Quality Control of Compounded Crystalloid Fluids for Intravenous Delivery to Horses.
Abstract: Periodic lack of availability and high cost of commercially produced isotonic fluids for intravenous (IV) use in horses have increasingly led to use of home-made or commercially compound fluids by veterinarians. Data regarding the quality control and safety of compounded fluids would be of benefit to equine veterinarians. Objective: To compare electrolyte concentrations, sterility, and endotoxin contamination of commercially available fluids to 2 forms of compounded isotonic crystalloid fluids intended for IV use in horses. Methods: Prospective study. Two methods of preparing compounded crystalloids formulated to replicate commercial Plasma-Lyte A (Abbott, Chicago, IL) were compared. One formulation was prepared by a hand-mixed method involving chlorinated drinking water commonly employed by equine practitioners, and the other was prepared by means of ingredients obtained from a commercial compounding pharmacy. The variables for comparison were electrolyte concentrations, sterility, and presence of endotoxin contamination. Results: Electrolyte concentrations were consistent within each product but different between types of fluids (P < 0.0001). Hand-mixed fluids had significantly more bacterial contamination compared to commercial Plasma-Lyte A (P = 0.0014). One of the hand-mixed fluid samples had detectable endotoxin contamination. Conclusions: Chlorinated drinking water is not an acceptable source of water to compound isotonic fluids for IV administration. Equine practitioners should be aware of this risk and obtain the informed consent of their clients.
Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Publication Date: 2017-11-08 PubMed ID: 29114956PubMed Central: PMC5787182DOI: 10.1111/jvim.14864Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research study investigates the quality and safety of two types of homemade or compounded isotonic crystalloid fluids for horses, compared to commercially produced fluids. The study finds that homemade fluids have inconsistent electrolyte concentrations, more bacterial contamination, and potential endotoxin contamination, highlighting the risks associated with using chlorinated drinking water as a source for creating such fluids.
Objective and Methodology of the Study
- The primary objective of this study was to check the quality control and safety issues related to compounded crystalloid fluids used as intravenous (IV) therapy for horses, as compared to commercial isotonic fluids.
- Two types of compounded fluids were prepared and analyzed. One used chlorinated drinking water while the other used ingredients procured from a commercial compounding pharmacy.
- The electrolyte concentrations, sterility, and presence of endotoxin contamination were compared across the commercially available fluids and the two prepared crystalloid fluids.
Findings of the Study
- The study revealed that while electrolyte concentrations were consistent within each type of product, there were significant differences between the various types of fluids, particularly in the homemade ones.
- The hand-mixed fluids—those made using chlorinated drinking water—showed notably higher bacterial contamination compared to the commercial Plasma-Lyte A alternative. This poses serious questions about the adequacy of commonly-used water sources in homemade fluid production.
- Furthermore, the study detected endotoxin contamination in one of the samples of hand-mixed fluids, presenting another layer of risk in usage.
Conclusions and Recommendations
- The research concluded that chlorinated drinking water is not a safe source for compounding isotonic fluids meant for IV administration in horses. This is due to the risk of bacterial and endotoxin contamination.
- It recommended equine practitioners be informed of these risks and consult with clients before making decisions on fluid administration. This could promote caution and ensure the use of safer and higher-quality alternatives.
Cite This Article
APA
Magnusson CB, Poulsen KP, Budde JA, Hartmann FA, Aulik NA, Raabis SM, Moreira ASD, Darien BJ, Peek SF.
(2017).
Quality Control of Compounded Crystalloid Fluids for Intravenous Delivery to Horses.
J Vet Intern Med, 32(1), 469-473.
https://doi.org/10.1111/jvim.14864 Publication
Researcher Affiliations
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Wisconsin Veterinary Diagnostic Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- UW Veterinary Care Pharmacy, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Clinical Pathology Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Wisconsin Veterinary Diagnostic Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
MeSH Terms
- Animals
- Crystalloid Solutions
- Drug Compounding / methods
- Drug Compounding / veterinary
- Drug Contamination
- Electrolytes / standards
- Endotoxins / analysis
- Horses
- Infusions, Intravenous / standards
- Infusions, Intravenous / veterinary
- Isotonic Solutions / chemistry
- Isotonic Solutions / pharmacology
- Quality Control
- Water / chemistry
Grant Funding
- T32 OD010423 / NIH HHS
References
This article includes 11 references
- Food and Drug Administration Center for Veterinary Medicinen. Large Volume Intravenous (IV) Solution Shortage. 2015.
- Denkhaus M, Van Amstel S. Adverse effects following intravenous fluid therapy in the horse using non-commercial fluids: preliminary findings.. J S Afr Vet Assoc 1986 Jun;57(2):105-7.
- Williamson P, Munyua S, Martin R, Penhale WJ. Dynamics of the acute uterine response to infection, endotoxin infusion and physical manipulation of the reproductive tract in the mare.. J Reprod Fertil Suppl 1987;35:317-25.
- Burrows GE. Equine Escherichia coli endotoxemia: comparison of intravenous and intraperitoneal endotoxin administration.. Am J Vet Res 1979 Jul;40(7):991-8.
- Burrows GE. Endotoxaemia in the horse.. Equine Vet J 1981 Apr;13(2):89-94.
- Hendrickson R. How to deal with the IV fluid shortage. 2014.
- United States Pharmacopeial Convention (USP). USP 37 Microbiological tests/Sterility tests. 2015.
- Eppinger M, Bunk B, Johns MA, Edirisinghe JN, Kutumbaka KK, Koenig SS, Creasy HH, Rosovitz MJ, Riley DR, Daugherty S, Martin M, Elbourne LD, Paulsen I, Biedendieck R, Braun C, Grayburn S, Dhingra S, Lukyanchuk V, Ball B, Ul-Qamar R, Seibel J, Bremer E, Jahn D, Ravel J, Vary PS. Genome sequences of the biotechnologically important Bacillus megaterium strains QM B1551 and DSM319.. J Bacteriol 2011 Aug;193(16):4199-213.
- Anderson RL, Highsmith AK, Holland BW. Comparison of the standard pour plate procedure and the ATP and Limulus amebocyte lysate procedures for the detection of microbial contamination in intravenous fluids.. J Clin Microbiol 1986 Mar;23(3):465-8.
- United States Pharmacopeial Convention (USP). USP 85 Bacterial Endotoxins Test. 2015.
- Menzies-Gow NJ, Bailey SR, Katz LM, Marr CM, Elliott J. Endotoxin-induced digital vasoconstriction in horses: associated changes in plasma concentrations of vasoconstrictor mediators.. Equine Vet J 2004 Apr;36(3):273-8.
Citations
This article has been cited 2 times.- Crabtree NE, Epstein KL. Current Concepts in Fluid Therapy in Horses. Front Vet Sci 2021;8:648774.
- Kopper JJ, Bolger ME, Kogan CJ, Schott HC 2nd. Outcome and complications in horses administered sterile or non-sterile fluids intravenously. J Vet Intern Med 2019 Nov;33(6):2739-2745.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
