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

• Multibic is used to manage electrolyte balance during haemodialysis and related renal replacement procedures.
• Haemodialysis: provides essential electrolytes to maintain plasma osmolarity and acid‑base status.
• Acute renal failure: supports electrolyte replacement during continuous renal replacement therapy.
• Intravascular volume management: assists in preserving appropriate fluid and electrolyte composition during extracorporeal circulation.

• Multibic delivers sodium, calcium, magnesium, and chloride ions together with bicarbonate buffering capacity. The solution restores plasma electrolyte concentrations, corrects metabolic acidosis, and stabilises osmotic pressure during haemodialysis. By matching the composition of normal plasma, it facilitates efficient diffusion of solutes across the dialysis membrane and supports cardiovascular stability throughout the treatment.

Multibic may be associated with infusion‑related reactions and electrolyte shifts.

Common Side Effects

• Hypotension: transient drop in blood pressure during infusion.
• Electrolyte imbalance: mild hypernatremia, hypercalcemia, or hypermagnesemia.
• Fever or chills at the infusion site.
• Mild nausea or discomfort.
• Local irritation at the injection site.

Serious or Rare Side Effects

• Anaphylactic reaction: severe allergy requiring immediate medical attention.
• Cardiac arrhythmia: due to rapid electrolyte changes.
• Pulmonary edema: from fluid overload.
• Severe metabolic alkalosis: excessive bicarbonate effect.
• Hemolysis: rare but possible with improper mixing.

• When using Multibic, clinicians should observe several safety measures.
• Patient assessment: evaluate baseline electrolytes and acid‑base status before infusion.
• Infusion rate: administer at a controlled rate to avoid rapid shifts.
• Cardiac monitoring: watch for arrhythmias during and after administration.
• Renal function: adjust composition if residual kidney function is present.
• Compatibility: ensure solution is compatible with dialysis equipment and other IV fluids.
• Store at ambient temperature: keep in original container, protect from light and moisture.

Multibic can interact with other medications that affect electrolyte balance or acid‑base status.

Major Interactions (Avoid)

• Calcium channel blockers: may increase calcium load.
• High‑dose diuretics: risk of profound electrolyte depletion.
• Additional bicarbonate‑containing solutions: can cause metabolic alkalosis.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: monitor potassium and blood pressure.
• Beta‑blockers: observe for additive hypotensive effects.
• Blood products: watch calcium levels during concurrent transfusion.