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

Multibic is used to manage electrolyte and acid‑base disturbances during haemodialysis and intravenous therapy.

• Haemodialysis: provides sodium, chloride, calcium, magnesium and bicarbonate to maintain electrolyte homeostasis.
• Intravenous therapy in critically ill patients: supports acid‑base balance when rapid correction is needed.
• Renal replacement therapy: assists in preventing electrolyte depletion during continuous renal replacement therapy (CRRT).

• Multibic delivers sodium, chloride, calcium, magnesium and bicarbonate ions directly into the bloodstream. The supplied ions replenish deficits caused by dialysis or acute illness, while bicarbonate buffers excess hydrogen ions to correct metabolic acidosis. By restoring extracellular electrolyte concentrations, the solution helps maintain membrane potential, cardiac contractility and neuromuscular function.

Multibic may cause a range of adverse reactions, most of which are related to electrolyte shifts or the injection process.

Common Side Effects

• Injection site pain: mild discomfort at the infusion site.
• Transient hypernatremia: temporary elevation of serum sodium.
• Mild hypotension: slight drop in blood pressure during rapid infusion.
• Mild metabolic alkalosis: modest increase in blood pH.

Serious or Rare Side Effects

• Severe hyperkalemia: dangerous rise in potassium levels.
• Severe hypermagnesemia: excessive magnesium causing cardiac effects.
• Anaphylactic reaction: acute allergic response requiring emergency care.
• Severe fluid overload: pulmonary edema or heart failure from excess volume.

When using Multibic, clinicians should observe several safety measures.

• Renal function: monitor serum electrolytes closely during therapy.
• Cardiac status: watch for arrhythmias related to rapid electrolyte changes.
• Fluid balance: avoid excessive volume administration, especially in heart‑failure patients.
• Pregnancy and lactation: use only if the anticipated benefit justifies potential risk.
• Concomitant electrolyte supplements: adjust doses to prevent overload.
• Store at controlled room temperature: keep in original container, protect from light and moisture.

Multibic can interact with other medications that affect electrolyte or fluid status.

Major Interactions (Avoid)

• Calcium channel blockers: may potentiate hypercalcemia.
• Loop diuretics: increase risk of electrolyte imbalance.
• Alkali therapy: may cause excessive alkalosis.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: monitor potassium levels.
• Beta‑blockers: watch for blood pressure changes.
• Other intravenous electrolytes: adjust dosing to avoid cumulative overload.