Pressure Build Up in Vials – Comedy and Chemistry in the IV Suite

When IV vitamin C is manufactured the stock ascorbic acid has a pH of about 2, so the solution is buffered to a pH of between 5.5-7.0 with sodium bicarbonate and sodium hydroxide. There can be a mild reaction between the buffering chemicals and the ascorbic acid during storage and pressure may develop in the vial. Some brands of ascorbic acid injection (500 mg/mL, 50 mL vial) tend to be free of pressure, while others have mild degrees of pressurization. Here is a quote from a Merit Pharmaceuticals package: “Pressure may develop upon storage. Exercise care when withdrawing.” Over the years I have not found any vials with excessive pressure buildup – until today!

I have a patient who obtains all of the injectable nutrients for their protocol from Switzerland, as the primary care giver for their health complaint has a large clinic there. The IV vitamin C is manufactured by Laboratorium Dr G Bichsel AG in Interlaken. The reason I mention this is so that if you need to use this product, you can be prepared for possible “pressure buildup” in the vial. I have used this product several times in the past and noted a tendency for pressurization; it is a 15% solution of vitamin C in a 50 mL vial.

I have started using a protective apron when setting up IV solutions to protect my clothing from drops of nutrients that invariably find their way onto my pants legs, later to dry in nice white crystalline deposits. Today I was very glad to have the apron. I use a 35 mL syringe with an 18 gauge Admix needle to draw up vitamin C and when I entered the vial the pressure buildup in the vial was sufficient to push the plunger all the way to the 35 mL mark, where it normally stops due to syringe design. This time the madly foaming liquid pushed the plunger out of the barrel and all of the vitamin C ended up on the front of my apron and the floor. I took it quite well, no cussing, as the patient was in the adjacent room.  So if you use this vitamin C in the future, be aware that pressure buildup may be more than you expect. My apron is normally a nice consistent light blue.

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