Multibic (Sodium Hydrogen Carbonate, Magnesium Chloride Hexahydrate, Sodium Chloride, Calcium Chloride Dihydra)

Multibic is used in electrolyte management and renal replacement therapy to maintain ion balance during specific clinical procedures.

• Haemodialysis: restores sodium, chloride, calcium, magnesium and bicarbonate levels to maintain plasma osmolarity during the session.
• Chronic kidney disease patients undergoing renal replacement therapy: supplies essential electrolytes to prevent acid‑base disturbances.
• Intravenous electrolyte replacement: provides rapid correction of electrolyte deficits in hospitalized patients.

• Multibic delivers sodium, chloride, calcium, magnesium and bicarbonate ions directly into the bloodstream or dialysis circuit. The supplied sodium and chloride contribute to extracellular fluid volume and osmotic balance, while calcium and magnesium support neuromuscular and cardiac function. Bicarbonate acts as a buffer, correcting metabolic acidosis. Together, these ions help re‑establish normal plasma electrolyte concentrations and acid‑base status during haemodialysis or intravenous therapy.

The following adverse reactions have been reported with the use of Multibic.

Common Side Effects

• Infusion site irritation: mild pain or erythema at the injection site.
• Nausea: transient feeling of sickness.
• Headache: mild to moderate.
• Mild hypernatremia: slight increase in serum sodium.

Serious or Rare Side Effects

• Severe hypernatremia: marked elevation of serum sodium leading to neurological symptoms.
• Metabolic alkalosis: excessive bicarbonate causing high blood pH.
• Anaphylactic reaction: acute hypersensitivity requiring emergency treatment.
• Cardiac arrhythmia: potentially life‑threatening rhythm disturbances.

When using Multibic, consider the following precautions to ensure safe administration.

• Renal function monitoring: assess serum electrolytes and acid‑base status regularly.
• Cardiovascular status: watch for fluid overload and hypertension in patients with heart disease.
• Pregnancy and lactation: use only if clearly needed, as safety data are limited.
• Concomitant electrolyte-modifying drugs: adjust doses of diuretics, ACE inhibitors or other agents affecting sodium, potassium or calcium.
• Hypersensitivity: discontinue if signs of allergic reaction appear.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Multibic may interact with other medicines that influence electrolyte balance or acid‑base status.

Major Interactions (Avoid)

• Calcium supplements: risk of hypercalcemia when combined.
• Potassium‑sparing diuretics: may cause dangerous electrolyte shifts.
• Alkali therapy (e.g., oral sodium bicarbonate): can exacerbate metabolic alkalosis.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: monitor potassium and blood pressure.
• Loop diuretics: may increase loss of calcium and magnesium, requiring electrolyte monitoring.
• Blood transfusions: can affect acid‑base balance, necessitating close observation.