Multibic (Sodium Hydrogen Carbonate, Magnesium Chloride Hexahydrate, Potassium Chloride, Sodium Chloride, Calc)

Multibic is used in renal replacement therapy to manage electrolyte balance during haemodialysis.

• Renal failure requiring haemodialysis: restores sodium, potassium, calcium and magnesium levels to maintain physiological balance.
• Electrolyte replacement during dialysis: supplies essential ions to prevent depletion during the procedure.
• Metabolic acidosis in dialysis patients: provides bicarbonate buffering to correct acid‑base disturbances.
• Fluid management in renal replacement therapy: assists in maintaining appropriate osmolarity and volume status.

• Multibic delivers a balanced mixture of sodium hydrogen carbonate, magnesium chloride, potassium chloride, sodium chloride and calcium ions directly into the bloodstream. The bicarbonate component buffers excess hydrogen ions, while the electrolytes replenish those lost during dialysis, supporting normal cellular function, nerve conduction and cardiac rhythm. The solution’s composition is designed to match physiological plasma concentrations, facilitating rapid equilibration during haemodialysis.

Multibic may be associated with adverse reactions related to its electrolyte composition and infusion characteristics.

Common Side Effects

• Hypernatremia: elevated blood sodium levels causing thirst or confusion.
• Hyperkalemia: increased potassium leading to muscle weakness or cardiac changes.
• Hypocalcemia: low calcium resulting in tingling or muscle cramps.
• Hypotension: drop in blood pressure during rapid infusion.
• Nausea or vomiting: gastrointestinal discomfort after administration.
• Local irritation at infusion site: redness or pain.

Serious or Rare Side Effects

• Severe electrolyte imbalance: life‑threatening cardiac arrhythmias.
• Anaphylactic reaction: sudden rash, airway swelling, hypotension.
• Pulmonary edema: fluid overload causing breathing difficulty.
• Metabolic alkalosis: excessive bicarbonate causing pH elevation.

When using Multibic, clinicians should observe specific safety measures to minimize risks.

• Assess baseline electrolytes: verify serum sodium, potassium, calcium and magnesium before infusion.
• Monitor blood pressure: watch for hypotension during and after administration.
• Adjust infusion rate: avoid rapid delivery to reduce cardiac stress.
• Use compatible dialysis fluid: ensure the solution matches the dialysate composition.
• Review concomitant medications: consider diuretics or ACE inhibitors that affect electrolyte balance.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Multibic can interact with other agents that influence electrolyte or fluid status.

Major Interactions (Avoid)

• High‑potassium supplements: may cause dangerous hyperkalemia.
• Calcium‑containing IV drugs: risk of hypercalcemia and cardiac arrhythmia.
• Large volume sodium‑rich fluids: can lead to fluid overload and hypertension.

Moderate Interactions (Monitor Closely)

• Loop diuretics: may amplify electrolyte shifts, requiring closer monitoring.
• ACE inhibitors or ARBs: can affect potassium balance.
• NSAIDs: may impair renal handling of electrolytes.
• Blood transfusions: alter calcium and magnesium levels.