Special IV Remarks
Albumin 5% and 25% Premix:
Infusion rate : Admixture 5%: 12.5gm/250ml infused over 30 to 60min and 25gm/500ml infused over 1-3hrs. Albumin 5% solution: 5-10 ml/minute maximum. Albumin 25%: 12.5gm/50ml over 30min. 25gm25% vials: 2-3 ml/minute maximum/100ml infused over 45 to 60min. Maximum dose/day: 250 grams/48 hours. Discard unused solution after 4 hours.
Additives added to Diabetic IV Fluids (Ped):
Additives added to make D10 NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make D10 1/2NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make D10 1/4NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make 1/2NS + K Acet 25meq/L + KPO4 10mMols/L
Ampho B - Lipid:
The recommended daily dosage for adults and children is 5 mg/kg given as a single infusion. ABELCET® should be administered by intravenous infusion at a rate of 2.5 mg/kg/hr. If the infusion time exceeds 2 hours, mix the contents while infusion by shaking the infusion bag every 2 hours.
BABYBIG INFUSION (Botulism Immune Globulin Intravenous (Human) (BIG-IV)
Bigin infusion slowly - Administer BabyBig intravenously at 0.5ml per Kg body weight per hour (25mg/kg/hr). If no untoward reactions occur after 15 minutes, the rate may be increased to 1.0 ml/kg/hr. DO NOT EXCEED THIS RATE OF ADMINISTRATION. Monitor the patient closely during and after each rate change. At the recommended rates infusion of the indicated dose should take 127.5 minutes total elapsed time.
IVIG (Ped)
IVIG 400mg-500mg/kg (for 10 kg patient)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to maximum of 48ml/hr. Complete the total infusion over 2 to 3 hours.
IVIG 1,000mg/kg (for 10 kg patients)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to a maximum of 48ml/hr. Complete the total infusion over 4 to 6 hours.
IVIG 2,000mg/kg (for 10 kg patients)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to a maximum of 48ml/hr. Complete the total infusion over 8 to 10 hours.
IV Fluids w/ Additives (Ped)
Each 240ml (10ml/hr X 24 hrs) contains all additives per 24 hours as shown above on this label. Total made 270ml (240ml + 30ml extra):
MVI added once a day
Per Hospital Policy MVI, Thiamine, Folic acid, and MgSO4 added to only one IV bag daily. Whenever Banana bag (MVI bag) completed in less than 20 hours run the base solution w/o MVI @ same IV rate during the remaining 24 hours of that particular day.
Per Hospital Policy MVI, Thiamine, and Folic acid added to only one IV bag daily. Whenever MVI bag completed in less than 20 hours run the base solution w/o MVI @ same IV rate during the remaining 24 hours of that particular day.
Potassium Chloride: (Ped)
Infusion Rate – Potassium salts may NOT be administered direct IV (IV push). Infusion rate includes all sources of intravenous potassium. Maximum recommended rate = 0.3 – 0.5 mEq/kg/hr. For concentrations in excess of 80 mEq/L, these infusion should be given through a central line or large venous cut-down.
Potassium and Sodium Phosphate: (Ped)
Rate of Administration: Administer over 6 hours or 0.02 mM/kg/hr. Maximum rate NOT to exceed 0.06 mM/kg/hr in severe hypophosphatemia. For central line NaPo4/ K P04 1ml of salt diluted in 25ml IV solution but for peripheral line NaPO4 1ml diluted in in 25ml whereas KPO4 1ml diluted in 60ml.
Septra or Bactrim (Usual diluent D5W)
1 to 80 mg/ 100 ml over 60 min
81 to 120 mg/ 150-250 ml over 90 min
121 to 240 mg/ 250 ml over 90 min
241 to 450 mg/ 500 ml over 2 hours
Renal Dose Adjustments
ACYCLOVIR (ZOVIRAX): For Creatinine Clearance >50 ml/min use standard regimen, 30-50 ml/min use 5-10mg/kg q12h, 10-30ml/min 5-10mg/kg q24h, and for <10 ml/min use 2.5 to 5mg/kg q24h
FAMOTIDINE: Dose adjusted due to poor creatinine clearance 35ml/min which requires dose adjustment for creatinine clearance <49ml/min to decrease the dose by 50% (e.g. 10mg q12h or 20mg qhs) or extend the interval to q36-48h.
LEVOQUIN: Dose adjustment for poor creatinine clearance, If >50 no change,
20-49 ml/min use 500 x 1, then 250mg q24h, and 10-19 ml/min 500mg x 1, 250mg q48h and for Complicated skin/structure if creatinine clearanc 20-49ml/min use 750 mg x 1, then 750mg q48h and if creatinine clearanc <19ml/min use 750mg X1 and then 500mg Q48H.
METFORMIN: Contraindicated: Males with a serum creatinine > 1.5 mg/dl or females >1.4 mg/dl. Also patients with an abnormal creatinine clearance (~ <60-70 ml/min).
NITROPRUSSIDE: During renal impairment accumulation of thiocyanate may occur. Use the lowest end of the dosage <2 mcg /kg /minute to avoid toxicity. Signs of toxicity include: venous hypoxemia, acidosis, mental status changes, and death. Thiocyanate levels >60 mg/L are mildly neurotoxic and can become life-threatening at approximately 200 mg/L.
PIPERACILLIN/TAZOBACTAM (ZOSYN): For creatinine clearance 40-90 ml/min use 3.375 grams q6h, 20-40 ml/min use 2.25 gm q6h, for nosocomial pneumonia use 3.375g q6h, and when creatinine clearance <20 use 2.25 grams q8h and for nosocomial pneumonia use 2.25 gm q6h.
TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM): Patients who receive cotrimoxazole intravenously or orally and have impaired renal function should be dosed according to the following dosage schedule for Creatinine Clearance >30ml/min standard regimen, 15-30 ml/min 1/2 standard regimen, and < 15ml/min not recommended.
DISCLAIMER
The information contained on this website is for informational purposes only, and should not be used to replace professional medical advice. Visitors to the website are responsible for how they chose to utilize this content.
This information should not be considered complete, nor should it be relied on in diagnosing or treating a medical condition. Content on this website does not contain information on all diseases, ailments, physical conditions or their treatment.
It is best to seek advice and attention from your physician or qualified healthcare professional. Always consult your physician before beginning a new treatment, diet or fitness program.
Walnut HealthCare and the participating hospitals do not endorse nor have responsibility for the contents of any other websites linked to or from www.walnuthealthcare.com or www.walnuthealthcare.org.
Please note that all inpatient pharmacists at the participating hospitals are trained and contiuously recertified before they can use any of the protocols per pharmacy on patients. Per Pharmacy Protocols are those Protocols which are approved by hospital’s P&T committee and to which the pharmacy adheres in order to provide medications to patients in a safe, efficient and ethical manner.
Albumin 5% and 25% Premix:
Infusion rate : Admixture 5%: 12.5gm/250ml infused over 30 to 60min and 25gm/500ml infused over 1-3hrs. Albumin 5% solution: 5-10 ml/minute maximum. Albumin 25%: 12.5gm/50ml over 30min. 25gm25% vials: 2-3 ml/minute maximum/100ml infused over 45 to 60min. Maximum dose/day: 250 grams/48 hours. Discard unused solution after 4 hours.
Additives added to Diabetic IV Fluids (Ped):
Additives added to make D10 NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make D10 1/2NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make D10 1/4NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make NS + K Acet 25meq/L + KPO4 10mMols/L
Additives added to make 1/2NS + K Acet 25meq/L + KPO4 10mMols/L
Ampho B - Lipid:
The recommended daily dosage for adults and children is 5 mg/kg given as a single infusion. ABELCET® should be administered by intravenous infusion at a rate of 2.5 mg/kg/hr. If the infusion time exceeds 2 hours, mix the contents while infusion by shaking the infusion bag every 2 hours.
BABYBIG INFUSION (Botulism Immune Globulin Intravenous (Human) (BIG-IV)
Bigin infusion slowly - Administer BabyBig intravenously at 0.5ml per Kg body weight per hour (25mg/kg/hr). If no untoward reactions occur after 15 minutes, the rate may be increased to 1.0 ml/kg/hr. DO NOT EXCEED THIS RATE OF ADMINISTRATION. Monitor the patient closely during and after each rate change. At the recommended rates infusion of the indicated dose should take 127.5 minutes total elapsed time.
IVIG (Ped)
IVIG 400mg-500mg/kg (for 10 kg patient)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to maximum of 48ml/hr. Complete the total infusion over 2 to 3 hours.
IVIG 1,000mg/kg (for 10 kg patients)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to a maximum of 48ml/hr. Complete the total infusion over 4 to 6 hours.
IVIG 2,000mg/kg (for 10 kg patients)
Start infusion at 6ml/hr, if no adverse reactions, then every 30 minutes, double the rate of infusion up to a maximum of 48ml/hr. Complete the total infusion over 8 to 10 hours.
IV Fluids w/ Additives (Ped)
Each 240ml (10ml/hr X 24 hrs) contains all additives per 24 hours as shown above on this label. Total made 270ml (240ml + 30ml extra):
MVI added once a day
Per Hospital Policy MVI, Thiamine, Folic acid, and MgSO4 added to only one IV bag daily. Whenever Banana bag (MVI bag) completed in less than 20 hours run the base solution w/o MVI @ same IV rate during the remaining 24 hours of that particular day.
Per Hospital Policy MVI, Thiamine, and Folic acid added to only one IV bag daily. Whenever MVI bag completed in less than 20 hours run the base solution w/o MVI @ same IV rate during the remaining 24 hours of that particular day.
Potassium Chloride: (Ped)
Infusion Rate – Potassium salts may NOT be administered direct IV (IV push). Infusion rate includes all sources of intravenous potassium. Maximum recommended rate = 0.3 – 0.5 mEq/kg/hr. For concentrations in excess of 80 mEq/L, these infusion should be given through a central line or large venous cut-down.
Potassium and Sodium Phosphate: (Ped)
Rate of Administration: Administer over 6 hours or 0.02 mM/kg/hr. Maximum rate NOT to exceed 0.06 mM/kg/hr in severe hypophosphatemia. For central line NaPo4/ K P04 1ml of salt diluted in 25ml IV solution but for peripheral line NaPO4 1ml diluted in in 25ml whereas KPO4 1ml diluted in 60ml.
Septra or Bactrim (Usual diluent D5W)
1 to 80 mg/ 100 ml over 60 min
81 to 120 mg/ 150-250 ml over 90 min
121 to 240 mg/ 250 ml over 90 min
241 to 450 mg/ 500 ml over 2 hours
Renal Dose Adjustments
ACYCLOVIR (ZOVIRAX): For Creatinine Clearance >50 ml/min use standard regimen, 30-50 ml/min use 5-10mg/kg q12h, 10-30ml/min 5-10mg/kg q24h, and for <10 ml/min use 2.5 to 5mg/kg q24h
FAMOTIDINE: Dose adjusted due to poor creatinine clearance 35ml/min which requires dose adjustment for creatinine clearance <49ml/min to decrease the dose by 50% (e.g. 10mg q12h or 20mg qhs) or extend the interval to q36-48h.
LEVOQUIN: Dose adjustment for poor creatinine clearance, If >50 no change,
20-49 ml/min use 500 x 1, then 250mg q24h, and 10-19 ml/min 500mg x 1, 250mg q48h and for Complicated skin/structure if creatinine clearanc 20-49ml/min use 750 mg x 1, then 750mg q48h and if creatinine clearanc <19ml/min use 750mg X1 and then 500mg Q48H.
METFORMIN: Contraindicated: Males with a serum creatinine > 1.5 mg/dl or females >1.4 mg/dl. Also patients with an abnormal creatinine clearance (~ <60-70 ml/min).
NITROPRUSSIDE: During renal impairment accumulation of thiocyanate may occur. Use the lowest end of the dosage <2 mcg /kg /minute to avoid toxicity. Signs of toxicity include: venous hypoxemia, acidosis, mental status changes, and death. Thiocyanate levels >60 mg/L are mildly neurotoxic and can become life-threatening at approximately 200 mg/L.
PIPERACILLIN/TAZOBACTAM (ZOSYN): For creatinine clearance 40-90 ml/min use 3.375 grams q6h, 20-40 ml/min use 2.25 gm q6h, for nosocomial pneumonia use 3.375g q6h, and when creatinine clearance <20 use 2.25 grams q8h and for nosocomial pneumonia use 2.25 gm q6h.
TRIMETHOPRIM/SULFAMETHOXAZOLE (BACTRIM): Patients who receive cotrimoxazole intravenously or orally and have impaired renal function should be dosed according to the following dosage schedule for Creatinine Clearance >30ml/min standard regimen, 15-30 ml/min 1/2 standard regimen, and < 15ml/min not recommended.
DISCLAIMER
The information contained on this website is for informational purposes only, and should not be used to replace professional medical advice. Visitors to the website are responsible for how they chose to utilize this content.
This information should not be considered complete, nor should it be relied on in diagnosing or treating a medical condition. Content on this website does not contain information on all diseases, ailments, physical conditions or their treatment.
It is best to seek advice and attention from your physician or qualified healthcare professional. Always consult your physician before beginning a new treatment, diet or fitness program.
Walnut HealthCare and the participating hospitals do not endorse nor have responsibility for the contents of any other websites linked to or from www.walnuthealthcare.com or www.walnuthealthcare.org.
Please note that all inpatient pharmacists at the participating hospitals are trained and contiuously recertified before they can use any of the protocols per pharmacy on patients. Per Pharmacy Protocols are those Protocols which are approved by hospital’s P&T committee and to which the pharmacy adheres in order to provide medications to patients in a safe, efficient and ethical manner.
