Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults

Annals of Intensive Care

Table 2 Most used medication in the intensive care unit to be diluted for continuous infusion, slow bolus administration or both. The stability of the diluted product is dependent on its end concentration and environmental temperature. The product’s stability in its compatible diluent has been confirmed for the conventional administration times and volumes. For detailed data, we refer to each drug’s SmPC (summary of product characteristics) or relevant databases

	NaCl 0.9% mandatory	G5% or D5% or NaCl 0.9% equally possible	G5% or D5% mandatory	Administration in its pure form using a syringe pump feasible
Anti-infectives
Continuous or prolonged (4-8 h) infusion		Benzylpenicillin
		Cefepime dihydrochloride
		Ceftazidime pentahydrate
		Meropenem trihydrate^a
		Piperacillin–tazobactam
		Temocillin
		Vancomycin^b
Short infusion (15–90 min, depending on product)	Amoxicillin–clavulanate^c	Benzylpenicillin
	Acyclovir^d	Cefepime dihydrochloride
		Ceftazidime pentahydrate
		Ciprofloxacin^e
		Flucloxacillin
		Meropenem trihydrate^a
		Piperacillin–tazobactam
		Sulfamethoxazole–trimethoprim^f
		Temocillin
		Vancomycin^b
Vasoactive and antiarrhythmic medication
Continuous infusion	Somatostatin	Adrenaline tartrate or HCl^g	Amiodarone HCl	Isosorbide dinitrate
		Dobutamine HCl	Norepinephrine^k	Labetalol
		Isosorbide dinitrate^h		Nicardipine
		Labetalol		Nimodipine
		Milrinone		Urapidil HCl
		Molsidomine
		Nicardipine^h
		Urapidil HCl
		Clonidine HCl
Short infusion (15–90 min, depending on product)		Labetalol	Amiodarone HCl
Sedatives, analgetics and antiepileptic agents
Continuous infusion		Alfentanyl		Alfentanyl
		Clonidine HCl		Fentanyl citrate
		Dexmedetomidine HCl		Ketamine
		Fentanyl citrate		Midazolam HCl
		Ketamine		Morphine HCl
		Midazolam HCl		Sufentanyl citrate
		Morphine HCl
		Remifentanyl
		Sufentanyl citrate
		Thiopental sodium
		Valproate sodium
Short infusion (15–90 min, depending on product)	Phenytoin sodium	Levetiracetam
Short infusion (15–90 min, depending on product)	Phenytoin sodium	Valproate sodium

	G5% or D5% or NaCl 0.9% equally possible	Administration in its pure form using a syringe pump feasible
Other common medications used in the ICU
Continuous infusion	Cisatracurium besylate	Bumetanide
	Concentrated electrolytes (KCl, MgSO4)	Cisatracurium besylate
	Furosemideⁱ	Concentrated electrolytes^j
	Heparin sodium	Furosemide
	Methylprednisolone sodium succinate	Heparin sodium
	N-Acetylcysteine
	Regular insulin
Short infusion (15–90 min, depending on product)	Bumetanide
	Concentrated electrolytes (KCl, MgSO4)
	Furosemideⁱ
	N-Acetylcysteine
	Methylprednisolone sodium succinate

D5% dextrose 5%
G5% glucose 5%
^aSome sources report a stability of less than 4 h in G5%
^bAfter reconstitution with aqua
^cAfter reconstitution with aqua or NaCl 0.9%
^dGlucose 5% possible but probably less stable because of Maillard reaction
^eMostly commercially prediluted, solvent differs by brand
^fMinimal necessary volume for dilution: 400 mg + 80 mg/5 mL in 75 mL
^gpH of G5% needs to be around 5.5, otherwise reduced stability
^hAvoid polyvinylchloride (PVC) when diluted in NaCl (sorption to PVC 9 pH of G5% needs to be around)
ⁱPrecipitation possible if pH < 5.5–7
^jDepending on the initial concentration
^kAlthough strictly not impossible to dissolve in NaCl 0.9%, G5% is recommended for protection against significant drug loss due to oxidation