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Appendix 1 (Fluids A-H)
Fluids A
Distilled Water
Dextrose 21/2% in Water
Dextrose 5% in Water
0.45% Sodium Chloride
0.9% Sodium Chloride
Dextrose 21/2% in 0.45% Sodium Chloride
Dextrose 21/2% in 0.9% Sodium Chloride
Dextrose 31/3% in 0.3% Sodium Chloride
Dextrose 5% in 0.2% Sodium Chloride
Dextrose 5% in 0.3% Sodium Chloride
Dextrose 5% in 0.45% Sodium Chloride
Dextrose 5% in 0.9% Sodium Chloride
Alcohol 5%, Dextrose 5% in Water
Alcohol 5%, Dextrose 5% in 0.9% Sodium Chloride
Ordway's Solution with 31/2% Dextrose
0.2% Potassium Chloride with 5% Dextrose
Sodium Chloride 3%
Sodium Chloride 5%
Fluids B
Dextrose 10% in Water
Dextrose 25% in Water
Dextrose 50% in Water
Dextrose 10% in 0.9% Sodium Chloride
Dextrose 20% in 0.9% Sodium Chloride
Dextrose 25% in 0.9% Sodium Chloride
Invert Sugar 5% in Water
Invert Sugar 10% in Water
Invert Sugar 5% in 0.9% Sodium Chloride
Invert Sugar 10% in 0.9% Sodium Chloride
Levulose 5% in Water
Levulose 10% in Water
Levulose 10% in 0.9% Sodium Chloride
0.3% Potassium Chloride in 10% Invert
Sugar with 0.45% Sodium Chloride
Fluids C
Lactated Ringer's
Dextrose 21/2% in Half-Strength Lactated Ringer's
Dextrose 21/2% in Lactated Ringer's
Dextrose 5% in Lactated Ringer's
Darrow's Solution
M/6 Sodium Lactate
Electrolyte #48 with 5% Dextrose
Electrolyte #75 with 5% Dextrose
Polysal G in Water
Polysal with 5% Dextrose
Polysal-M with 21/2% Dextrose
Polysal-M with 5% Dextrose
Fluids D
Dextrose 10% in Lactated Ringer's
Electrolyte #48 with 5% Levulose
Electrolyte #48 with 10% Levulose
Electrolyte #75 with 5% Levulose
Polysal-M with 10% Dextrose
Electrolyte # 1 with 10% Invert Sugar
Electrolyte #2 with 10% Invert Sugar
Electrolyte #3 with 10% Invert Sugar
0.9% Ammonium Chloride in Water
2.14% Ammonium Chloride in Water
Fluids E
CPHO 5% in Water
CPH 5%, Dextrose 5% in Water
CPH 5%, Dextrose 5%, Alcohol 5% in Water
CPH 31/3%, Dextrose 31/3% in 1/3-Strength Lactated Ringer's
Fluids F
Ringer's Solution
Dextrose 21/2% in Half-Strenth Ringer's
Dextrose 5% in Ringer's
Dextrose 10% in Ringer's
Fluids G
Vitadex-BID with 5% Dextrose in Water
Vitadex-B with 10% Dextrose in Water
Vitadex-B with 5% Dextrose in 0.9% Sodium Chloride
Vitadex-B with 10% Dextrose in 0.9% Sodium Chloride
Vitadex-B with 5% Dextrose in Water with 5% Alcohol
Vitadex-B with 5% Dextrose in 0.9% Sodium Chloride with 5% Alcohol
Fluids H
0.1% Procaine Hydrochloride in 0.9% Sodium Chloride
0.2% Procaine Hydrochloride in 0.45% Sodium Chloride
0.2% Procaine Hydrochloride in 0.9% Sodium Chloride
Appendix 2 (Abbo-Vac Solutions)
Alcohol 5%
Dextrose 5%
Aminosol 5%
Beclysyl with Dextrose 5%, NaCl
Beclysyl with Dextrose 5%
Dextran (Dextran 75) 6%, Dextrose 5%
Dextran (Dextran 75) 6% in Saline
Dextrose 5% in LRS
2.5% Dextrose in Half-Strength LRS
Dextrose 5% in Ringer's Injection
2.5% Dextrose in Half-Strength Ringer's Injn
Dextrose 10% in Saline
Dextrose 5% in Saline
Dextrose 5% in Half-Strength Saline
Dextrose 5% in Quarter-Strength Saline
Dextrose 5% in Third-Strength Saline
2.5% Dextrose in Half-Strength Saline
Dextrose 50% in Water
Dextrose 20% in Water
Dextrose 10% in Water
Dextrose 5% in Water
2.5% Dextrose in Water
Fructose 10% in Water
Inpersol with Dextrose 1.5%
Invert Sugar 10% in Saline
Invert Sugar 10T in Water
Invert Sugar 5% in Water
Ionosol B with Dextrose 5%
Ionosol B with Invert Sugar 10%
Ionosol D-CM
Ionosol D-CM with Dextrose 5%
Ionosol D Mod. with Invert Sugar 10%
Ionosol G with Dextrose 10%
Ionosol G with Invert Sugar 10%
Ionosol MB with Dextrose 5%
Ionosol T with Dextrose 5%
Lactated Ringer's Injection
LIVID 10% w/v in Dextrose 5%
LIVIC 10% w/v in Saline 0.9%
Normosol-M in D5W
Normosol-M 900 Cal
Normosol-M and Surbex-T in D5W
Normosol-R
Normosol-R in D5W
Normosol-R pH 7.4
Ringer's Injection
Sodium Chloride 0.45%
Sodium Chloride Injection
Sodium Chloride 5%
Sodium Lactate, 1/6 Molar
Surbex-T Solution in D5W
Infusion Fluid Abbreviations
| Abbreviation | Definition |
|---|---|
| UNSP | Reports data on direct admixture without dilution, or those combinations for which an infusion fluid was not specified in the original research report. The reader should refer to the written entries for details on dose, concentration, temperature, etc. |
| BWFI | Bacteriostatic Water For Injection |
| SWFI | Sterile Water For Injection |
| D5W | Dextrose 5% in Water (5% Dextrose Injection, U.S.P.) |
| D2.5½S | Dextrose 2.5% in 0.45% Sodium Chloride, U.S.P. |
| D5.33S | Dextrose 5% in 0.3% Sodium Chloride, U.S.P. |
| D5.45S | Dextrose 5% in 0.45% Sodium Chloride, U.S.P. |
| D10W | Dextrose 10% in Water (10% Dextrose Injection, U.S.P.) |
| D20W | Dextrose 20% in Water (20% Dextrose Injection, U.S.P.) |
| D5LR | Dextrose in Lactated Ringer's® Solution (5% Dextrose in Lactated Ringer's® Injection) |
| D5¼S | Dextrose 5% in 1/4 Strength Saline (5% Dextrose and 0.22% Sodium Chloride Injection, U.S.P.) |
| D5½S | Dextrose 5% in 1/2 Strength Saline (5% Dextrose and 0.45 % Sodium Chloride Injection, U.S.P.) |
| D5NS | Dextrose 5% in Normal Saline (5% Dextrose and 0.9% Sodium Chloride Injection, U.S.P.) |
| D5R | Dextrose 5% in Ringer's® Injection (5% Dextrose in Ringer's® Injection) |
| D10NS | Dextrose 10% in Normal Saline (10% Dextrose and 0.9% Sodium Chloride Injection, U.S.P.) |
| IS10S | Invert Sugar 10% in Saline (10% Invert Sugar in 0.9% Sodium Chloride Injection) |
| IS10W | Invert Sugar 10% in Water for Injection, U.S.P. |
| LR | Lactated Ringer's® Injection, U.S.P. |
| Pr Hyd | Protein Hydrolysate (Protein Hydrolysate Injection, U.S.P.) |
| R | Ringer's® Injection, U.S.P. |
| NS | Sodium Chloride 0.9% (Normal Saline) (0.9% Sodium Chloride Injection, U.S.P.) |
| SOD CL 5 | Sodium Chloride 5% (5% Sodium Chloride Injection) |
| SL | Sodium Lactate, 1/6 Molar (M/6 Sodium Lactate Injection, U.S.P.) |
Compatibility Symbols
The special grid included on monograph pages allows for quick reporting of compatibility 
,
incompatibility 
, or conflicting data 
. In some instances conflicting
results have been reported in the literature for a particular admixture.
These contradictory reports are noted with a , and are described in the
written entries.
NOTE:
Absence of a notation in the grid does not imply that
the combination is compatible. Rather, it means that no information has been
reported for that particular combination. The presence of other symbols in
the grid, such as # and *, are included to help the reader locate the
specific written entry about the drug combination, and the reference that
pertains to that entry.
| Symbol | Definition |
|---|---|
|
Incompatible |
|
Compatible |
|
Conflicting Reports |
| NA or blank | No Information Available (do not mix) |
Types of Incompatibility
Many studies on the compatibility of parenteral admixtures have used precipitation, effervescence, color change, and related visual methods as the criteria for deciding if a combination is compatible. These changes that are detected by the unaided eye are termed physical or visual incompatibilities. Physically incompatible combinations of parenterals should not be administered.Some studies on the compatibility of parenteral admixtures have investigated the change in potency or stability of the admixed drugs. These changes that are not visible with the unaided eye are termed nonvisual or chemical incompatibility. Stability, per se, has been defined as a product or combination of drugs that retain at least 90% of its original potency during the life of the product. Therefore a mixture is rated chemically incompatible(or unstable) if it loses more than 10% of its original concentration. Chemically incompatible combinations of parenterals should not be administered.
Conflicting Reports
Contradictory results have been reported over the years in research studies on parenteral drug admixture compatibility. Some of these conflicting reports may be attributed to the concentrations used in a particular study, the order of mixing, adjuvants included in the formulations, materials from which contained may be fabricated, and unavoidable differences in various lots of the same drug product. Variations in permissible pH ranges of some infusion fluids may also contribute to the problem of conflicting reports. In addition some combinations may be physically (i.e., visually) compatible yet be chemically (i.e., nonvisually) incompatible. The symbol in the grid for conflicting data is Ø. The reader should use caution when deciding on the appropriateness of a given admixture if conflicting data has been reported.
Compatbility of Multiple Drug Admixtures
Most drug research and studies report compatibility of two drugs. The compatibility of two or more drugs in the same IV line/container should not be inferred from information presented in King Guide, unless data on that specific combination has actually been reported in the monograph. That is, if King Guide reports that drug A is compatible with drug B, and that drug A is compatible with drug C, one must not assume that drug A plus drug B plus drug C would be compatible in the same container or IV line.
Although situations may occur that necessitate using individual clinical and scientific judgment to decide on the advisability of co-mixing drugs, the practitioner is cautioned that the safest approach is to rely upon published data, rather than assuming compatibility.
In the absence of valid published research data on a given combination, all possible avenues should be explored in lieu of admixture, such as consideration of alternative routes of administration and alternative ways of administering the same drugs intravenously. If the practitioner decides to prepare and administer an admixture without supporting data on stability and compatibility, careful evaluation of the resultant admixture and monitoring of the patient is mandatory.
Frequently Asked Questions
Below are answers to some of our most common questions regarding the internet edition.
Q: I do not see the drug in the list?
A: There is no information in the King Guide to Parenteral Admixtures for the drug. The list you see is a list of drugs that are in the King Guide or a list of drugs that there is information on in combination with another drug already chosen. Therefore, if it is not in the list, there is no information available.
Q: How can I determine compatibility of several drugs at once?
A: Add up to 10 drugs to the results. The screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the fluids and dosages used to determine compatibility, click any symbol in the table.
Q: Where do I find compatibility information for a single injectable drug and a fluid?
A: Put a single drug in the 'Search List' then view the sections titled 'Stability' and/or 'Uncombined' on the screen.
Q: Where do I find information on fluids?
A: Fluids With A Single Drug:
Search for a single drug then click one of the three type of mixing ('y-site', 'syringe', 'admixture') buttons to view the compatibility table on the resulting screen. The compatibility table lists every drug there is information on with the first drug along with a grid of 12 fluids with symbols that indicate compatibility for that fluid. Click on any drug in the table to view the complete text of the monograph for the drug combination including details on fluids, temperatures, dosages etc.
Fluids With Multiple Drugs:
Add up to 10 drugs to the results. The resulting screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the fluids and dosages used to determine compatibility, click any symbol in the table.
Q: Where do I find compatibility information for Y-Site administration?
A: Single Drug:
Search for a single drug then click the 'y-site' button to view the y-site compatibility table on the resulting screen. The compatibility table lists every drug there is information on with the first drug along with a grid of 12 fluids with symbols that indicate compatibility for that fluid. Click on any drug in the table to view the complete text of the monograph for the drug combination including details on fluids, temperatures, dosages etc.
Multiple Drugs:
Add up to 10 drugs to the results. The resulting screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the fluids and dosages used to determine compatibility, click any symbol in the table.
Each monograph specifies (if available) the routes, temperatures, dosages, and containers used in the study.
Q:What is the meaning of the infusion fluid column 'UNSP'?
The word Unspecified is currently used as the miscellaneous category of certain infusion fluids in our compatibility tables. Initially, it was a column that we used to show results of published reports on the compatibility of 2 drugs in which the authors did not specific an infusion fluid, hence the word, unspecified. We have continued to use that "shorthand" but have expanded the meaning of the column heading Unspecified to include any other infusion fluid that is not already shown as a column heading. (Space and formatting limitations restricted us to column headings for 11 fluids).
For example, the compatibility of 2 drugs in SWFI or BWFI would be reported with a symbol in the unspecified column. Or, if drug A was diluted in NS and drug B was diluted in SWFI, then we would indicate their compatibility with a symbol in both the NS and SWFI columns.
We strive to include a statement and reference along with the column designation to provide more specific information when available.
Q:How do I find compatibility of electrolytes with IV drugs?
King Guide to Parenteral Admixtures provides monographs for individual drugs in combination with many other drugs, including specific electrolytes, e.g., potassium chloride. These monographs also provide stability information with a variety of infusion fluids, some of which contain electrolytes. Examples include various ringer's solutions, various saline concentrations, and others.
In addition, major electrolytes are listed as individual monographs, with data on combining with other drugs. For example, calcium chloride, calcium gluconate, potassium acetate, potassium chloride; potassium phosphate, etc. These monographs provide data on compatibility with a variety of parenteral drugs. However, we do not provide a monograph, Electrolytes. Rather, one must search by the specific name.
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