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9.5 Fluid and Electrolyte imbalances

First line drugs Second line drugs Specialist drugs Secondary care drugs

9.5 Fluid and electrolyte imbalances

 

Bicarbonate

 

Sodium bicarbonate (Amber 2)

  • Capsules, 500mg
  • Infusion 1.26%, 2.74%, 8.4%
  • Injection 8.4%

 

 

Potassium

 

Hyperkalaemia

 

Management of hyperkalaemia (Potassium Removal)

Polystyrene sulphonate resins       

 

Calcium Resonium®  (Amber 2)

  • Powder calcium polystyrene sulphonate.  
  • Enema 30g in 100mL U      

 

Resonium A® (Amber 2)

  • Powder sodium polystyrene sulphonate.

Note: Calcium Resonium or Resonium A can be taken orally mixed in water (not fruit squash or other potassium containing fluids), or as a paste. It may also be administered rectally (contact your pharmacist for formulation details). 

 

 

Hypokalaemia

Sando-K®

  • Effervescent tablets each containing 12mmol potassium       

 

Kay-Cee-L®

  • Syrup SF containing 1mmol potassium per ml

 

Slow-K®

  • Modified release tablets each containing 8mmol potassium  

Notes:

  • Potassium supplementation is indicated for proven hypokalaemia.
  • Potassium salts are preferably given as the effervescent tablets or liquid preparation, rather than the modified release tablets. Slow-K® tablets only contain 8mmol potassium per tablet and are associated with oesophageal ulceration.

 

Pre-mixed Infusion solutions

 

  • Pre-mixed infusion solutions should be used when possible.
  • Medical errors involving Sterile Potassium Chloride Concentrate (20mmol/10ml {15%}) can be potentially fatal.
  • The use of Sterile Potassium Chloride Concentrate (20mmol/10ml {15%}) is restricted to use in areas that require potassium-containing fluids not available as pre-mixed solutions.

  

Recommended: Pre-mixed infusion solutions

Base fluid

Volume

Potassium content

per bag

Potassium chloride

content

Sodium chloride 0.9%

1000ml

20mmol

0.15%

Sodium chloride 0.9%

1000ml

40mmol

0.30%

Glucose 5%

1000ml

20mmol

0.15%

Glucose 5%

1000ml

40mmol

0.30%

Glucose 4% & Sodium chloride 0.18%

1000ml

20mmol

0.15%

Glucose 4% & Sodium chloride 0.18%

1000ml

40mmol

0.30%

Glucose 10%*

500ml

10mmol

0.15%

*Unlicensed product.

  • Other pre-mixed solutions are expected to become available. Please check the current position with Pharmacy

 

 

Specific indication:

Sterile Potassium Chloride Concentrate (20mmol/10ml {15%})

  • Restricted to Critical Care areas

Potassium Chloride prefilled syringe (50mmol/50ml {7.5%})

  • Restricted to Critical Care areas

Potassium Acid Phosphate Sterile Solution for injection {13.6%}

  • Restricted to Critical Care areas

 

 

 

Sodium

The terms "saline", "normal saline" and "NS" must not be used to describe sodium chloride 0.9%

Sodium chloride injection/infusion 0.45%, 0.9%, 1.8%

 

Sodium chloride 0.9%

for injection

  • 5mL, 10mL, 20mL ampoules
  • 50mL vials   

 

Slow Sodium®  (Amber 3)

  • Modified release tablets containing 600mg sodium chloride (equivalent to 10mmol Sodium)  

 

Oral solution 30% - unlicensed

 

Sodium chloride 5%

  • Critical care only

 

 

Sodium chloride with other ingredients

Sodium chloride 0.18% and glucose 4% intravenous infusion

  • Please note that following a NPSA alert sodium chloride 0.18% and glucose 4% intravenous infusion should not be used in children.

Sodium chloride 0.45% and glucose 5% intravenous infusion

Sodium chloride 0.45% and glucose 2.5% intravenous infusion

Sodium lactate intravenous infusion compound (Hartmann's solution)

 

 

Nutrients

Sugars (Glucose)

Glucose infusion/injection 5%, 10%, 20%, 50%

 

Oral gel - Dextrogel 40%

 

Oral Glucose       

Glucose 30%

  • 10mL oral solution  U       

 

Oral rehydration therapy (ORT)

 

Oral rehydration salts       

  Na+ K+ Cl- Glucose Other
Dioralyte® - 5 sachets reconstituted with 1 litre of water  60 mmol 20 mmol 60 mmol  90 mmol 10 mmol citrate 
Dioralyte®Relief - 5 sachets reconstituted with 1 litre of water  60 mmol 20 mmol 50 mmol 30g Rice starch 10 mmol citrate
Electrolade® - 5 sachets reconstituted with 1 litre of water  50 mmol 20 mmol 40 mmol 111 mmol 30 mmol HCO3-
WHO formulation - 1 litre  U 90 mmol 20 mmol 80 mmol 111 mmol 10 mmol citrate

 

Notes:

  • WHO formulation (St Marks solution) is an unlicensed preparation and not commonly used in the UK.
  • It is usually for short bowel patients requiring oral rehydration

 

 

 

 


Calcium imbalance

 

Hypercalcaemia and hypercalciuria

Calcium regulating drugs

Cinacalcet

  • Tablets 30mg, 60mg, 90mg

Notes:

  • GP can continue to prescribe for patients already stabilised on it

 

 

 

Etelcalcetide 

  • Parsabiv® Solution for injection; 2.5mg, 5mg, 10mg in vial

Use as per NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism (June 2017)

 

 

 

Hypocalcaemia

 

Before calcium supplements are initiated, dietary calcium should be optimised. Below are two links from the National Osteoperosis Foundation with information on this:

 

 

Adcal®

  • Chewable tablets containing 600mg calcium (15mmol)

      

Sandocal-1000® 

  • Effervescent tablets containing 1000mg calcium (25mmol)    

Notes: Approved for the short term treatment of hypocalcaemia post thyroidectomy.           

        

Calcium Gluconate 10%

  • 10mL ampoule           

 

Calcium chloride 10%

  • Min-I-jet 10mL           

Notes:

  • Patients should be encouraged to increase their dietary intake of calcium.
  • Calcium supplements are usually only required where dietary calcium intake is deficient. Patients with coeliac disease are at increased risk of osteoporosis due to malabsorption of calcium, weight loss and low BMI. With a good response to a gluten free diet, bone mineral density increases. However, many coeliacs require supplementary calcium. (see section 9.6.4)
  • Approximately 700mg of calcium is required per day. In osteoporosis, double the recommended daily amount reduces the risk of bone loss. For specific advice on the use of calcium in treatment and prophylaxis of osteoporosis see chapter 6 section 6.6 ‘Drugs affecting bone metabolism’.
  • Calcium Sandoz®syrup is included where a liquid form of calcium is required.
  • Calcium and vitamin D products are included in Section 9.6.4.   

 

 

 

Low blood volume

Gelatin

Gelatin 40g per 1ml (4%) (Gelofusine®, Isoplex®)

 

 

 

Magnesium imbalance

 

Hypomagnesaemia

 

Magnesium (as aspartate dihydrate) (TLS: Amber 1)

  • Magnaspartate® Powder in Sachets containing magnesium (as aspartate dihydrate) 243mg (10mmol) per 6.5g peach/apricot flavoured powder in sachet for oral solution

 

Magnesium Glycerophosphate (TLS: Amber 1)

  • Neomag® Chewable Tablets containing 97mg (4mmol) magnesium per tablet

      

Magnesium Glycerophosphate   U (TLS: Amber 1)

  • Liquid containing  10mmol in 10mL      

 

Magnesium sulfate

  • Injection 50% (approximately 2 mmol magnesium per mL) 10mL amps.     

Notes:

 

 

 

Phosphate imbalance

 

Hyperphosphataemia

 

Sevelamer

  • Renvela®tablets sevelamer carbonate 800mg
  • Renvela® sachets sevelamer carbonate 2.4g - for use via enteral feeding tubes when sevelamer is indicated.
  • Renagel® tablets sevelamer hydrochloride 800mg  

Note:

  • For use by Renal Team only
  • Hospital use only for new patients 

 

 

Lanthanum

  • Fosrenol® chewable tablets lanthanum carbonate hydrate 500mg
  • Fosrenol® chewable tablets lanthanum carbonate hydrate 750mg
  • Fosrenol® chewable tablets lanthanum carbonate hydrate 1g
  • Fosrenol® powder lanthanum carbonate hydrate 750mg
  • Fosrenol®powder lanthanum carbonate hydrate 1g

 

Note:

  • For use by Renal Team only 
  • Renagel and Lanthanum are available for third line management of hyperphosphataemia in dialysis patients with serum phosphate levels that are not controlled, or where aluminium and calcium salts are inappropriate

 

 

Hypophosphataemia

 

Phosphate supplements       

 

Phosphate-Sandoz® (Amber 1)  

  • Effervescent tablets containing the equivalent of 16.1mmol phosphate  

 

Phosphates polyfusor

  • 0.1mmol phosphate per ml infusion

 

Phosphate mixture U 

  • Mixture 100mL, containing the equivalent of 527mmol phosphate/L 

 

 

 

 

Return to Chapter: 9. Nutrition and Blood

Last updated by: Dupe Fagbenro on 10-12-2018 14:16