9.2 Fluid and electrolyte imbalances

9.2 Fluid and electrolyte imbalances

Electrolyte concentrations - intravenous fluids

Bicarbonate

Sodium bicarbonate 500mg capsules (TLS Green)

Sodium bicarbonate injection/infusion 1.26%, 2.7%, 8.4% (TLS Green)

Oral rehydration therapy (ORT)

Oral Rehydration Salts (ORS) (TLS Green)

Specific patients: 

Short bowel patients requiring oral rehydration

WHO solution / St Marks solution (TLS Blue)

• Sodium chloride (table salt), glucose powder, sodium bicarbonate powder and water.
• See BNSSG 'Oral Rehydration Solution- Patient information leaflet' for more information

UHB solution (TLS Blue)

• Sodium chloride (table salt), glucose powder, sodium citrate powder and water.
• See BNSSG 'Oral Rehydration Solution- Patient information leaflet' for more information

Potassium

• 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.

*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%}) (TLS Red)

• Restricted to Critical Care areas

Potassium chloride prefilled syringe (50mmol/50mL {7.5%}) (TLS Red)

• Restricted to Critical Care areas

Potassium acid phosphate sterile solution for injection {13.6%} (TLS Red)

• 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% (TLS Green)

Specific indication:

Sodium chloride 5% (TLS Red)

• Critical care only

Sodium chloride with other ingredients

Sodium chloride 0.18% / glucose 4% intravenous infusion (TLS Green)

• 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% / glucose 5% intravenous infusion (TLS Green)

Sodium chloride 0.45% / glucose 2.5% intravenous infusion (TLS Green)

Sodium lactate intravenous infusion compound (Hartmann's solution) (TLS Green)

Sugars (Glucose)

Glucose infusion/injection 5%, 10%, 20%, 50% (TLS Green)

9.2.1 Low blood volume

Gelatin

Succinylated gelatin 40g (4%) (Gelofusine^®, Isoplex^®) (TLS Red)

9.2.3 Hypercalcaemia and hypercalciuria

Calcimimetic agents

Specific indication: (TLS Red/Amber)

Cinacalcet (TLS Red)

• NICE TA117 Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy

Cinacalcet (TLS Amber 3 months) (SCP click here)

• As per NHSE Policy Cinacalcet for complex primary hyperparathyroidism in adults

Etelcalcetide (TLS Red)

• NICE TA448 Etelcalcetide for treating secondary hyperparathyroidism

9.2.4 Hypocalcaemia

Calcichew^® chewable tablets (TLS Green)

Calcium gluconate 10% 2.2mmols per 10mL (parenteral) (TLS Green)

Calvive^® 1000 (TLS Green)

9.2.5 Hypomagnesaemia

Magnesium aspartate (Magnaspartate^®) (TLS Green)

• For the treatment of hypomagnesaemia
• See BNSSG Magnesium supplementation prescribing guidance on guideline page

Magnesium glycerophosphate (Neomag^®) (TLS Green)

• 4mmol Mg²⁺ per tablet.

Magnesium glycerophosphate oral solution (TLS Green)

• 1mmol/mL Mg²⁺, named patient

Magnesium sulphate 50% (parenteral) (TLS Red)

• 2mmol/mL Mg²⁺

 Specific indication:

Magnesium oxide capsules (TLS Blue)

• 2.5mmol Mg²⁺ per capsule
• On the advice of Consultant Gastroenterologist only, for use in Short Bowel patients

MagTab^® (TLS Red)

• For use by the Renal team at NBT only

9.2.7 Hyperphosphataemia

NICE Clinical Guideline NG203 Chronic Kidney disease: assessment and management

Calcium acetate (Renacet^®) (TLS Green)

Calcium acetate (Phosex^®) (TLS Blue)

Alternatives: (TLS Blue)

Calcichew^® (calcium carbonate) chewable tablet

Calcium 500^® (calcium carbonate) tablet

Specific indications:

Sevelamer (TLS Amber Specialist Recommended) 

• For use by Renal team only 
• Sevelamer carbonate is the first line choice of sevelamer salt and is available for  management of hyperphosphataemia in dialysis patients with serum phosphate levels that are not controlled, or where aluminium and calcium salts are inappropriate

Sevelamer carbonate sachets (TLS Red)

• For use via enteral feeding tubes when sevelamer is indicated

Sucroferric oxyhydroxide (TLS Amber Specialist Recommended)

• For use for management of hyperphosphataemia in dialysis patients with serum phosphate levels that are not controlled after calcium based binder and sevelamer have been tried or in patients intolerant to other agents

Lanthanum (TLS Amber Specialist Recommended) 

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

9.2.8 Hypophosphataemia

Phosphate-Sandoz^® tablets (TLS Green)

• 16.1mmol phosphate per tablet

Phosphates polyfusor infusion (TLS Green)

• 0.1mmol phosphate per mL

 Specific indication: (TLS Red)

Dipotassium hydrogen phosphate

• 1mmol phosphate and 2mmol of potassium per mL

9.2.9 Hyperkalaemia

Polystyrene sulfonate resins (TLS Green)

• Brands include Calcium Resonium^®, Resonium A^®

Sodium zirconium cyclosilicate (TLS Red)

• emergency treatment of hyperkalaemia
• NICE TA599 Sodium zirconium cyclosilicate for treating hyperkalaemia

Sodium zirconium cyclosilicate (TLS Amber specialist initiated)

• for persistent hyperkalaemia for patients with CKD (stages 3b-5) or heart failure in line with Potassium Binder Pathway for persistent hyperkalaemia in line with NICE TA599

Patiromer (TLS Red)

• emergency treatment of hyperkalaemia
• NICE TA623 Patiromer for treating hyperkalaemia

Patiromer (TLS Amber specialist initiated)

• for persistent hyperkalaemia for patients with CKD (stages 3b-5) or heart failure in line with Potassium Binder Pathway for persistent hyperkalamia in line with NICE TA623

9.2.10 Hypokalaemia

Sando K^® (TLS Green)

• 12mmol of K⁺ per tablet

Alternative: 

Potassium chloride syrup (1mmol per mL) (TLS Blue)

• Please refer to BNF for guidelines on the use of oral potassium supplements
• Where appropriate, potassium-sparing diuretics may be considered as an alternative to potassium supplements

Potassium supplements should be prescribed with care and reviewed every 2 to 3 days according to plasma potassium levels

Potassium Chloride 600mg (8mmol) modified release tablets (TLS Red)

• For short courses for patients where other preparations are not suitable or tolerated 

Potassium Chloride 600mg (8mmol) modified release tablets (TLS Amber Specialist Recommended)

•  For long term treatment courses for patients where other preparations are not suitable or tolerated 

9.2.11 Sodium

Sodium chloride modified-release (Slow Sodium^®) (TLS Green)

• 10mmol Na⁺ per tablet
• Please note that sodium depletion usually requires intravenous administration of sodium chloride see above

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