This chart is not all inclusive.

It is based on manufacturer’s recommendations

and Trissel’s.
KEY
C
 Compatible*

Dextran 6%/D5W/NS
Dextran 6% in D5W or normal saline
W
 Compatible in water not NS

D21⁄2W
 21⁄2% Dextrose in water

Fruc 10%/W/NS
Fructose 10% in water or normal saline
D5W
 5% Dextrose in water

D10W
 10% Dextrose in water

Invert sug 10%/W/NS

Invert sugar 10% in water or normal saline
D5/1⁄4NS
 5% Dextrose in1⁄4 normal saline

D5/1⁄2NS
 5% Dextrose in1⁄2 normal saline

Na Lactate1⁄6 M Sodium lactate1⁄6 M

D5NS
 5% Dextrose in normal saline
1
 Stable for 1 hour
NS
 Normal saline
2
 Stable for 2 hours
⁄ NS
12

1⁄2 Normal saline

4
 Stable for 4 hours
R
 Ringer’s solution
6
 Stable for 6 hours
LR
 Lactated Ringer’s solution
10
 Stable for 10 hours
D5R
 5% Dextrose in Ringer’s solution
P
 Preferred diluent
D5LR
 5% Dextrose in Lactated Ringer’s

solution
*Compatibility in various concentrations may vary; consult pharmacist.
Mosby items and derived items © 2010 by Mosby, Inc., an
affiliate of Elsevier Inc.
Some material was previously published.
VANCOMYCIN --drug class --Glycopeptide antibiotics
A drug may be classified by the chemical type of the active ingredient or by the way it
is used to treat a particular condition. Each drug can be classified into one or more
drug classes.

Rapid bolus administration (e.g., over several minutes) may be associated with exaggerated
hypotension, including shock, and, rarely, cardiac arrest. Vancomycin should be administered
over a period of not less than 60 minutes to avoid rapid-infusion-related reactions. Stopping
the infusion usually results in prompt cessation of these reactions.

Rapid infusion may also cause flushing of the upper body (“red neck”) or pain and muscle
spasm of the chest and back. These reactions usually resolve within 20 minutes but may
persist for several hours. Such events are infrequent if vancomycin is given by a slow infusion
over 60 minutes. In studies of normal volunteers, infusion-related events did not occur when
vancomycin was administered at a rate of 10 mg/min or less.

Compatibility with Other Drugs and Intravenous Fluids

Solutions that are diluted with 5% Dextrose Injection or 0.9% Sodium
Chloride Injection may be stored in a refrigerator for 14 days without
significant loss of potency. Solutions that are diluted with the
following infusion fluids may be stored in a refrigerator for 96 hours:

5% Dextrose Injection, USP

5% Dextrose and 0.9% Sodium Chloride Injection, USP
Lactated Ringer’s Injection, USP
Lactated Ringer’s and 5% Dextrose Injection, USP
Normosol®-M and 5% Dextrose
ISOLYTE® E

Vancomycin solution has a low pH and may cause chemical or

physical instability when it is mixed with other compounds.

Mixtures of solutions of vancomycin and beta-lactam antibiotics have

been shown to be physically incompatible. The likelihood of
precipitation increases with higher concentrations of vancomycin. It is
recommended to adequately flush the intravenous linesbetween the
administration of these antibiotics. It is also recommended to dilute
solutions of vancomycin to 5 mg/mL or less.
Compatibility with Other Drugs and IV Fluids

The following diluents are physically and chemically compatible (with 4 g/L
Vancomycin Hydrochloride):

5% Dextrose Injection, USP

5% Dextrose Injection and 0.9% Sodium Chloride Injection, USP

Lactated Ringer's Injection, USP

5% Dextrose and Lactated Ringer's Injection

Normosol®-M and 5% Dextrose

0.9% Sodium Chloride Injection, USP

Isolyte® E
5% Dextrose in water—A carbohydrate solution that uses glucose
(sugar) as the solute dissolved in sterile water. Five percent dextrose in
water is packed as an isotonic solution but becomes hypotonic once
in the body because the glucose (solute) dissolved in sterile water is
metabolized rapidly by the body’s cells.
Colloid solutions—IV fluids containing large proteins and molecules
that tend to stay within the vascular space (blood vessels).
Crystalloid solutions—IV fluids containing varying concentrations of
electrolytes.
Extracellular space—Space outside the cells consisting of the intravascular
and interstitial spaces.
Hypertonic crystalloid—A crystalloid solution that has a higher concentration
of electrolytes than the body plasma.
Hypotonic crystalloid—A crystalloid solution that has a lower concentration
of electrolytes than the body plasma.
Intracellular space—Space within the cells.
Intravascular volume—Volume of blood contained within the blood
vessels.
Intravenous fluids—Chemically prepared solutions that are administered
to a patient through the IV site.
Isotonic crystalloid—A crystalloid solution that has the same concentration
of electrolytes as the body plasma.
Lactated Ringer’s—An isotonic crystalloid solution containing the
solutes sodium chloride, potassium chloride, calcium chloride, and
sodium lactate, dissolved in sterile water (solvent).

Normal saline solution—An isotonic crystalloid solution that contains

sodium chloride (salt) as the solute, dissolved in sterile water (solvent).
The specific concentration for normal saline solution is 0.9%.
NS—See Normal saline solution.
NSS—See Normal saline solution.
Osmosis—The movement of water across a semipermeable membrane
from an area of lower solute concentration to an area of higher solute
concentration. This movement of water allows the equalization of the
solute-to-solution ratio across the membrane.
Oxygen-carrying solutions—Chemically prepared solutions that can
carry oxygen to the cells.
Plasma—Fluid surrounding the cells of the body.
Ringer’s lactate—See Lactated Ringer’s.
Solute—Particles that are dissolved in the sterile water (solvent) of an IV
fluid.
Solvent—The liquid portion of an IV solution that the solute(s) dissolves
into. The most common solvent is sterile water.
Total body water—Water contained within the cells, around the cells,
and in the bloodstream. Water comprises about 60% of the body’s
weight.
Case
INTRODUCTION
Intravenous fluids are chemically prepared solutions that are administered
to the patient. They are tailored to the body’s needs and used to replace lost
fluid and/or aid in the delivery of IV medications. For patients that do not
require immediate fluid or drug therapy, the continuous delivery of a small
amount of IV fluid can be used to keep a vein patent (open) for future use.
IV fluids come in different forms and have different impacts on the body.
Therefore, it is important to have an understanding of the different types of
IV fluids, along with their indications for use.

SUMMARY
There are several different types of fluids used for IV therapy. Depending
on their specific type and makeup, IV fluids can cause the shift and redistribution
of body water between the intracellular and extracellular compartments.
Therefore, it is important for the EMT to have a basic
understanding of the different IV fluids and to choose the fluid most
appropriate to the patient’s needs. Because most IV fluids are packaged in
similar-looking plastic bags, it is imperative for the EMT to carefully
examine the label on the bag to ensure the right fluid has been selected.
Administering an inappropriate IV fluid can result in undesirable complications,
as well as a less than optimal patient outcome.

AMPHOTERICIN B ---
The infusion solution, providing 0.1 mg Amphotericin B per mL, is then obtained by
further dilution (1:50) with 5% Dextrose Injection USP of pH above 4.2. The pH of
each container of Dextrose Injection should be ascertained before use. Commercial
Dextrose Injection usually has a pH above 4.2; however, if it is below 4.2, then 1 or 2
mL of buffer should be added to the Dextrose Injection before it is used to dilute the
concentrated solution of Amphotericin B.
Do not reconstitute with saline solutions. The use of any diluent other than the ones
recommended or the presence of a bacteriostatic agent (e.g., benzyl alcohol) in the
diluent may cause precipitation of the antibiotic.