Calcium Chloride / Dextrose / Potassium Chloride / Sodium Chloride / Sodium Lactate

This combination IV fluid has several supported uses, depending on the product.

• Potassium Chloride in Lactated Ringers and Dextrose: source of water, electrolytes and calories, or an alkalinizing agent, in adults and pediatric patients.
• Lactated Ringers and Dextrose: same use, in adults and pediatric patients.
• Dextrose in Lactated Ringers: same use, in adults and pediatric patients.
• Lactated Ringers/Lactated Ringers and Dextrose: replacing lost fluid and electrolytes outside the cells, with or without minimal carbohydrate calories.

The electrolytes in this solution closely resemble those in normal blood plasma, so they replace lost fluid and minerals. Sodium helps control water balance, and potassium supports nerve and muscle function, including the heart. Calcium supports bones, clotting and heart function, and chloride helps balance acid levels.

Lactate is processed by the liver, which helps correct acid-base balance (metabolic acidosis). Dextrose supplies calories, restores blood sugar and may reduce protein breakdown.

This medicine is given only by IV infusion by healthcare professionals. Dose and duration depend on age, weight, clinical condition and other treatments.

• A peripheral vein is used when the dextrose concentration is 5% or less and osmolarity is under 900 mOsm/L.
• A central vein may be considered for stronger solutions to avoid vein irritation.
• Blood sugar and electrolytes are monitored, especially with long use.

Because it is given in a care setting, missed doses and food timing are not something you manage yourself.

Most reported reactions involve the infusion site or allergy-type symptoms.

Tell your care team right away about trouble breathing, facial swelling, confusion, seizures, chest pain or swelling.

• Ceftriaxone in newborns: deaths have occurred when newborns 28 days or younger received calcium-containing IV solutions with ceftriaxone.
• Air embolism: can cause stroke, organ damage or death, so special IV setup steps are used.
• Allergic reactions: the infusion is stopped immediately if they occur.
• Electrolyte problems: high potassium, low sodium, high calcium and acid-base changes are possible.
• Fluid overload and high blood sugar: especially with kidney disease, diabetes or central nervous system disease.
• It can interfere with interpreting serum lactate levels in severe metabolic acidosis.

Several medicines can change how safe this solution is.

• Ceftriaxone: dangerous in newborns because of calcium precipitation.
• Potassium-raising drugs (potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor blockers, calcineurin inhibitors): risk of high potassium.
• Diuretics and SIADH-causing drugs: risk of low sodium.
• Thiazide diuretics and vitamin D: risk of high calcium.
• Corticosteroids and corticotropin: sodium and fluid retention.
• Lithium: lower lithium levels.
• Digoxin: higher risk of toxicity and heart rhythm problems.
• Drugs cleared by the kidneys depending on urine pH: clearance may change.
• Blood: do not give through the same set, because of clotting.

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Not for newborns on ceftriaxone, people with known allergy to its components, significant high potassium or significant high blood sugar.
• Avoid in severe kidney impairment if possible.
• Severe liver impairment: lactate may not be processed well and monitoring is needed.
• Diabetes or impaired glucose tolerance: blood sugar may rise.
• Older adults: more likely to have kidney changes and electrolyte imbalances.
• Children: young children and newborns need close electrolyte and glucose monitoring.
• Pregnancy and breastfeeding: not expected to cause harm when used appropriately.

Too much can cause high potassium and sodium, fluid overload with swelling, very high blood sugar with dehydration, alkalosis and high calcium. The label says to stop the infusion, treat the electrolyte imbalances and high blood sugar, and closely monitor fluids, electrolytes and acid-base balance.

The label says the relationship between exposure and effect for the potassium chloride product has not been fully characterized. In general, the solutions replace fluid and electrolytes, and dextrose restores blood glucose and provides calories. Dextrose may also reduce liver glycogen depletion and spare protein.

Most potassium (about 80 to 90%) leaves the body in urine. The kidneys control sodium and chloride levels. The liver breaks lactate down into carbon dioxide and water, and dextrose is also oxidized to carbon dioxide and water.

Store at 20 to 25°C (68 to 77°F). Protect from freezing.