9.6 Fluid and electrolyte imbalances

9.6 Fluid and electrolyte imbalances

Bicarbonate

Sodium bicarbonate 500mg capsules (TLS Amber)

Sodium bicarbonate 8.4% injection / infusion (TLS Amber)

Sodium bicarbonate 8.4% (1mmol/mL) oral liquid  (TLS Amber)

Potassium citrate mixture BP (1mL solution = 2.8 mmol/K⁺ = 2.8 mmol/Bicarbonate = 0.9mmol/citrate) (TLS Amber)

Oral rehydration therapy (ORT)

Oral Rehydration Salts (ORS) (TLS Green)

Potassium

• Premixed 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

Specific indication:

Sterile potassium chloride concentrate (20mmol/10mL {15%}) (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% (TLS Green)

Specific indication:

Sodium chloride 5% (parenteral) (TLS Red)

Sodium chloride 2.7% (TLS Red)

Sodium Chloride with Other Ingredients

• Please refer to NICE NG29 - Intravenous fluid therapy in children and young people in hospital

Sodium chloride 0.45% / Glucose 5% intravenous infusion (TLS Amber)

Sodium chloride 0.45% / Glucose 2.5% intravenous infusion (TLS Amber)

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

Sodium chloride 0.18% / Glucose 4% intravenous infusion (TLS Red)

• Please note that following a NPSA alert sodium chloride 0.18% and glucose 4% intravenous infusion should not be routinely used in children
• Critical Care and Renal only

Sodium chloride 0.9% / Glucose 5% (TLS Red)

Sugars (Glucose) 

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

9.6.1 Hypercalcaemia and hypercalciuria

Calcimimetic agents

Specific indication: (TLS Red)

Cinacalcet

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

9.6.2 Hypocalcaemia

Calcichew^® chewable tablets (TLS Green)

Calcium lactate / Calcium gluconate liquid (Alliance Calcium Syrup^®) (TLS Green)

• 0.51 mmol of calcium per mL

Calvive^® 1000 (TLS Green)

• Each tablet contains 25mmol of calcium

Calcium gluconate 10% 2.2mmols/10mL (parenteral) (TLS Red)

9.6.3 Low blood volume

Gelatin

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

Other

Plasmalyte 148 (TLS Red)

Plasmalyte 148 and 5% glucose (TLS Red)

9.6.4 Hypomagnesaemia

First line

Magnesium aspartate (Magnaspartate^®) (TLS Green)

• 10mmol/sachet
• For the treatment of hypomagnesaemia

Second line

Magnesium glycerophosphate (Neomag^®) (TLS Blue)

• 4mmol chewable tablet

Magnesium glycerophosphate liquid (unlicensed) (TLS Blue)

• For use only when sachet or chewable tablet cannot be swallowed.
• 1mmol/mL Mg²⁺

Magnesium sulphate 50% (parenteral) (TLS Red)

• 2mmol/mL Mg²⁺

Specific indication:

Magnesium oxide (capsules) (TLS Blue)

• 2.5mmol Mg²⁺ per 100mg capsule, 4mmol Mg²⁺ per 160mg capsule

9.6.5 Hyperphosphataemia

NICE NG203 Chronic kidney disease: assessment and management

Calcium acetate (Renacet^® or Phosex^®) (TLS Green)

Alternatives: (TLS Blue)

Calcichew^® (Calcium carbonate) chewable tablet

Calcium carbonate dispersible 250mg tablet & 600mg/5mL suspension

Calcium 500^® (Calcium carbonate) tablet

Specific indications:

Sevelamer (TLS Red)

• 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

Sevelamer carbonate sachets (TLS Red)

• For use via enteral feeding tubes when sevelamer is indicated

Lanthanum (TLS Red)

• For use by Renal team only

9.6.6 Hypophosphataemia

Phosphate-Sandoz^® tablets (TLS Red)

• 16.1mmol phosphate per tablet

Joulies phosphate solution (TLS Red)

Phosphates polyfusor infusion (TLS Red)

• 0.1mmol phosphate per mL

Specific indication: (TLS Red)

Dipotassium hydrogen phosphate

• 1mmol phosphate and 2mmol of potassium per mL

 Sodium Glycerophosphate 17.9% solution (TLS Red)

• Phosphate replacement in renal filtration in PICU

9.6.7 Hyperkalaemia

Polystyrene sulfonate resins (TLS Red)

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

9.6.8 Hypokalaemia

Potassium chloride syrup 1mmol/mL (TLS Red)

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

Sando K^® (TLS Red)

• 12mmol of K⁺ per tablet

  Alternatives:

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

9.6.9 Sodium

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

• 10mmol Na⁺ per tablet
• Please note that sodium depletion usually requires intravenous administration of sodium chloride see section 9.6