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

Multibic is employed in the management of electrolyte balance during haemodialysis.

• Hemodialysis: supplies sodium, potassium, magnesium, chloride and bicarbonate to maintain plasma electrolyte concentrations.
• Electrolyte replacement during dialysis: corrects deficits of key electrolytes that arise during the procedure.
• Acid‑base control: provides bicarbonate buffering to help sustain appropriate blood pH during treatment.

• Multibic delivers a balanced mixture of sodium, potassium, magnesium, chloride and bicarbonate ions directly into the bloodstream during haemodialysis. The solution equilibrates across the dialysis membrane, replenishing electrolytes lost to the dialysate and offering buffering capacity that stabilises blood pH, thereby supporting normal cellular function throughout the session.

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

Common Side Effects

• Mild hypotension: temporary drop in blood pressure during infusion.
• Nausea or vomiting: gastrointestinal discomfort reported by some patients.
• Headache: mild to moderate headache during or after treatment.
• Muscle cramps: transient cramping of limbs.
• Mild electrolyte shift: temporary changes in serum sodium or potassium levels.
• Local irritation at infusion site.

Serious or Rare Side Effects

• Severe hyperkalemia: dangerous rise in potassium leading to cardiac arrhythmia.
• Severe hyponatremia: marked low sodium causing neurological symptoms.
• Cardiac arrhythmia: abnormal heart rhythm due to electrolyte imbalance.
• Anaphylactic reaction: rare severe allergic response.
• Metabolic alkalosis: excessive bicarbonate causing high blood pH.
• Severe hypotension requiring medical intervention.

When using Multibic, clinicians should observe specific safety measures to minimise risk.

• Monitor electrolytes: check serum sodium, potassium, magnesium and chloride before, during and after infusion.
• Assess cardiac status: observe ECG for arrhythmias, especially in patients with pre‑existing heart disease.
• Use cautiously in fluid‑overload patients: adjust volume to avoid pulmonary edema.
• Adjust dialysate composition: tailor the dialysis prescription to individual electrolyte needs.
• Verify compatibility: ensure the solution is compatible with other IV fluids and medications.
• Store at below 25°C: keep in the original container, protect from moisture and light, do not freeze.

Multibic can interact with other agents that affect electrolyte balance or acid‑base status.

Major Interactions (Avoid)

• Calcium‑containing IV solutions: risk of precipitation with magnesium.
• High‑potassium IV preparations: may cause dangerous hyperkalemia.
• Additional sodium bicarbonate infusions: can lead to severe metabolic alkalosis.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may increase serum potassium, requiring close monitoring.
• Loop or thiazide diuretics: can amplify electrolyte shifts, especially sodium and potassium.
• NSAIDs: may affect renal handling of electrolytes, necessitating periodic lab checks.
• Other dialysis fluids: ensure compatible electrolyte composition to avoid additive imbalances.