hi, i need to ask why should we always combine dobutamine,dopamine,NE with Dextrose 5% only? some book said that it is to prevent oxidation or because it will inactive those drugs but i don't understand how?what kind of oxidation?..i've checked some books ( stoelting's pharm. in anesthetic practice, pharmacology for anesth) but can't find any answer about it..

is there any one can give me some clue? thx u so much,friends 🙂

best regards,
Ketap

PRAGMATICALLY AND NOT ACADEMICALLY,

It really doesn't matter what you mix your inotrope with.

Mix dopamine, dobutamine, epinephrine, milrinone, et al with .9% normal saline, .45% normal saline, Lactated Ringers, D5W, D5halfnormal, et al:

IT'LL WORK.

For that matter,

YES YOU CAN HANG BLOOD WITH LACTATED RINGERS AND

The sky is NOT gonna fall.

WELCOME TO THE WORLD OF ACADEMIC DOGMA.

yes that just happened

All you are taught is sometimes

NOT TRUE.

If you are a resident, your questioning is great man.

I encourage you to

KEEP QUESTIONING.

 

[gasp]

hi, i need to ask why should we always combine dobutamine,dopamine,NE with Dextrose 5% only? some book said that it is to prevent oxidation or because it will inactive those drugs but i don't understand how?what kind of oxidation?..i've checked some books ( stoelting's pharm. in anesthetic practice, pharmacology for anesth) but can't find any answer about it..

is there any one can give me some clue? thx u so much,friends 🙂

best regards,
Ketap

Because some old guy started it, duh!

 

[usnavdoc]

It's not academic dogma nonsense. The reason is because the dextrose preserves the potency of the vasopressor. Sure if you mix it in the or and use it you will be fine. But if you are a pharmacist and mix it with the intent to use it at a later time frame. You chill it and use a dextrose containing solution.

Not sure of the mechanism but that's the reason. That being said I use ns all the time to mix norepi

 

[jetproppilot]

It's not academic dogma nonsense. The reason is because the dextrose preserves the potency of the vasopressor. Sure if you mix it in the or and use it you will be fine. But if you are a pharmacist and mix it with the intent to use it at a later time frame. You chill it and use a dextrose containing solution.

Not sure of the mechanism but that's the reason. That being said I use ns all the time to mix norepi

I'm an anesthesiologist, not a pharmacist, Doctor.

The above bolded post proves that it's ACADEMIC DOGMA!!!

Anesthesia residents currently ensconced in their daily lives setting up drips need to know what I said and what you said:

IF YOU MIX IT IN THE OR AND USE IT YOU WILL BE FINE.

I.E. short term,

THE DILUENT DOESN'T MATTER...YOUR INOTROPE WILL WORK and won't be magically rendered useless because you chose the wrong bag to mix it with!!!

Attendings don't tell residents this kinda stuff, man.

All residents know is what they are taught.

DEAR RESIDENT READERS, has an attending ever had a conversation like this with you?

DEAR RESIDENT READERS,

you are the MOST IMPORTANT GROUP ON THIS SITE MAN.

It is IMPORTANT

that you are informed.

 

[gasp]

I'm an anesthesiologist, not a pharmacist, Doctor.

The above bolded post proves that it's ACADEMIC DOGMA!!!

Anesthesia residents currently ensconced in their daily lives setting up drips need to know what I said and what you said:

IF YOU MIX IT IN THE OR AND USE IT YOU WILL BE FINE.

I.E. short term,

THE DILUENT DOESN'T MATTER...YOUR INOTROPE WILL WORK and won't be magically rendered useless because you chose the wrong bag to mix it with!!!

Attendings don't tell residents this kinda stuff, man.

All residents know is what they are taught.

DEAR RESIDENT READERS, has an attending ever had a conversation like this with you?

DEAR RESIDENT READERS,

you are the MOST IMPORTANT GROUP ON THIS SITE MAN.

It is IMPORTANT

that you are informed.

Lots of attendings don't tell residents this stuff because they don't know it themselves..

 

[deleted9493]

Dextrose does not seem to add any sort of stability over the clinically relevant range of use (days after mixture). In this study, saline was just as stable a vehicle as D10W and D5W. http://journals.lww.com/pccmjournal..._dopamine_and_epinephrine_solutions_up.5.aspx

This study shows the stability over a clinically relevant period at room temperatures:

http://link.springer.com/article/10.1007/BF03016090?LI=true

As far as I can tell, keeping vasopressors cool and out of light is relevant really only to storage in the pharmacy. There is no shortage of data to support Jet's position that it doesn't matter what you mix it in...as long as the diluent is pH neutral.

 

[BLADEMDA]

I use normal saline for decades. No issues. I don't use D5W because high blood glucose is bad for patients. Again, no issues with the drugs mentioned.

Any of you studs try plasmalyte instead of saline? That would be interesting

 

[ketap]

hi, friends..thx for all the responses,,actually i am quiet amazed by all of your answers because it is very contradictive to what the book said..you see, that when i had my internship, the residents used those inotrpic and vasopressor not with D5% ,but with NS,..just like what u did..but when i read those books, they told me to dilute it with only Dextrose..that' really confuse me because almost all of the time, we are using NS to dilute those drugs..glad to know that everything that what we have done is still right..😛

But, really, this question really bothering me.."why do those books suggest to use dextrose to dilute the inotropes and vassopressor ?what is the reason? what chemical reaction will occure with D5% that will not occure if we dilute it with any other solution?


i am not a resident yet, but i am trying to become one someday..sorry if i bothering u with this question again..i know it might not be important, but i really curious to why those books said that..

please tell me if you know the answer, please ...thx a lot 🙂

best regards,

Ketap

 

[jetproppilot]

But, really, this question really bothering me.."why do those books suggest to use dextrose to dilute the inotropes and vassopressor ?what is the reason? what chemical reaction will occure with D5% that will not occure if we dilute it with any other solution?


i am not a resident yet, but i am trying to become one someday..sorry if i bothering u with this question again..i know it might not be important, but i really curious to why those books said that..

please tell me if you know the answer, please ...thx a lot 🙂

best regards,

Ketap

Hey Ketap,

I dunno the answer... you're gonna haffta ask the

"PROFESSIONALS"

who wrote the books!! 😆

All kidding aside,

there are scientific and academic things we learn and propagate because of how we were taught.

There's alotta things we are taught that are untrue or are irrelevant to physicians out in the trenches doing cases every day. For a living.

There is a huge void between how medicine is taught and how it is practiced in an academic center verses how things are done in the REAL WORLD of private practice.

Certainly not saying what academic places do is "wrong."

I will tell you fervently, however, that they do alotta extra steps and pay alotta attention to DOGMA that has no bearing on patient care.

I'm impressed by you, dude/dudette.

I love your inquisition of what you are reading.

Keep it up, Happy New Year, and best of luck with your aspirations!!!

 

[ketap]

thx,jetproppilot...i need to ask dr.Stoelting then haha..😛 but many thanks for your response..i appreciate it very much..thx a lot again especially for the encouragement you gave in that post..i'll keep doing it, of course..😉 because i need to know if those things i've done was correct or not for my pateint's sake ,besides that i am also preparing for residency and i hope i'll be prepared for it when that opportunity comes some day 🙂

regards,Ketap..🙂

 

[Planktonmd]

It's basically BS...
that's all you need to know!

 

[jetproppilot]

Dextrose does not seem to add any sort of stability over the clinically relevant range of use (days after mixture). In this study, saline was just as stable a vehicle as D10W and D5W. http://journals.lww.com/pccmjournal..._dopamine_and_epinephrine_solutions_up.5.aspx

This study shows the stability over a clinically relevant period at room temperatures:

http://link.springer.com/article/10.1007/BF03016090?LI=true

As far as I can tell, keeping vasopressors cool and out of light is relevant really only to storage in the pharmacy. There is no shortage of data to support Jet's position that it doesn't matter what you mix it in...as long as the diluent is pH neutral.

It's The Truth man.... just don't tell anyone practicing in the IVORY TOWERS