0.9% sodium chloride intravenous fluid and 5% B.Braun glucose as a infusion solvent (500ml)

Dosage form Bottle
Specifications Sodium chloride, glucose, and injection

Ingredient

Composition information	Content
Sodium chloride	4.5g
Glucose	25g
The water is stored in the injection phase	500ml

Uses

Indications

0.9% sodium chloride intravenous infusion & 5% Braun 500ml is indicated in the following cases:

Treat dehydration. Sodium and chloride are worthy of the physiological concentration in plasma. In addition, this solution contains 5% (KL/TT) carbohydrate in the form of glucose.

Sodium is the main cation of the extracellular compartment and together with other anions that adjust the size of this compartment. Sodium and potassium are the main intermediates of biological processes in the body. Sodium chloride is the main salt related to the maintenance of blood and tissue osmotic pressure.

Change of sodium and chloride ionic concentration leads to a change in osmotic pressure and thus affects the transport of fluids and the diffusion of salts into cell tissue. Chloride is exchanged with hydrocarbonate in the micro system and therefore related to alkaline balance regulation.

Glucose is metabolized everywhere as a natural substrate of body cells. In normal physiological condition Glucose is the most important energy carbohydrate with energy value of about 16kJ or 3.75kcal/g. It is the only energy substrate that every cell of the body can use directly. Nervous tissue, red blood cells and kidney marrow are among those with mandatory glucose needs. The concentration of blood sugar is reported is 50 - 95mg/100ml, or 2.8 - 5.3mmol/l (hungry).

On the one hand glucose helps glycogen synthesis from carbohydrates and on the other hand is hydrolyzed into pyruvate and lactate for energy production in cells. Glucose also helps maintain blood sugar levels and the synthesis of important components of the body. It is insulin, glucagon, glucocorticoid and catecholamine mainly related to the adjustment of blood sugar levels.

The appropriate dose (40ml/kg/day) of the solution can be used to compensate for the body's required carbohydrate needs at about 2g of glucose/kg/day (transmission therapy due to calories).

pharmacokinetics

The total amount of sodium of the body is calculated as 80mmol/kg of which 97% in extracellular and 3% in intracellular. The daily replacement speed used is 100 - 180mmol (equivalent to 1.5 - 2.5mmol/kg).

When transmitted, the glucose will first enter the circuit and then enter the intracellular. During glucose hydrolysis is converted into pyruvate or lactate. Lactate can be partially put into glucose transformation (Cori ring). In Pyruvate gas, fully oxidized into carbon dioxide and water.

The final product of completely oxidation glucose is excreted through the lungs (carbon dioxide) and the kidneys (water). In fact, glucose is not excreted through the kidneys in healthy people. In the status of pathological metabolism (such as diabetes, post -injury metabolism) combined with hyperglycemia (blood sugar levels greater than 120mg/100ml or 6.7mmol/l), glucose is also excreted through the kidneys (with sugar in urine) when exceeding the maximum ability to absorb through the tube (180mg/100ml or 10mmol/l).

Before taking 0.9% sodium chloride intravenous fluid and 5% B.Braun glucose as a infusion solvent (500ml)

How to use

Use intravenously.

Each bottle is only used once. The non -use part must be canceled.

Do not use if the bottle is leaked or the solution is not transparent.

The transmission rate must not exceed the patient's oxidation of glucose to avoid hyperglycemia.

For all patients, it is necessary to slowly increase the rate of transmission at the beginning of the product containing glucose.

0.9% sodium chloride intravenous fluid & 5% 500ml braun glucose should be tested with the naked eye for sub -feces and color changes before transmission. Only transmitted when the solution is transparent and the lid is intact. Should conduct the transmission immediately after plugging the transmission line.

The solution should be transmitted to the device, aseptic device and use aseptic transmission technique.

Equipment and tools need to be bait with the first solution to prevent gas from entering the system.

Supplementing electrolytes can be indicated according to the patient's clinical needs. Do not use equipment and tools in the infusion to connect many times. Using such can lead to air obstruction due to the remaining air is drawn from equipment and tools in the infusion before connecting to the intravenous system.

Increase the pressure of intravenous solutions contained in devices and tools to increase the flow rate that can lead to gas congestion if the gas remains in the packaging are not completely escaped before transmission.

Add drugs can be included before or while transmission at the transmission position. When added, the ultimate osmotic pressure of the solution needs to be checked. The solution of solution with high osmotic pressure can lead to intravenous and intravenous irritation. Therefore, any highly osmotic pressure is recommended to be transmitted through a large central vein, to quickly dilute solutions with high osmotic pressure.

Monitoring: The balance of fluid and glucose and electrolytes (especially sodium) in plasma should be monitored during the transmission process. Supplementing electrolytes can be indicated according to the needs of the person.

Dosage

Specific selection of concentrations, dose, volume, speed and time of sodium chloride and glucose dependence on weight, age, clinical condition of patients and simultaneous treatment and decided by the doctor. For patients with abnormal electrolytes and glucose and for pediatric patients, it is necessary to consult a doctor with experience in intravenous infusion treatment. Quickly overcome blood hyponatremia and hyperchemical sodium potentially dangerous (the risk of serious neurological complications)

Adults, the elderly and adults (> 12 years old)

The recommended dose is 500ml –3L/24 hours. The transmission speed is usually 40ml/kg/24 hours and does not exceed the ability to oxidize glucose to avoid hyperglycemia. Therefore the maximum transmission speed is 5mg/kg/minute.

Pediatric patients

From 0 - 10kg weight: 100ml/kg/24 hours, transmission speed 6 - 8ml/kg/hour.

From 10 - 20kg weight: 1000ml + (50ml/per kg from 10kg or more)/24 hours, transmission speed 4 - 6ml/kg/hour.

From> 20kg of weight: 1500ml + (20ml/per kg from 20kg or more)/24 hours, transmission speed 2 - 4ml/kg/hour.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

How to overdose: Stop transmission immediately, take diuretics and continue checking serum electrolytes, adjusting electrolyte imbalance and alkaline acidosis, which can be appointed to use insulin if necessary.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using 0.9% sodium chloride intravenous fluid & 5% Braun 500ml, you may experience unwanted effects (ADR).

The following unwanted effects are reported during circulation. The frequency may not be conventional from the existing data, because the adverse reactions below are listed based on voluntary reports.

The immune system: Anaphylaxis, hypersensitivity.

Nutrition and metabolism: hypernodic blood, hyperglycemia.

blood vessel: Vien inflammation.

Skin and subcutaneous tissue: rash, itching.

Common disorders and status in the transmission position: fever, chills, pain and blistering at the transmission position.

Other ADR: hypoglycet blood, acidosis due to hyperlly chlorine.

Instructions on how to handle ADR

Notify the doctor with unwanted effects when using the drug. With minor adverse reactions, usually just stop the drug. In case of severe sensitivity or allergic reactions, supportive treatment (airy keeping and using epinephrine, oxygen breathing, antihistamine, corticoid ...).

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Sodium chloride intravenous infusion 0.9% & Glucose 5% Braun 500ml Contraindicated in the following cases:

Hypersensitivity to the ingredients of the drug.

Perfect water.

Sodium hyperplasia, hyperconemia, potassium.

Severe kidney failure (with urinary disorders/anuria).

Damage heart failure. edema and cirrhosis.

Clinical hyperglycemia.

Integrated glucose (such as pathological metabolism), coma due to increased osmotic pressure or hyperlactic blood.

Precautions when using

Hypotension

transmission of 0.9% sodium chloride solution and 5% glucose can lead to hypokalemia. Strict clinical monitoring is recommended in patients at risk of hypokalemia, for example: patients with alkaline metabolism, patients with cyclic paralysis due to thyroid poisoning. Glucose intravenous infusion is likely to lead to epidemic and electrolyte disorders such as hypotension, patients with increased gastrointestinal tract damage (for example, diarrhea, vomiting), prolonging low potassium diet, aldosterone patients, patients treated with drugs that increase the risk of hypotension (eg diuretics, Beta - 2 Agonists or Insulin)

Keep sodium, overload and edema

0.9% sodium chloride intravenous infusion & 5% 500ml Braun Glucose should be used with special caution in the following cases:

Patients with metabolic acidosis.

Patients at risk: hyperemia, hypercassemia, increased abnormal blood volume.

Patients in the condition can lead to sodium hold, overload, edema (central and peripheral) such as primary Aldosterone, secondary Aldosterone, for example, for example, hypertension, hemorrhagic heart failure, liver disease (including cirrhosis), renal disease (including kidney artery stenosis, kidney fibrosis), pre -proliferation.

Patients taking drugs may increase the risk of sodium and fluid, such as corticosteroids.

Depends on the volume, transmission speed, the basic clinical condition of the patient and the metabolism of glucose, the infusion may cause:

Increased osmotic pressure, osmotic and dehydration.

Electrolyte disorders such as hypoglyc sodium, hypotension, phosphate hypoglycemia, hypogsi blood.

Acid imbalance - base.

water stasis, increase abnormal blood volume, for example: obstruction, including central edema (pulmonary obstruction) and peripheral edema.

Increased serum glucose concentration in combination with increased serum osmotic pressure. Diuretics in combination with hyperglycemia can lead to or contribute to dehydration and loss of electrolytes.

Sodium imbalance

0.9% sodium chloride intravenous infusion & 5% 500ml braun glucose should be used with special caution in patients with or have the risk of blood sodium, for example: Children, the elderly, women, after surgery, people with thirst for many minds.

Lower blood can lead to headaches, nausea, seizures, sleep, coma, brain edema and death. Acute sodium hypoglycemia is considered a medical emergency.

Clinical and subclinical assessments may be necessary to monitor changes in fluid balance, electrolytic concentration and acid -base balance while prolonged intravenous treatment, or whenever the patient condition or the transmission speed should be closely monitored.

Hyperglycemia

Quick transmission of glucose solution can cause significant hyperglycemia and osmotic hypertension syndrome. To avoid hyperglycemia, the transmission speed must not exceed the patient's glucose ability. To reduce the risk of complications associated with hyperglycemia, the transmission rate must be adjusted or injected with insulin if the blood sugar level exceeds the acceptance of each patient.

glucose intravenous infusion should be cautious in the following patients

Glucose tolerance decline (such as diabetes, kidney failure, infection, trauma, or shock). Electrolytes may be worse due to glucose or free water load.

Be cautious when using 0.9% sodium chloride solution and 5% glucose on other patient groups including

Patients with stroke due to ischemia. Hyperglycemia associated with increased brain damage due to ischemia and weakening the recovery after a stroke due to acute ischemia. Early hyperglycemia is associated with bad results in patients with serious brain injury.

Newborn children

prolonged glucose intravenous infusion and combined with hyperglycemia can lead to the consequence of reducing the rate of insulin secretion.

The solution containing glucose should be used carefully in patients with a history of allergies to corn and corn products.

Feeding syndrome

Restoration of severe malnutrition patients can lead to feeding syndrome, it is characterized by the change of potassium, phosphorus and intracellular magnesium due to the patient become assimilated. Thiamin deficiency and water retention can also occur. Careful monitoring and slowly increasing the nutrition and overeating to prevent complications.

Severe kidney failure

0.9% sodium chloride intravenous infusion & 5% 500ml braun glucose should be used with special caution in patients at risk of severe renal failure. In these patients, infusion can lead to sodium or overload.

used for pediatric patients

The transmission speed and transmission volume depend on the age, weight, clinical and metabolism of the patient, the treatment therapy simultaneously and should be determined by a specialist.

The ability to drive and operate machinery

Be careful when used for driving objects and operating machinery.

Pregnancy

There is no adverse reaction that has been reported. However, the sugar concentration indicates that the solution is rapidly containing 25g of glucose or more leading to acidosis for the fetus and increasing blood insulin, reducing blood glucose and jaundice. Therefore, it is recommended to limit the transmission, not exceeding 6g of glucose in 1 hour right before birth, until the safety transmission speed is set.

Breastfeeding period

Drug interaction

Caution in patients treated with:

Lithium: Sodium and lithium clearance of the kidney may increase while transmitting and leading to lithium concentration.

Storage

Store in a dry place, with a temperature not exceeding 30 ° C.

To be out of reach of children.

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