Drugs that can only be dispensed with saline Sodium bicarbonate Sodium bicarbonate is an acid-base balance regulator with a large degree of dissociation, which provides more bicarbonate ions (HCO3-). The pH of 0.5% or 10% glucose injection is 3.2-6.5, which is acidic and causes the decomposition of bicarbonate ions to form water and carbon dioxide, which makes the drug ineffective and cannot neutralize the excessive acid in the body. 0.9% sodium chloride injection has sodium ions, which can ease the dissociation of sodium bicarbonate. Therefore, sodium bicarbonate is more stable in combination with sodium chloride. Clinically sodium bicarbonate is used for intravenous administration mostly diluted with saline. Amoxicillin Clavulanate Potassium Amoxicillin Sodium/Clavulanate for Injection is composed as sodium and potassium salts and is unstable in solutions containing glucose, dextran or acidic carbonates. It may precipitate in solutions below pH 6.5 and is soluble and more stable in neutral solutions of sodium chloride (pH 6.5-7.0). It should be dissolved in 50-100ml of sodium chloride injection in strict accordance with the legal instructions. Otherwise, it is easy to discolor and cause the reduction of drug efficacy and the risk of adverse drug reactions. Furosemide injection is a high alkaline sodium salt injection, which is a sterilized aqueous solution made of furosemide plus sodium hydroxide and sodium chloride. When furosemide injection is paired with glucose injection, sodium hydroxide and hydrochloric acid in the mixed liquid start neutralization reaction, the pH value changes, furosemide precipitates and crystals are precipitated, resulting in a cloudy solution. Clinically, furosemide injection is often used with sodium chloride injection, the pH value does not change much and does not affect the stability of furosemide. Therefore, furosemide injection is strictly prohibited to be paired with glucose injection, and sodium chloride injection is recommended to be used. Edaravone Edaravone Injection is mostly used to improve neurological symptoms, impairment in activities of daily living and functional impairment caused by acute cerebral infarction. However, this drug has contraindications with sugar-containing infusion solutions, high-energy infusion solutions and amino acid preparations, and the concentration of edaravone can be reduced when paired with these solutions. Therefore, edaravone is clinically diluted in appropriate amount of saline and then dripped intravenously within 30 minutes. Esomeprazole Esomeprazole has the chemical structure of thionylbenzimidazole, and in an acidic environment, its chemical structure is prone to change, stability decreases, and polymerization and discoloration occur. Glucose injection is mostly acidic (pH 3.2-6.5), therefore, it is often diluted with 0.9% sodium chloride injection. Amrinone The lactam group contained in the structure of amrinone is easily hydrolyzed under acidic conditions. Therefore, amrinone is not stable in glucose injection (pH 3.2-6.5), but amrinone is almost insoluble in water and must be dissolved in lactic acid. Clinically, use Amrinone intravenous powder injection with 1 Amrinone solvent for injection per injection warmed, shaken, completely dissolved, and then diluted with appropriate amount of saline. Procaine Procaine is a short-acting ester local anesthetic, when preparing procaine injection, it is appropriate to use 0.9% sodium chloride injection for dilution. It should not be diluted with glucose injection, because glucose can reduce the local anesthetic effect of this drug. Lipoic acid Lipoic acid is clinically used for sensory abnormalities caused by diabetic peripheral neuropathy, and its chemical structure contains a heterocyclic ring with disulfide bonds. The drug’s instructions state that it should not be used with glucose solutions, Ringer’s solution and all solutions that may react with sulfur groups or disulfide bonds. It is not recommended to dilute the formulation with glucose solution probably because of the acidic nature of glucose solution, which can cause the opening of the ring of lipoic acid. It is often added to sodium chloride injection for intravenous infusion, e.g. 250-500 mg lipoic acid in 100-250 ml sodium chloride injection for about 30 minutes. Drugs not suitable for saline dosing Sodium nitroprusside Sodium nitroprusside, as a fast-acting antihypertensive drug, is unstable in aqueous solution and accelerates decomposition under light. Clinically, 5% glucose injection is often prepared into 0.05% sodium nitroprusside solution for intravenous infusion, and the ph of saline is higher than that of glucose. Therefore, the stability of sodium nitroprusside in saline is poorer than that in glucose. Usage: The injection should be prepared with 5% glucose before use, dripped away from light, and used up within 12h. Water-soluble vitamins Water-soluble vitamins are a group of vitamins that can be dissolved in water, including B vitamins and ascorbic acid, which are involved in body metabolism as components of coenzymes or cofactors. Water-soluble vitamins are stable in aqueous solutions in the pH range of 5.6-6.1, and are unstable in high concentrations. Electrolyte ions accelerate their decomposition. Water-soluble vitamins have a cationic effect with strong electrolytes, point neutralization, and salt precipitation. This increases the number of insoluble particles in the solution and increases the incidence of adverse reactions. Therefore, water-soluble vitamins should not be added to saline containing electrolytes, but can be added to glucose injection without electrolytes. Human immunoglobulin Human immunoglobulin is an immunoglobulin preparation prepared by taking plasma or serum from healthy people after immunization with hepatitis B vaccine and purified by low-temperature ethanol method, containing 10% protein. Therefore, it is best not to use sodium chloride injection for dilution, as sodium chloride may cause precipitation due to immunoglobulin salinization. Usage: Dissolve the product to the required volume with water for injection and give it directly intravenously or dilute it 1-2 times with 5% glucose solution for intravenous infusion.