Potassium chloride + Calcium chloride + Magnesium chloride + Sodium lactate + Sodium chloride (Kalii chloridum + Calcii chloridum + Magnii chloridum + Natrii lactas + Natrii chloridum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Regulators of water-electrolyte balance and KHS

Included in the formulation
АТХ:

B.05.B.B.01   Electrolytes

Pharmacodynamics:

Change in the buffer capacity of blood. Hemodilution. Reducing the viscosity of the blood.

Pharmacokinetics:

There is no information. Calcium and magnesium ions penetrate the placental barrier and into breast milk. Renal excretion is performed (potassium ions - in distal tubules in exchange for sodium ions or hydrogen), a small amount excreted in sweat. 25-30% of magnesium binds to plasma proteins.

Indications:

Disturbances of blood circulation against the background of dehydration and / or escape of fluid from the vascular bed into the extracellular space.

In severe shock (hemorrhagic, surgical, postoperative) - in combination with blood, dextran, plasma, protein, but only after removing the patient from the hemodynamic crisis.

Burn disease.

Injury.

Metabolic acidosis.

Violations of water-electrolyte balance and / or acid-base state, peritonitis, intestinal obstruction, intestinal paresis, ulcerative colitis, diarrhea of ​​various etiology (shigellosis).

Acute circulatory disorders on the background of severe purulent-septic complications (peritonitis, pancreatitis, sepsis).

ICD-10

IX.I95-I99.I98 *   Other disorders of the circulatory system in diseases classified elsewhere

XVIII.R50-R69.R57.8   Other types of shock

IV.E70-E90.E87.2   Acidosis

Contraindications:

Hypersensitivity.

Hypervolaemia, hypertonic dehydration, hyperkalemia, hypernatremia, hyperlactacidemia, hyperchloremia.

Arterial hypertension, cardiac and / or renal failure.

Alkalosis.

Hepatic insufficiency (decrease in the formation of bicarbonate from lactate).

For sodium chloride: with caution in hypertension, heart failure, peripheral edema or pulmonary edema, renal failure, pre-eclampsia, and other conditions associated with sodium ion retention.

Do not use for hyperchloremia!

For sodium lactate: metabolic or respiratory alkalosis, hypocalcemia, hypochlorhydria.

Carefully:For potassium chloride: with caution in heart diseases and conditions predisposing to hyperkalemia (renal or adrenal insufficiency, acute dehydration, massive tissue damage, for example, with severe burns). Regular monitoring of the clinical condition, concentration of electrolytes in the blood plasma, and ECG is necessary.

For calcium chloride: with caution in renal failure, diseases associated with increased calcium concentrations (sarcoidosis, some malignant tumors).Do not use in patients with calcium kidney stones or stones in the kidneys in the anamnesis. Regular monitoring of calcium in patients with renal insufficiency and simultaneous administration of high doses of vitamin is required.

For magnesium chloride: with caution in cardiac blockade and severe renal failure, myasthenia gravis gravis.

Pregnancy and lactation:

After the appointment of magnesium chloride, pregnant women with eclampsia described meconium delay in newborns with hypermagnesia. Magnesium inhibits the function of smooth muscle cells in the gastrointestinal tract. In 36 newborns with hypermagnesia, born from mothers with pre-eclampsia who received magnesium sulfate, within 24 hours after birth, the following are noted: neuro-behavioral disorders in the form of long-term weakness of activity indicators; oppression of the functions of the gastrointestinal tract, sucking reflex; reaction in the form of crying. In studies in women with preeclampsia and in her absence and with the appointment of magnesium sulfate intravenously, there was a decrease in the short-term variability of the heart rate in the fetus, but it was regarded as clinically insignificant.

The category of FDA recommendations is not defined.

Dosing and Administration:

In severe shock: dose - depending on the condition, but not less than 1-2 liters.

Shock traumatic in the first stage: 2-3 liters of solution intravenously struyno, with improvement of hemodynamic parameters - intravenously drip.

Burn disease, in the I period with burns no more than 10-15% of the body surface apply in a dose of up to 3 liters. With more extensive damage, a lack of plasma volume and hypotension: on the first day - at least 1-2 liters in combination with dextran, plasma, human albumin, on the second day - half the volume introduced in the first 24 hours. In the II-III periods, burns diseases - dosing depending on the severity of the condition (400-1000 ml).

Violations of the water-electrolyte balance and / or acid-base state, peritonitis, intestinal obstruction, intestinal paresis, ulcerative colitis, diarrhea of ​​various etiology (shigellosis) - 1-3 liters per day.

Acute circulatory disorders on the background of severe purulent-septic complications (peritonitis, pancreatitis, sepsis) - up to 2-4 liters per day for 3-4 days (as part of combination therapy).

Side effects:

Violations of the acid-base state.

For sodium chloride - associated with electrolyte imbalance due to excess sodium or with the effects of the actual sodium and chloride ions,accumulation of extracellular fluid to maintain normal plasma osmolality: hypernatremia (thirst, decreased salivation and tear, fever, sweating, tachycardia, hypo- or hypertension, headache, dizziness, restlessness, irritability, weakness, muscle twitching or stiffness, dehydration of the brain, drowsiness, confusion and convulsions, coma, respiratory failure, death), the risk of developing pulmonary edema and peripheral edema, the risk of losing bicarbonate with subsequent acidifying eff ktomu.

For potassium chloride: hyperkalemia, especially with renal failure (paresthesia in the limbs, muscle weakness, paralysis, cardiac arrhythmias, blockade, cardiac arrest, confusion).

For calcium chloride: hypercalcemia (anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, impaired thinking, thirst, polyuria, nephrocalcinosis, cardiac arrhythmias, coma), calcification of soft tissues (especially in renal failure and simultaneous intake of vitamin D) .

For sodium lactate: hypokalemia, metabolic alkalosis, mood changes, fatigue, slow breathing,muscle weakness, irregular heartbeat, muscle hypertonia, twitching and tetanus (especially with hypocalcemia), panic attacks (especially in patients with anxiety).

For magnesium chloride: hypersensitivity, hypermagnia (loss of deep tendon reflexes, respiratory depression due to neuromuscular blockade, nausea, vomiting, redness of the skin, thirst, hypotension due to peripheral vasodilation, drowsiness, confusion and speech, double vision, muscle weakness, bradycardia, coma, cardiac arrest), intoxication.

Overdose:

Symptoms: edema of the papilla of the optic nerve, cerebral edema, convulsions, hyperthermia. The toxic dose of sodium chloride is 100-150 g.

Treatment of sodium chloride overdose: gastric lavage, symptomatic maintenance therapy, hemodialysis.

Treatment of hyperkalemia (concentration of potassium above 6-7 mmol / L, changes in ECG): administration of calcium preparations to stop the effect on cardiac conduction (10-20 ml of 10% calcium gluconate solution intravenously, dose titrated under ECG changes control).

Short-acting insulin (5-10 units with 50 ml of 50% dextrose intravenously slowly for 5-10 minutes, repeat if necessary), or sodium hydrogen carbonate (with severe acidosis, pH less than 7.2), or salbutamol intravenously or through a nebulizer (increases intracellular capture of potassium, but also can cause cardiac arrhythmias, perhaps more effective when used with insulin).

Enhancement of potassium excretion with cation-exchange resins (calcium or sodium polystyrene sulfonate or rectally), hemo- or peritoneal dialysis.

Symptoms of hypermagnia: loss of deep tendon reflexes, respiratory depression due to neuromuscular blockade, nausea, vomiting, redness of the skin, thirst, hypotension due to peripheral vasodilation, drowsiness, confusion and speech, double vision, muscle weakness, bradycardia, coma, stop heart.

Treatment of hypermagnesia: support breathing and circulation (the introduction of 10% calcium gluconate solution at a dose of 10-20 ml).

With normal kidney function - an adequate amount of infusion to ensure renal clearance, furosemide.

With inefficiency and in patients with renal insufficiency - hemodialysis with solutions that do not contain magnesium.

Interaction:

Dextrose is a decrease in serum potassium concentration.

For potassium preparations: use with caution with funds that increase the potassium concentration (potassium-sparing diuretics, ACE inhibitors; ciclosporin; flavoring agents containing potassium salts; medicines, which are potassium salts).

Potassium-sparing diuretics cause the development of hyperkalemia.

Non-steroidal anti-inflammatory drugs, androgens, estrogens, anabolic hormones, corticotropin, mineralocorticoids, vasodilators or ganglion blockers lead to increased sodium retention.

Calcium preparations (thiazide diuretics, vitamin D) reduce renal calcium excretion, increase the risk of hypercalcemia.

Cardiac glycosides increase the risk of their toxic effects in combination with calcium, strengthen their influence on the heart.

Special instructions:

Common for solutions that affect the electrolyte balance.

Distinctive characteristics

In the treatment of severe hypovolemia, simultaneous administration of colloidal solutions, blood and its components (due to the short-term action of the drug) is recommended.

With prolonged administration in large doses, it is necessary to control the content of electrolytes in blood plasma and urine.
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