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

Multibic is used in renal replacement therapy to correct electrolyte and acid‑base disturbances during haemodialysis.

• Renal failure: provides essential electrolytes and bicarbonate to maintain plasma balance during dialysis.
• Haemodialysis: buffers metabolic acids and stabilises serum pH throughout the treatment session.
• Electrolyte imbalance in dialysis: corrects sodium, potassium, calcium and magnesium levels to prevent complications.
• Acute kidney injury: supports electrolyte homeostasis when temporary dialysis is required.

• Multibic delivers a balanced mixture of sodium hydrogen carbonate, magnesium chloride, potassium chloride, sodium chloride and calcium ions directly into the bloodstream during haemodialysis. The bicarbonate component acts as a systemic buffer, neutralising excess hydrogen ions and correcting metabolic acidosis. The accompanying electrolytes replenish those removed by the dialysis membrane, helping to preserve osmotic equilibrium, cardiac electrophysiology and neuromuscular function. The solution’s composition is designed to match physiological plasma concentrations, minimizing shifts that could provoke arrhythmias or hemodynamic instability.

Intravenous administration of Multibic may be associated with several adverse reactions, ranging from mild to severe.

Common Side Effects

• Mild hypernatremia: transient increase in serum sodium.
• Infusion site irritation: redness or discomfort at the catheter site.
• Nausea: occasional gastrointestinal upset during infusion.
• Headache: transient headache reported by some patients.

Serious or Rare Side Effects

• Severe hyperkalemia: marked potassium rise leading to cardiac arrhythmia.
• Metabolic alkalosis: excessive bicarbonate causing elevated blood pH.
• Anaphylactic reaction: rare hypersensitivity with respiratory distress.
• Volume overload: fluid accumulation that may result in pulmonary edema.

When using Multibic, clinicians should observe specific precautions to minimise risks and ensure therapeutic effectiveness.

• Monitor electrolytes: check serum sodium, potassium, calcium and magnesium before and after infusion.
• Adjust volume: tailor infusion rate in patients with fluid overload or heart failure.
• Cardiac monitoring: observe ECG for arrhythmias when high potassium or calcium levels are possible.
• Avoid in severe hyperkalemia: do not administer if potassium exceeds safe thresholds without correction.
• Use aseptic technique: ensure sterile handling of the intravenous solution to prevent infection.
• Store below 25°C: keep in original packaging, protect from moisture and direct sunlight.

Multibic can interact with other intravenous fluids and medications that affect electrolyte balance or acid‑base status.

Major Interactions (Avoid)

• High‑potassium supplements: may cause dangerous hyperkalemia when combined.
• Sodium‑rich medications: can exacerbate hypertension or fluid overload.

Moderate Interactions (Monitor Closely)

• Calcium‑containing drugs: risk of hypercalcemia if given concurrently.
• Diuretics: may alter sodium and potassium levels, requiring dose adjustment.
• ACE inhibitors or ARBs: can affect potassium homeostasis, necessitating close monitoring.