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

Multibic is used in renal replacement therapy to manage electrolyte balance and acid‑base status during haemodialysis.

• Haemodialysis: Maintains optimal electrolyte concentrations and buffering capacity throughout the treatment.
• Acute kidney injury requiring dialysis: Provides necessary ions to correct disturbances while supporting renal support.
• Chronic kidney disease on maintenance dialysis: Assists in long‑term electrolyte replacement and pH regulation during regular sessions.
• Peritoneal dialysis (when adapted): Supplies electrolytes to complement dialysate solutions for peritoneal exchange.

• Multibic supplies a balanced mixture of sodium, potassium, calcium, magnesium, chloride and bicarbonate ions. During haemodialysis the solution is circulated through the dialyzer, allowing diffusion and convection of these electrolytes across the semipermeable membrane. The bicarbonate component provides buffering to neutralize excess hydrogen ions, correcting metabolic acidosis, while the other ions replace those lost from the patient’s blood, helping to maintain physiologic plasma concentrations.

Adverse reactions to Multibic may occur during or after haemodialysis.

Common Side Effects

• Hypotension: transient drop in blood pressure during treatment.
• Nausea: mild feeling of sickness.
• Muscle cramps: involuntary contractions, often in the legs.
• Headache: mild to moderate pain in the head.
• Flushing: temporary redness of skin.
• Itching: localized pruritus at infusion site.

Serious or Rare Side Effects

• Severe allergic reaction: rash, swelling, bronchospasm requiring immediate medical attention.
• Hyperkalemia: elevated potassium levels that may cause cardiac rhythm changes.
• Metabolic alkalosis: excessive bicarbonate leading to pH imbalance.
• Cardiac arrhythmia: irregular heart rhythm potentially life‑threatening.
• Pulmonary edema: fluid accumulation in lungs presenting with shortness of breath.

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

• Patient assessment: evaluate electrolyte levels and acid‑base status before initiating therapy.
• Fluid balance: monitor volume status to avoid overload or depletion.
• Compatibility: verify compatibility with the dialysis machine and other solutions.
• Monitoring: check blood pressure and cardiac rhythm continuously during treatment.
• Contraindications: avoid use in patients with known hypersensitivity to any component.
• Store at ambient temperature: keep in original container, protect from light and moisture, do not freeze.

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

Major Interactions (Avoid)

• Calcium channel blockers: may potentiate hypotensive effects when combined with dialysate.
• High‑dose potassium supplements: can cause dangerous hyperkalemia when added to the solution.

Moderate Interactions (Monitor Closely)

• Anticoagulants (heparin): monitor for bleeding as dialysate composition can affect clotting.
• Diuretics: adjust dosing as electrolyte shifts may be amplified.
• Insulin: watch for hypoglycemia due to changes in potassium levels.