In this episode, I’ll discuss new compatibility information for IV hydrocortisone infusions.
Current Surviving Sepsis Campaign Guidelines recommend giving hydrocortisone 200 mg per day to patients with septic shock and inadequate response to vasopressor therapy.
This is typically administered in one of two ways:
1. Intermittent bolus doses of 50 mg hydrocortisone IV q6 hours
2. Continuous infusion of 200 mg hydrocortisone over 24 hours
Many clinicians prefer the continuous infusion of hydrocortisone because of data showing a lower rate of hyperglycemia when compared with intermittent dosing. This effect has been demonstrated in both retrospective and randomized prospective trials.
However critically ill patients with septic shock often require multiple simultaneous infusions, and if IV compatibility is not known an additional IV line may need to be placed to accommodate infusions with unknown compatibility.
These additional lines are not without risk to the patient as thrombus formation, vascular injury, infection, and line misplacement are all potential consequences of additional central line placement.
The authors of a recent study in the American Journal of Health-System Pharmacy examined the physical compatibility of hydrocortisone with a number of commonly used IV medications.
The study mixed hydrocortisone in a simulated Y-site scenario with 13 different medications and examined physical compatibility by both visual and turbidimetric assessments.
All 13 of the medications were found to be physically compatible with IV hydrocortisone 1mg/mL as the author’s concluded:
Hydrocortisone was found to be physically compatible with acetaminophen, albumin, cefepime, ciprofloxacin,
cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine in simulated Y-site admixtures for up to 1 hour.
Each medication in the study was either a commercially available preparation or, when no such preparation was available, diluted with normal saline or sterile water according to manufacturer directions. Concentrations used were logical for medications that are given via IVMB such as cefepime and meropenem. In the case of epinephrine and norepinephrine, the concentration tested was 128 mcg/mL to represent a need for infusions at “maximum concentration” to reduce excess fluid administration.
This was a well thought out physical compatibility study that provides practical information for clinicians who wish to administer hydrocortisone as a continuous infusion while minimizing the need for the placement of extra IV lines.
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