magnesium chloride hexahydrate + potassium chloride + sodium acetate trihydrate + sodium chloride + sodium gluconate: clinical use

Prescribing considerations

• Select according to indication, fluid status, electrolyte and acid–base findings, comorbidities and concurrent therapy.
• Use particular caution where sodium, potassium or magnesium retention, fluid overload, hypocalcaemia or alkalosis is possible.
• It is not appropriate as primary treatment for severe metabolic acidosis, severe potassium deficiency, hypomagnesaemia or hypochloraemic hypokalaemic alkalosis.
• Account for its electrolyte contribution when used with parenteral nutrition or medicines added to the bag.

Contraindications and cautions

• Hyperkalaemia.
• Renal failure.
• Heart block.
• Metabolic or respiratory alkalosis.
• Hypochlorhydria.
• Hypersensitivity to an active substance or excipient.

Monitoring

• Clinical fluid balance and signs of pulmonary or peripheral oedema.
• Serum and urine electrolytes, particularly sodium and potassium.
• Acid–base status and renal function.
• Cannula site and symptoms of hypersensitivity or infusion reaction.
• Interpret a positive Bio-Rad Platelia Aspergillus EIA cautiously because gluconate-containing solutions can cause false-positive results.

Clinical pharmacology

An isotonic balanced crystalloid that expands intravascular and interstitial extracellular fluid. Acetate is metabolised in muscle and peripheral tissues to bicarbonate; acetate and gluconate provide an alkalinising effect.

Formulation and product differences

• The selected formulation is a clear, glucose-free and calcium-free solution for intravenous infusion.
• Additive compatibility must be established before mixing; use aseptic technique and inspect for colour change, precipitation or crystals.
• It may be administered before, during or after a blood transfusion.