Textbook and Publication Errata

Errors reported in publications

From the April, 22,1998 Issue

The following caution statement in the monograph for albumin will appear in the upcoming 10 th edition (1998) of Trissel's Handbook on Injectable Drugs: CAUTION: Substantial reduction in tonicity, creating the potential for fatal hemolysis and acute renal failure, may result from the use of sterile water as a diluent. The hemolysis and acute renal failure that result from the use of a sufficient volume of sterile water as a diluent may be life-threatening. This strengthens a reminder in the 9 th edition (1996) that hemolysis could occur if the tonicity of the final solution isn't taken into account. The 8 th edition (1994) did not specifically mention this consequence although it did mention sterile water as a possible diluent. We are aware of two recent cases (ISMP Medication Safety Alert! January 14, 1998 and March 25, 1998) where pharmacists consulted the long-expired 8 th edition text and subsequently used large volumes of sterile water to prepare albumin solutions for plasmapheresis. Both patients hemolyzed. One patient did not recover. We urge pharmacy managers to immediately seek out older versions of the text to include the new caution! Then destroy and replace these older editions when the 10 th edition is available later this year. FDA is also alerting pharmacists not to dilute 25% human albumin solution with sterile water for injection to provide a 5% albumin solution for plasmapheresis.