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

• Multibic is used as an electrolyte and buffer solution in haemodialysis and related renal replacement therapies.
• Chronic kidney disease patients undergoing haemodialysis: provides necessary bicarbonate and electrolytes to maintain plasma balance during treatment.
• Acute renal failure requiring renal replacement therapy: supplies a controlled composition of sodium, calcium, magnesium and chloride to support hemodynamic stability.
• Patients with metabolic acidosis during dialysis: delivers bicarbonate to correct low pH and improve acid‑base status.

• Multibic delivers sodium hydrogen carbonate, magnesium, calcium and chloride ions directly into the extracorporeal dialysis circuit. Across the semipermeable dialyzer membrane, these ions diffuse according to concentration gradients, correcting plasma electrolyte deficits and providing a bicarbonate buffer that neutralises excess hydrogen ions, thereby restoring acid‑base equilibrium during renal replacement therapy.

Multibic may be associated with a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Mild hypotension during treatment
• Muscle cramps or spasms
• Nausea or vomiting
• Headache
• Dizziness or light‑headedness
• Transient fever or chills

Serious or Rare Side Effects

• Severe hypernatremia or hypercalcemia
• Cardiac arrhythmias due to electrolyte shifts
• Anaphylactic or severe allergic reaction
• Metabolic alkalosis requiring intervention
• Pulmonary edema from fluid overload
• Severe hypotensive shock

• When using Multibic, careful monitoring and appropriate handling are essential.
• Monitor serum electrolytes: check sodium, calcium, magnesium and chloride levels before and during treatment.
• Adjust solution composition: tailor electrolyte concentrations to individual patient needs.
• Use appropriate dialysis machine settings: ensure correct flow rates and temperature.
• Avoid in patients with severe hypernatremia: may exacerbate the condition.
• Pregnancy and lactation: use only if clearly needed, safety not established.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Multibic can interact with other medications or fluids that affect electrolyte balance.

Major Interactions (Avoid)

• Concurrent high‑dose calcium supplements: risk of hypercalcemia.
• Co‑administration with other bicarbonate‑containing IV fluids: may cause metabolic alkalosis.
• Use with potassium‑sparing diuretics: can lead to hyperkalemia.

Moderate Interactions (Monitor Closely)

• Concurrent antihypertensive agents: may enhance hypotensive effect.
• Combination with other intravenous electrolytes: monitor fluid and electrolyte balance.
• Blood transfusion with citrate anticoagulant: may affect calcium levels.