glucose monohydrate + magnesium chloride hexahydrate + potassium chloride + sodium acetate trihydrate + sodium chloride: clinical use

Prescribing considerations

• Base selection on the indication, intake and losses, comorbidities, concomitant treatment, and clinical and laboratory response.
• Assess risks of fluid overload, acute hyponatraemia, hyperglycaemia, hyperkalaemia, hypermagnesaemia and alkalosis.
• Use particular caution with cardiac, pulmonary or renal impairment, diabetes, hypocalcaemia, myasthenia gravis, cerebral pathology and sodium-retaining states.
• Consider refeeding risk in severe malnutrition or prolonged starvation.
• It contains no calcium and is unsuitable for correcting symptomatic hypomagnesaemia or severe metabolic or respiratory acidosis.
• Paediatric safety and effectiveness are not adequately established; specialist assessment and close biochemical monitoring are required.

Contraindications and cautions

• Hyperkalaemia.
• Severe renal insufficiency with oliguria or anuria.
• Uncompensated cardiac or pulmonary failure.
• Uncontrolled diabetes, known glucose intolerance, hyperosmolar coma, hyperglycaemia or hyperlactataemia.
• Hypersensitivity to an active substance or excipient.
• The initial period following head trauma because the solution contains glucose.

Monitoring

• Fluid balance, urine output and signs of oedema or pulmonary congestion.
• Serum sodium, potassium, magnesium and other relevant electrolytes.
• Blood glucose, particularly in diabetes, newborns and cerebral pathology.
• Blood and urine acid–base status where clinically relevant.
• The infusion site for phlebitis, thrombosis, infection or extravasation.
• Signs of hypersensitivity, hypermagnesaemia and refeeding-related disturbance.

Clinical pharmacology

A hypertonic maintenance solution whose effects reflect its water, glucose and electrolyte components. Glucose supplies energy; acetate is converted mainly in muscle and peripheral tissues to bicarbonate. Intravenous magnesium is principally eliminated in urine, making renal function important to accumulation risk.

Formulation and product differences

• Clear, particle-free solution for peripheral or central intravenous infusion in a single-use Viaflo bag.
• Contains glucose and sodium, potassium and magnesium salts, but no calcium.
• Compatibility must be established before adding another medicine; it must not share infusion equipment with whole blood.