calcium chloride dihydrate + glucose, anhydrous + glucose monohydrate + magnesium chloride hexahydrate + sodium chloride + sodium hydrogen carbonate + sodium lactate: clinical use

Prescribing considerations

• Individualise solution selection to fluid-removal needs while limiting dehydration, hypovolaemia and protein loss.
• Assess abdominal integrity, peritoneal function, pulmonary disease, recent aortic graft surgery and infection risk.
• Use lactate-containing solutions cautiously with raised lactate or risk factors for lactic acidosis.
• Account for glucose absorption and losses of proteins, water-soluble vitamins and dialysable medicines.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient
• Uncorrectable mechanical defects preventing effective peritoneal dialysis or increasing infection risk
• Documented loss of peritoneal function or extensive adhesions compromising function

Monitoring

• Fluid balance, weight and signs of overhydration or dehydration
• Drained-fluid clarity, catheter site and symptoms of peritonitis
• Electrolytes, particularly potassium, bicarbonate, magnesium, calcium and phosphate
• Blood glucose in people with diabetes
• Blood chemistry, parathyroid hormone, lipid and haematological parameters
• Dialysis adequacy, peritoneal function and signs of encapsulating peritoneal sclerosis

Clinical pharmacology

Glucose makes the solution hyperosmolar to plasma and drives ultrafiltration; diffusion removes nitrogenous waste. Absorbed glucose, electrolytes and water enter normal metabolic pathways.

Formulation and product differences

• The bicarbonate/lactate buffer produces a final physiological pH after mixing.
• The two chambers separate glucose and electrolytes from the buffer until use.
• Single-bag configurations support automated peritoneal dialysis; twin-bag configurations include a drain bag for continuous ambulatory peritoneal dialysis.
• Potassium is not included because of hyperkalaemia risk.