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

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

• Haemodialysis: Maintains electrolyte concentrations and provides bicarbonate buffering during the procedure.
• Metabolic acidosis: Corrects low blood pH by supplying bicarbonate during dialysis.
• Renal replacement therapy: Supports overall electrolyte homeostasis throughout treatment.

• Multibic delivers sodium hydrogen carbonate, which dissociates to bicarbonate ions that buffer excess hydrogen ions, raising blood pH. Simultaneously, the solution supplies sodium, potassium, magnesium and chloride ions, replenishing those lost in the dialysis circuit and preserving osmotic balance. The combined effect restores normal acid‑base status and electrolyte concentrations, facilitating safe and effective haemodialysis.

Multibic may be associated with several adverse reactions, which are categorized by frequency.

Common Side Effects

• Mild nausea or gastrointestinal discomfort.
• Transient hypotension during infusion.
• Local irritation at the infusion site.
• Mild headache.
• Small shifts in serum electrolytes, such as mild hyperkalemia.

Serious or Rare Side Effects

• Severe hyperkalemia leading to cardiac arrhythmia.
• Significant hypertension.
• Anaphylactic or severe allergic reaction.
• Metabolic alkalosis.
• Life‑threatening cardiac arrhythmias.

When using Multibic, clinicians should observe the following precautions to minimise risk.

• Patient assessment: Evaluate baseline electrolyte levels and acid‑base status before infusion.
• Infusion rate: Adjust rate according to dialysis prescription and patient tolerance.
• Monitoring: Continuously monitor blood pressure, heart rhythm and serum electrolytes during treatment.
• Contraindications: Avoid in patients with severe hyperkalemia or uncontrolled hypertension.
• Compatibility: Use only with compatible dialysis machines and tubing as specified by the manufacturer.
• Store at ambient temperature: Keep the solution below 25 °C, protected from light and moisture, in the original sealed container.

Multibic can interact with certain medications and solutions; awareness of these interactions helps ensure safe use.

Major Interactions (Avoid)

• Concurrent use of high‑dose potassium supplements may cause dangerous hyperkalemia.
• Co‑administration with other bicarbonate‑containing solutions can lead to metabolic alkalosis.
• Use with calcium‑channel blockers that affect vascular tone may exacerbate hypotension.

Moderate Interactions (Monitor Closely)

• Loop diuretics may increase electrolyte losses, requiring closer monitoring.
• ACE inhibitors or ARBs can alter potassium balance, necessitating serum checks.
• Anticoagulants used during dialysis (heparin) may increase bleeding risk if volume status changes rapidly.