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

Prescribing considerations

• Restricted to continuous haemofiltration for acute renal failure under an experienced physician’s direction.
• Base solution selection and treatment settings on haemodynamic status, electrolyte and acid–base results, metabolic state and fluid balance.
• Account for clearance of filterable concomitant medicines.
• Replace the solution and tubing immediately if precipitation appears.
• Assess compatibility before adding any medicine to the mixed solution.

Contraindications and cautions

• Hyperkalaemia
• Metabolic alkalosis
• Marked hypercatabolic acute renal failure when uraemic symptoms cannot be corrected by haemofiltration
• Inadequate vascular-access blood flow
• Conditions with increased bleeding risk from systemic anticoagulation

Monitoring

• Haemodynamic status and fluid balance
• Serum electrolytes, particularly potassium and phosphate
• Acid–base balance and bicarbonate status
• Blood glucose
• Urea and plasma creatinine
• Solution clarity and evidence of calcium carbonate precipitation

Clinical pharmacology

A bicarbonate-buffered electrolyte solution that replaces ultrafiltrate during continuous haemofiltration. Distribution and elimination depend on metabolic requirements, residual kidney function and other fluid losses.

Formulation and product differences

• Supplied as a two-chamber bag whose electrolyte and bicarbonate solutions must be mixed before use.
• This formulation contains potassium and is unsuitable in hyperkalaemia.
• The mixed solution is clear, colourless and intended for infusion into the extracorporeal circuit.
• Do not refrigerate or freeze, or mix with other medicines without a compatibility assessment.