Osmolality of solutions, emulsions and drugs that may have a high osmolality: aspects of their use in neonatal care

Objective: Administration of some hypertonic substances to neonates has been associated with a variety of adverse effects. This study was conducted to determine the osmolality of intravenous drugs and solutions used in neonates receiving intensive care. Methods: Osmolality was measured by freezing point depression. Vasoactive drugs, diuretics, anticonvulsants, antimicrobials, and glucose and electrolyte solutions were some of the substances analyzed. Results: The osmolalities of 90 substances were measured; the respective intra-assay and interassay coefficients of variation were always less than 5%. A few drugs were found to be extremely hypertonic (> 8000 mOsm/kg), and most of them contain propylene glycol as vehicle (e.g. digoxin, phenytoin, diazepam and phenobarbital). Other drugs, at the same concentration, evidenced a significant discrepancy of osmolality depending on the trademark. Conclusions: The finding of some extremely hypertonic drugs highlights the need for further investigation in order to study their potential adverse effects in neonates, as well as to evaluate any advantage in diluting, infusing slowly or even avoiding such substances. Given the fact that there exists a discrepancy in osmolalities in some drugs at the same concentration depending on the trademark, the more isotonic solutions should be the preferred choice for intravenous administration.