calcium chloride + icodextrin + magnesium chloride + sodium chloride + sodium lactate: clinical use

Prescribing considerations

• Use only within a physician-supervised CAPD or APD prescription for chronic renal failure; it is not recommended for acute renal failure or children.
• Review abdominal and respiratory conditions that may make peritoneal dialysis unsafe or ineffective.
• Assess lactic-acidosis risk, nutritional status, potassium deficiency, hydration and potential loss of dialysable medicines, proteins and water-soluble vitamins.
• Ensure diabetes and hospital records prominently specify that only a verified glucose-specific testing system is suitable.
• Investigate cloudy effluent promptly; retain the drained bag and batch number and obtain appropriate microbiological samples.

Contraindications and cautions

• Hypersensitivity to an ingredient or allergy to icodextrin or starch-based polymers such as maize starch
• Maltose or isomaltose intolerance
• Glycogen storage disease
• Pre-existing severe lactic acidosis
• Uncorrectable mechanical defects that prevent effective peritoneal dialysis or increase infection risk
• Documented loss of peritoneal function or extensive adhesions compromising peritoneal function

Monitoring

• Fluid balance, body weight and signs of overhydration or dehydration
• Haematology, blood chemistry and electrolytes, including sodium, chloride, magnesium and bicarbonate
• Potassium, particularly with cardiac glycosides
• Glycaemic control and glucose-monitoring technology
• Peritoneal effluent, catheter site and signs of peritonitis or aseptic peritoneal reaction
• Lactic acidosis in patients with relevant disease states or interacting medicines
• Serum amylase and liver-associated enzymes where clinically relevant

Clinical pharmacology

Icodextrin is a starch-derived colloid osmotic agent supporting sustained intraperitoneal ultrafiltration. Amylase hydrolyses it into smaller glucose polymers, including maltose, which can interfere with some glucose assays.

Formulation and product differences

• Sterile, clear, colourless electrolyte solution for intraperitoneal use only.
• Available in flexible PVC single-bag and twin-bag presentations with luer or spike connectors; not all authorised presentations may be marketed.
• Contains sodium, calcium, magnesium, chloride and lactate but no added potassium.
• Check compatibility before adding another medicine. Aminoglycosides must not be mixed with penicillins because of chemical incompatibility.