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

Multibic is used in renal replacement therapy to support electrolyte and acid‑base management during dialysis.

• Renal dialysis: helps maintain electrolyte concentrations and buffering capacity throughout the treatment.
• Haemodialysis: provides bicarbonate and essential ions to prevent metabolic acidosis during the procedure.
• Peri‑dialysis in kidney transplant patients: supports electrolyte homeostasis when intermittent dialysis is required.
• Acute kidney injury requiring dialysis: stabilizes serum potassium and calcium levels.
• Chronic dialysis patients: assists in long‑term electrolyte balance.

• Multibic delivers a balanced mixture of sodium, potassium, calcium, magnesium ions and bicarbonate directly into the bloodstream during haemodialysis. The bicarbonate component provides buffering capacity that neutralizes excess hydrogen ions, while the electrolytes replace those removed by the dialysis membrane, helping to preserve plasma osmolarity, prevent acid‑base disturbances, and maintain cardiac and neuromuscular function. The solution’s ionic composition is designed to approximate physiological plasma, thereby minimizing shifts in intracellular and extracellular compartments.

The following adverse reactions have been reported with the use of Multibic during dialysis.

Common Side Effects

• Mild hypotension: transient drop in blood pressure during infusion.
• Nausea: occasional feeling of queasiness.
• Headache: mild to moderate intensity.
• Transient electrolyte shifts: slight changes in serum potassium or calcium that resolve spontaneously.
• Flushing or warmth at the infusion site.

Serious or Rare Side Effects

• Severe hyperkalemia: dangerous elevation of serum potassium.
• Severe hyponatremia: marked reduction in sodium levels.
• Metabolic alkalosis: excessive increase in blood pH.
• Anaphylactic reaction: rare but potentially life‑threatening hypersensitivity.
• Cardiac arrhythmia: irregular heart rhythm associated with electrolyte imbalance.

When using Multibic, the following precautions should be observed to ensure patient safety.

• Assess baseline electrolyte levels: verify serum sodium, potassium, calcium and magnesium before infusion.
• Monitor acid‑base status: check arterial blood gases during treatment.
• Use caution in patients with cardiac disease: rapid electrolyte changes may affect heart rhythm.
• Avoid rapid infusion rates: administer according to recommended flow to prevent hypotension.
• Check compatibility with other IV solutions: ensure no precipitation occurs when mixed.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Multibic may interact with other medications or solutions; the interactions are categorized as follows.

Major Interactions (Avoid)

• High‑dose potassium supplements: risk of hyperkalemia when combined.
• Calcium‑containing IV solutions: may cause calcium overload and precipitation.
• Sodium bicarbonate infusion: additive alkalinizing effect leading to metabolic alkalosis.

Moderate Interactions (Monitor Closely)

• Loop diuretics: can amplify electrolyte shifts during dialysis.
• ACE inhibitors or ARBs: may increase serum potassium levels.
• Beta‑blockers: may mask signs of hypotension from infusion.