March 4, 2015
250 mL Normal Saline Supply Shortage –
Treatment Guidelines and Pharmacology Sheets Changes
The ongoing, nationwide shortage of 250-mL bags of Normal Saline Solution has created supply problems for some UTSW/BioTel EMS agencies. Effective immediately, 500-mL bags of Normal Saline Solution may be utilized instead. However, this substitution necessitates minor changes to several UTSW/BioTel EMS Treatment Guidelines and Pharmacology Sheets.
For all relevant changes, refer to the table below.
Critical points:
EMS Providers should consult BioTel at any time with questions or concerns about these modified Treatment Guidelines, especially for drug doses and infusion rates, and particularly for the pediatric patient.
TG/Drug |
Page | Drug | Current Wording | New Wording |
OB |
40 | Magnesium Sulfate | 2 g in 250 mL NS over 20 min |
4 g in 500 mL NS; waste 250 mL; administer remaining 250 mL over 20 min |
ADULT Respiratory Distress |
47 | Magnesium Sulfate X 2 | 2 g in 250 mL NS over 20 min |
4 g in 500 mL NS; waste 250 mL; administer remaining 250 mL over 20 min |
PEDIATRIC Respiratory Distress |
49 | Magnesium Sulfate | 2 g in 250 mL NS at 40 mg/kg (5 mL/kg) over 30 min; maximum dose 2 g | 4 g in 500 mL NS; waste 250 mL; administer 40 mg/kg (5 mL/kg) over 30 min; maximum dose 2 g |
Tachycardia – |
61 | Magnesium Sulfate | 2 g in 250 mL NS over 20 min |
4 g in 500 mL NS; waste 250 mL; administer remaining 250 mL over 20 min |
Ventricular Fibrillation/ |
67 | Magnesium Sulfate | 2 g in 250 mL NS over 20 min |
4 g in 500 mL NS; waste 250 mL; administer remaining 250 mL over 20 min |
Amiodarone |
140 | Amiodarone drip | Dilute 300 mg in 250 mL NS | Dilute 600 mg in 500 mL NS; waste 250 mL; contact BioTel for drip rate for remaining 250 mL |
Dopamine |
147 | Dopamine drip X 2 | 400 mg dopamine in 250 mL NS (1600 mcg/mL) |
800 mg dopamine in 500 mL NS (1600 mcg/mL); contact BioTel for drip rate for remaining 250 mL |
Epinephrine |
148 | Epinephrine drip | There is currently no recipe for this | 2 mg epinephrine 1:1000 in 500 mL NS; waste 250 mL; contact BioTel for drip rate for remaining 250 mL |
Magnesium Sulfate |
158 | Magnesium Sulfate X 2 | 2 g of magnesium sulfate in 250 mL NS |
4 g of magnesium sulfate in 500 mL NS; waste 250 mL; Adult: administer remaining 250 mL over 20 min; Pedi: contact BioTel to confirm dose and administer 40 mg/kg (5 mL/kg) over 30 min; maximum dose 2 g |
Norepinephrine |
166 | Norepinephrine drip X 2 | 4 mg norepinephrine in 250 mL NS |
8 mg norepinephrine in 500 mL NS; waste 250 mL; contact BioTel for drip rate for remaining 250 mL |