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Toradol

Guy Jackson r.g.m.jackson at qmul.ac.uk
Mon Apr 3 08:20:08 BST 2006


According to a pharmacist I once knew the reason is twofold. The whole
dilution thing is because the 3 ml in the ampoule can cause a chemical
phlebitis (sterile abscess is reported in im usage). I have seen and given
it in 500, 1000, and 20 ml dilutions. All seem to work fine. The reason for
RL over NaCl is pharmaceutical, and to do with the presence of bicarbonate,
which it is supposed to need to dissolve properly. As I have seen people
dilute it in 20 ml NaCl without incident I suspect this is all highly
theoretical.

Conclusion: If you wish to use, ensure no contra-indications, dilute, and
ensure adequate hydration.

As to ketoralac, I remember this being marketed in the early 1990s as a safe
NSAID that could be given by bolus injection and that did not require
dilution. Then all the reports of adverse effects came out (phase 4 study),
and its limitations were realised. Look back to the very early days of
diclofenac (I am reliably informed) and a not too dissimilar story regarding
renal function was played out. Plus ca change........

Guy Jackson
London, UK

----- Original Message ----- 
From: "Nick Macartney" <nick at macartney.org>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Saturday, April 01, 2006 6:23 PM
Subject: RE: Toradol


> Chuck said:
>
> > BTW..why RL instead of saline?
> I say:
> Why saline ( which is hyperchloraemic, and causes metabolic acidosis )
> rather than RL?
>
> Nick Macartney
>
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
> > Sent: 01 April 2006 12:43
> > To: trauma-list at trauma.org
> > Subject: Re: Toradol
> >
> >
> > In a message dated 31-Mar-06 23:37:52 Central Standard Time,
> > tch at sun.ac.za
> > writes:
> >
> > Just cos  the FDA have not approved of something - does not
> > mean it is not safe etc.  Just means FDA either have not
> > tested it or if failed on some usually minor  technical
> > agenda. Here in South Africa Diclofenac is also used
> > selectively as  an IV preparation, but only well diluted (1X
> > 75mg amp in 1000ml RL over 30  min.) in minor and non-trauma
> > surgery. Because it is for stable patients - the  U&E is
> > usually pre-checked!
> >
> >
> > Tim:
> >
> > primus: my friends call me Chuck...and you and I have been
> > corresponding long enough to be extended that point.
> >
> > secundus: I well understand that the US FDA has long lost its
> >  standing as the premier drug approval source. Unfortunately,
> > it's what I have to  work with in general. I've had good luck
> > in the past with diclofenac po, and  would like to see how
> > the IV version works, but it sounds like it's not the  thing
> > for our Urgent Care Centers and EMS crews.
> >
> > BTW..why RL instead of saline?
> >
> > ck
> >
> > Charles S. Krin, DO  FAAFP
> >
> > --
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> >
>
>
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