calcium chloride + disodium phosphate + magnesium chloride + potassium chloride + sodium chloride + sodium hydrogen carbonate: clinical use

Prescribing considerations

• Restrict use to clinicians competent in continuous renal replacement therapy.
• Select only when potassium is normal and phosphate is normal or low; reassess if either rises.
• Account for all fluid inputs and outputs and the total buffer supplied by citrate, bicarbonate and other fluids.
• The absence of glucose creates a risk of hypoglycaemia, including silent hypoglycaemia.
• Continuous renal replacement therapy can remove filterable medicines; review therapeutic response and drug concentrations where relevant.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient.
• Hyperkalaemia, hyperphosphataemia or metabolic alkalosis.
• Pronounced hypercatabolism when uraemic symptoms cannot be corrected by haemofiltration or haemodiafiltration.
• Insufficient arterial pressure at the vascular access.
• Systemic anticoagulation where haemorrhage risk is high.

Monitoring

• Potassium, phosphate and other electrolytes.
• Acid–base status and bicarbonate.
• Blood glucose, including in people without diabetes where clinically appropriate.
• Haemodynamic status and complete fluid balance.
• Calcium and total buffer load when citrate anticoagulation is used.
• Circuit function and the clinical effects of medicines that may be removed by continuous renal replacement therapy.

Clinical pharmacology

The constituents are normal body electrolytes at concentrations intended for renal replacement fluid. They replace water and ions removed by haemofiltration or provide dialysate for haemodialysis; bicarbonate supplies alkalising buffer.

Formulation and product differences

• This is a two-compartment bag that must be fully mixed before connection.
• The reconstituted solution contains phosphate and potassium but no glucose.
• It may be used as either replacement solution or dialysate with compatible extracorporeal equipment.
• Do not mix with other medicines unless compatibility has been established.