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

Multibic is employed in renal replacement therapy to maintain electrolyte and acid‑base balance during haemodialysis.

• Renal dialysis: helps preserve plasma electrolyte concentrations and prevents acidosis.
• Haemodialysis: provides buffering capacity to counter metabolic acidosis during treatment.
• Chronic kidney disease patients on dialysis: supports stable potassium, calcium and magnesium levels throughout the session.

• 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 acts as a systemic buffer, correcting metabolic acidosis, while the electrolytes replenish extracellular concentrations altered by the dialysis process, stabilising cardiac and neuromuscular function and helping maintain acid‑base homeostasis throughout the treatment.

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

Common Side Effects

• Mild nausea or vomiting: occasional gastrointestinal upset during or shortly after infusion.
• Transient hypotension during infusion: brief drop in blood pressure that resolves without intervention.
• Flushing or warmth at the injection site: temporary sensation of heat or redness.
• Mild headache: low‑intensity headache occurring during treatment.
• Dizziness: light‑headed feeling that usually subsides after the session.
• Slight electrolyte shifts (e.g., mild hypernatremia): minor changes in serum sodium that are self‑limiting.

Serious or Rare Side Effects

• Severe hyperkalemia leading to cardiac arrhythmia: dangerous rise in potassium that may cause irregular heartbeats.
• Significant hypercalcemia causing tetany or renal stones: excess calcium resulting in muscle cramps or stone formation.
• Anaphylactic or severe hypersensitivity reaction: rapid onset of rash, bronchospasm, or shock requiring emergency care.
• Metabolic alkalosis with pH >7.55: over‑correction of acidity leading to elevated blood pH.
• Cardiac arrest related to electrolyte imbalance: life‑threatening cessation of heart activity.
• Infection at infusion site: bacterial contamination causing local or systemic infection.

When using Multibic, clinicians should observe the following precautions to ensure patient safety and product integrity.

• Monitor electrolytes: check serum sodium, potassium, calcium and magnesium before and after infusion.
• Assess cardiac status: evaluate ECG and cardiac history due to electrolyte effects.
• Avoid in severe hyperkalemia: do not administer to patients with markedly elevated potassium levels.
• Use with compatible dialysis machines: ensure the solution is compatible with the equipment and tubing.
• Caution in pregnancy: limited data; weigh potential benefits against unknown risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Multibic may interact with other medications or solutions administered during dialysis.

Major Interactions (Avoid)

• Concurrent high‑dose potassium supplements: can precipitate dangerous hyperkalemia.
• Additional bicarbonate or alkalinizing agents: may cause severe metabolic alkalosis.
• Calcium‑containing infusions: risk of hypercalcemia and cardiac complications.
• Magnesium‑containing drugs: may lead to hypermagnesemia.
• Sodium‑rich medications: can exacerbate fluid overload and hypertension.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may increase serum potassium, requiring closer monitoring.
• Loop or thiazide diuretics: affect electrolyte balance and may necessitate dose adjustments.
• NSAIDs: can impair renal function and alter sodium handling.
• Anticoagulants used in dialysis circuits: monitor for bleeding if electrolyte shifts affect coagulation.