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9.2 Fluids and Electrolytes

9.2 Fluids and Electrolytes


9.2.1 Oral preparations for fluid and electrolyte imbalance
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 9.2.1.1 Oral potassium
   Compensation for potassium loss should be considered in those taking digoxin or anti-arrhythmics, in the elderly, with some 
   specific drugs and when there is excessive loss in the faeces. Potassium is not recommended for those on small doses of 
   diuretics.
       GREEN       Potassium chloride 
                          tablets effervescent (12mmol)
                          syrup 1mmol/ml
                          modified release tablets 600mg (8mmol)*
                         *(avoid unless effervescent tablets or liquid preparation inappropriate) 
 
   Potassium removal
   Polystyrene sulphonate resins may be used to remove excess potassium in mild hyperkalaemia or in moderate hyperkalaemia
   when there are not ECG changes. Intravenous therapy is required in emergencies.
 
       GREEN         Polystyrene sulphonate resins (Calcium Resonium®, Resonium A®)
       NICE TA623  Patiromer sorbitex calcium                                                                                                                     (CCG Commissioned)
       RED              Patiromer sorbitex calcium (Veltassa®) - Acute life-threatening hyperkalaemia in emergency care
       RED              Patiromer sorbitex calcium (Veltassa®) - confirmed persistent hyperkalaemia - NICE TA623

       RED              Sodium zirconium cyclosilicate (Lokelma®)                                                                                         (CCG Commissioned)
       NICE TA599  Sodium zirconium cyclosilicate is recommended as an option for treating hyperkalaemia in adults only if used:
                                 >  in emergency care for acute life-threatening hyperkalaemia alongside standard care or
                                 >  for people with persistent hyperkalaemia and chronic kidney disease stage 3b to 5 or heart failure, if they:
                                       > have a confirmed serum potassium level of at least 6.0mmol/litre and
                                       > because of hyperkalaemia, are not taking an optimised dosage of renin-angiotensin-aldosterone system (
                                          (RAS)  inhibitor and
                                       > are not on dialysis [amended 2022]
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9.2.1.2 Oral sodium and water 
       GREEN       Sodium chloride tablets m/r 600mg (10mmol sodium) 
 
   Oral rehydration therapy (ORT) 
   Oral rehydration is the main treatment for mild-moderate diarrhoea.  Any unused reconstituted solution should be discarded
   after 1 hour unless stored in a fridge when it may be kept for up to 24 hours.
 
       GREEN       Oral rehydration salts (Dioralyte® or Dioralyte Relief®) 
       AMBER      Sodium chloride oral solution 5mmoL/mL      Prescribe as SodiClor® (Arjun) 
 
9.2.1.3 Oral bicarbonate 
   Chronic acidotic states 
       GREEN      Sodium bicarbonate  
                         capsules 500mg    
                         tablets 600mg 
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 9.2.2 Parenteral preparations for fluid and electrolyte imbalance
   9.2.2.1 Electrolytes and water 
       RED         Glucose infusion 5% 
       RED         Glucose 5% with potassium chloride 20mmol/l, 40mmol/l 
       RED         Glucose 10% with potassium chloride 20mmol/l 
       RED         Glucose 5%, sodium chloride 0.45%  with potassium chloride 20mmol/500ml 
       RED         Glucose 50% 
       RED         Ringer’s solution for injection 
       RED         Sodium bicarbonate infusion 1.26%, 4.2%, 8.4%
       RED         Sodium chloride infusion 0.18%, 0.9%, 2.7% 
       RED         Sodium chloride 0.9% with potassium chloride 20mmol/l, 40mmol/L
       RED         Sodium chloride 0.18% and glucose 4% 
       RED         Sodium chloride 0.18% and glucose 4% with potassium chloride 20mmol/l  , 40mmol/l
       RED         Sodium chloride 0.9% with potassium chloride 10mmol (500ml) 
       RED         Sodium chloride 0.9% with potassium chloride 40mmol in 100ml (CCU use only) 
       RED         Potassium chloride concentrate 15%, ampoule (10ml) (Treat as a controlled drug) 
 
   Must be diluted with not less than 50 times its volume of sodium chloride intravenous infusion 0.9% or other suitable diluent and
   mixed well. Use ready made infusions wherever possible.
 
9.2.2.2 Plasma and plasma substitutes 
      RED        Gelatin (Volplex® or Geloplasma®) infusion 
      RED        Tetrastarch (Volulyte®) 6% infusion in sodium chloride 0.9%
 
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