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

Multibic is used in renal replacement therapy to maintain electrolyte and acid‑base balance during haemodialysis and intravenous fluid replacement.

• Renal failure requiring haemodialysis: restores sodium, chloride, magnesium and calcium levels while providing buffering capacity.
• Electrolyte replacement: corrects acute deficits of key electrolytes in patients with fluid loss or metabolic disturbances.
• Intravenous fluid replacement: supplies isotonic fluid for patients unable to maintain intravascular volume.

• Multibic delivers a balanced mixture of sodium, chloride, magnesium and calcium ions together with bicarbonate, which together replenish extracellular electrolytes, support osmotic equilibrium and provide buffering capacity to correct metabolic acidosis. The solution’s composition mimics plasma electrolyte concentrations, facilitating rapid distribution across vascular and interstitial compartments during haemodialysis or intravenous infusion.

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

Common Side Effects

• Infusion site pain or erythema: mild discomfort at the catheter site.
• Transient hypernatremia: temporary rise in serum sodium levels.
• Nausea or mild gastrointestinal upset.
• Headache: often related to rapid fluid shifts.
• Mild hypotension: drop in blood pressure during rapid infusion.
• Fever or chills: low‑grade febrile response.

Serious or Rare Side Effects

• Severe hypermagnesemia: can cause muscle weakness, respiratory depression.
• Severe hypercalcemia: may lead to cardiac arrhythmias.
• Anaphylactic reaction: rare but potentially life‑threatening hypersensitivity.
• Cardiac arrhythmia: due to abrupt electrolyte changes.
• Metabolic alkalosis: excessive bicarbonate load.
• Pulmonary edema: from volume overload in susceptible patients.

When using Multibic, clinicians should observe several safety measures.

• Baseline electrolyte assessment: verify serum sodium, potassium, calcium and magnesium before infusion.
• Cardiac monitoring: observe rhythm during and after administration, especially in patients with cardiac disease.
• Dose adjustment in renal impairment: reduce volume or concentration as needed.
• Avoid in hypercalcemia: high calcium content may exacerbate the condition.
• Pregnancy and lactation: safety not established; use only if clearly needed.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Concurrent calcium‑containing solutions: risk of precipitation and hypercalcemia.
• High‑dose magnesium sulfate: may cause severe hypermagnesemia.
• Additional bicarbonate agents: can precipitate metabolic alkalosis.
• Loop diuretics: may intensify electrolyte loss.
• ACE inhibitors or ARBs: increase risk of hyperkalemia when combined with other electrolyte solutions.

Moderate Interactions (Monitor Closely)

• Sodium‑rich medications: monitor for hypernatremia.
• Anticoagulants used during dialysis: watch for altered clotting parameters.
• Blood pressure‑lowering drugs: observe for additive hypotensive effects.