calcium chloride + lactic acid + magnesium chloride + sodium chloride + sodium hydrogen carbonate: clinical use

Prescribing considerations

• Restrict prescribing and administration to clinicians experienced in critical care and continuous renal replacement therapy.
• Use only with compatible extracorporeal renal replacement equipment.
• The solution is potassium-free and glucose-free; assess supplementation needs from laboratory monitoring.
• Check additives for solubility, stability and visible incompatibility, and add only to the fully reconstituted solution.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient.
• Do not administer before the electrolyte and buffer compartments have been fully mixed.
• Do not use contaminated, cloudy, discoloured, leaking or otherwise damaged containers.

Monitoring

• Serum potassium, phosphate and other electrolytes.
• Acid–base balance, including bicarbonate and pH.
• Blood glucose.
• Haemodynamic status and fluid balance.
• Calcium and buffer balance when citrate anticoagulation or additional calcium or bicarbonate is used.
• Clinical effect or concentrations of medicines liable to extracorporeal removal.

Clinical pharmacology

A pharmacologically inactive crystalloid solution providing sodium, calcium, magnesium, chloride, lactate and bicarbonate. It functions as an exchange or replacement medium; solute and water transfer occurs across the extracorporeal filter.

Formulation and product differences

• Hemosol B0 is supplied as a two-compartment bag containing separate electrolyte and bicarbonate-buffer solutions that must be mixed before use.
• The reconstituted product is clear and colourless, potassium-free and glucose-free.
• It can be used as replacement fluid or dialysate, according to the continuous renal replacement modality.