calcium chloride dihydrate + magnesium chloride hexahydrate + potassium chloride + sodium acetate trihydrate + sodium chloride + succinylated gelatin: clinical use

Prescribing considerations

• Use a colloid only where hypovolaemia cannot be sufficiently treated with crystalloids alone.
• Assess allergy history, including asthma, gelatin reactions, alpha-Gal sensitisation and allergy to mammalian meat or offal.
• Avoid circulatory overload, particularly with cardiac, pulmonary or renal impairment and in older or critically ill patients.
• Substantial replacement can dilute haemoglobin, plasma proteins and coagulation factors; blood components or specific factors may also be required after significant blood loss.
• Paediatric safety and efficacy are not adequately established; use requires clear benefit-risk justification and careful monitoring.
• Obtain blood-grouping and antibody samples before infusion where practicable because later interpretation may be hindered.

Contraindications and cautions

• Hypersensitivity to gelatin-containing solutions or any excipient.
• Alpha-Gal hypersensitivity or known allergy to mammalian meat or offal.
• Hypervolaemia or hyperhydration.
• Acute congestive cardiac failure.

Monitoring

• Haemodynamic status and clinical signs of volume overload.
• Fluid balance, serum electrolytes and acid-base status.
• Renal function, especially with oliguria, anuria or severe impairment.
• Haemoglobin or haematocrit, plasma proteins and coagulation parameters during substantial replacement.
• Continuous observation for hypersensitivity, particularly at the start of infusion.

Clinical pharmacology

Succinylation increases gelatin molecular volume and colloid-osmotic activity. The solution replaces intravascular and extracellular volume without supplying red cells, coagulation factors or plasma proteins. Modified gelatin is predominantly eliminated by renal filtration; larger molecules undergo proteolysis before renal excretion.

Formulation and product differences

• Clear, colourless or slightly yellow intravenous solution in single-use polyethylene bottles or non-PVC plastic bags.
• Contains acetate rather than lactate.
• Use immediately after connection to the giving set. Do not freeze.