Losec Infused Intravenously around the clock??

Well, maybe some of you, might encounter and had done this before. But as for some of us, and as far as we know, Losec (Omeprazole) usually given intravenously, in bolus form.

Okay, here's the scenario:

A patient admitted with abdominal pain and malaena stool, who's actually a known case of Acute Duodenal Ulcer. On admission his had a low HB count, which I can't remember heeeheee, and for sure he had 2 pints of packed cell and emergency OGD.

He was then prescribed, IV Losec 80mg over 24 hours, and to our understanding, it means, around the clock. And so the nurses, started the infusion, diluting it with 100mls of Normal Saline and infused it continously.

The day after, one of the nurse manager realised, that the solution (diluted in the Burrette) had changed its color. Well go to basic pharmacology and the 5R's.. when it changes it's colour, you should've start to query, isn't it?

For over 24 hours, the solvent changed its colour, and according to the delegated pharmacist, it wasn't usually administered that way i.e. around the clock.

And so, the nurse manager started to query out with the doctors and pharmacists on duty. Then our pharmacist on duty give us a leaflet for referring :

Recommended Method of reconstitution and preparation

1. With a syringe, draw 10mL of solvent from ampoule.
2. Slowly add approximately 5mL of solvent into the vial with the freeze-dried Omeprazole.
3. Withdraw as much as air as possible from the vial back into the syringe in order to reduce positive pressure. This will make it easier to add the remaining solvent.
4. Add the remaining solvent into the vial & ensure adequate mixing of the content.
5. Please note that upon reconstitution and preparation of infusion mix. The solution shall be kept below 25 degrees Celcius and to be use within 4 hours.
6. Thus infusion mix needs to be changed every 4 hours and dose to be adjusted.
7. Infusion bag should be protected from light after preparation and during infusion period.
8. Example of Rx: 8mg/hr for 72 hours. Therefore total dose in 4 hours = 32mg. Withdraw 32mg out of the reconstituted vial and add in 100mL - 250mL (depending on fluid requirement/restriction) of Glucose 5% or Sodium Chloride 0.9%