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 disturbances during dialysis.

• Renal failure requiring haemodialysis: maintains plasma sodium, potassium, calcium and magnesium levels to prevent electrolyte imbalance.
• Haemodialysis procedures: provides buffering capacity to control metabolic acidosis during treatment.
• Acute kidney injury with electrolyte disturbances: supplies essential ions intravenously to support homeostasis.

• Multibic delivers a balanced mixture of sodium hydrogen carbonate, magnesium chloride, potassium chloride, sodium chloride and calcium directly into the bloodstream or dialysis circuit. The sodium hydrogen carbonate acts as a bicarbonate source, buffering excess hydrogen ions and correcting metabolic acidosis. The accompanying electrolytes replenish plasma concentrations, stabilising membrane potentials and supporting cardiac and neuromuscular function. Together, the solution sustains physiological pH and electrolyte homeostasis throughout haemodialysis.

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

Common Side Effects

• Mild hypotension
• Nausea or vomiting
• Transient muscle cramps
• Slight increase in serum calcium
• Low‑grade fever

Serious or Rare Side Effects

• Severe hyperkalemia
• Severe hypocalcemia
• Anaphylactic or severe allergic reaction
• Metabolic alkalosis
• Cardiac arrhythmia
• Pulmonary edema

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

• Assess electrolyte levels: monitor serum sodium, potassium, calcium and magnesium before and during infusion.
• Check acid‑base status: evaluate blood pH and bicarbonate to guide dosing.
• Use with compatible dialysis fluids: verify compatibility with the dialysis machine’s settings and other solutions.
• Avoid rapid infusion: administer at the prescribed rate to prevent fluid overload and cardiovascular stress.
• Pregnancy and lactation: consider use only if potential benefits outweigh risks and after specialist consultation.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Multibic can interact with other medicines that affect electrolyte balance or cardiovascular function.

Major Interactions (Avoid)

• Calcium channel blockers: may increase risk of hypercalcemia.
• Potassium‑sparing diuretics: can lead to dangerous hyperkalemia.
• ACE inhibitors or ARBs: additive potassium elevation may occur.

Moderate Interactions (Monitor Closely)

• Loop diuretics: may cause rapid shifts in sodium and potassium.
• Beta‑blockers: may mask hypotensive effects of the solution.
• Blood transfusions: can alter calcium levels and affect coagulation.