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Physiochemical Stability of Intravenous Fat Emulsion in Combination with Medications Used for Resuscitation

Objective: Intravenous fat emulsion (IFE) is a potential therapy for lipophilic drug overdose. IFE stability with drugs commonly used in resuscitation has not been assessed. This study’s purpose is to examine the in vitro physiochemical stability of various combinations of IFE and medications commonly used in resuscitation by measuring the proportion of enlarged droplets greater than 5 micrometers (PFAT5) in IFE after mixture. Methods: We compared, in vitro, PFAT5 in various IFE-medication mixtures and a control (IFE alone). In order to assess the degree of coalescence, globule-size distribution was assessed according to method II of United States Pharmacopeia (USP) chapter 729. IFE was mixed in a 1:1 ratio with standard concentrations of medications. IFE- medication mixtures with PFAT5 >0.05% at time 0 and 1 hour were considered coalesced. If any results of method II exceeded PFAT5 of the control, analysis of the globule-size distribution data was conducted using a one tailed Student’s T test with a level of significance set at p<0.05. Results: At time zero, the PFAT5 of calcium chloride (p<0.001), dextrose 50% (p=0.03), glucagon (p<0.001), lidocaine (p=0.001), magnesium sulfate (p=0.02) and sodium bicarbonate (p<0.001) were significantly higher compared to control. At time 1 hour the PFAT5 of, amiodarone (p=0.02), calcium chloride (p<0.001), D50W (p<0.001), epinephrine (p<0.001), glucagon (p<0.001), insulin regular (p<0.001), magnesium sulfate (p<0.001), naloxone (p=0.02), sodium bicarbonate (p=0.01) and vasopressin (p<0.001) were significantly higher compared to control. Conclusion: IFE should be administered in a separate