calcium chloride dihydrate + glucose monohydrate + lactic acid + magnesium chloride hexahydrate + potassium chloride + sodium chloride + sodium hydrogen carbonate: clinical use

Prescribing considerations

• Reserved for use by or under a clinician competent in haemofiltration, haemodiafiltration and continuous haemodialysis.
• Confirm that a potassium-containing solution is appropriate from current serum potassium and the overall clinical picture.
• Account for potassium, calcium, glucose, lactate and buffer from all concurrent fluids and treatments.
• Glucose may originate from hydrolysed maize starch; do not use in patients with known maize or maize-product allergy.
• Use aseptic technique and appropriate equipment; contaminated solution can cause sepsis and shock.
• Assess compatibility before adding any substance; discard if precipitation, crystals or colour change occur.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient.
• Hyperkalaemia.
• Metabolic alkalosis.
• Technique-related contraindications include inadequate vascular-access pressure, uncorrectable uraemia in pronounced hypercatabolism, and circumstances where required systemic anticoagulation presents a high bleeding risk.

Monitoring

• Serum electrolytes, particularly potassium, calcium and phosphate.
• Acid–base status and bicarbonate.
• Blood glucose, especially in diabetes.
• Fluid input, output and overall balance.
• Haemodynamic status, including blood pressure.
• Clinical effect or concentrations of important filterable or dialysable medicines.

Clinical pharmacology

The constituents are physiological ions and glucose rather than pharmacologically active agents. The fluid replaces ultrafiltrate losses or provides an exchange medium across the dialysis membrane, while bicarbonate acts as an alkalising buffer and lactate contributes additional buffer potential.

Formulation and product differences

• This is a potassium-containing formulation intended for normokalaemic patients.
• It has separate electrolyte and buffer compartments that must be fully mixed before use.
• The reconstituted solution should be clear and slightly yellow, and contains calcium, magnesium, sodium, chloride, potassium, glucose, lactate and bicarbonate.