Dextrose Anhydrous / Lactic Acid / Magnesium Chloride / Potassium Chloride / Sodium Bicarbonate / Sodium Chloride

PRISMASOL and PHOXILLUM are intravenous electrolyte and buffer replacement solutions used exclusively during continuous renal replacement therapy (CRRT) in intensive care settings.

• PRISMASOL is indicated in adult and pediatric patients as a replacement solution during CRRT to replace plasma volume removed by ultrafiltration and to correct electrolyte and acid-base imbalances.
• PHOXILLUM is indicated in adult and pediatric patients as a replacement solution during CRRT for the same purposes.
• Both PRISMASOL and PHOXILLUM may be used when CRRT is employed to help remove a dialyzable substance in cases of drug poisoning.

PRISMASOL and PHOXILLUM are pharmacologically inactive — they don't act on receptors or block enzymes. Instead, they work by replenishing the specific electrolytes (such as sodium, potassium, magnesium, and calcium) that are filtered out of the blood during CRRT. The electrolyte concentrations in each formulation are designed to bring plasma levels back to a clinically safe range.

Each solution also contains a buffer — either bicarbonate directly, or lactate (a precursor that the body converts to bicarbonate) — to help correct metabolic acidosis, meaning too much acid in the blood. PHOXILLUM formulations also include phosphate to help address low phosphate levels during CRRT.

PRISMASOL and PHOXILLUM are given intravenously through specialized CRRT equipment — never by mouth. The right formulation, flow rate, and duration are determined entirely by the treating physician based on the patient's clinical status, electrolyte levels, acid-base balance, and glucose levels.

• PRISMASOL is available in 7 different formulations with varying electrolyte and buffer concentrations.
• PHOXILLUM is available in 2 different formulations, both containing phosphate.
• Both are supplied in a two-compartment bag that must be mixed immediately before use.
• Follow your care team's instructions exactly — therapy is individualized for each patient.

The following side effects have been reported with PRISMASOL and PHOXILLUM or similar CRRT replacement solutions:

• Metabolic acidosis (excess acid in the blood)
• Low blood pressure (hypotension)
• Acid-base disorders
• Electrolyte imbalances — including high potassium (hyperkalemia), high phosphate (hyperphosphatemia), or low phosphate (hypophosphatemia)
• Elevated ionized calcium levels (reported with PRISMASOL solutions containing calcium)
• Fluid imbalance
• High or low blood sugar — depending on the dextrose content of the solution used

Alert your care team immediately if you notice signs of serious electrolyte shifts — such as muscle weakness, an irregular heartbeat, difficulty breathing, or confusion — as these require prompt evaluation.

• Electrolyte and fluid changes: PRISMASOL and PHOXILLUM can cause electrolyte levels — especially potassium and phosphate — to go too high or too low. Your care team will monitor blood chemistry throughout the procedure and may adjust the formulation or flow rate.
• Metabolic acidosis risk with PHOXILLUM: PHOXILLUM contains hydrogen phosphate, a weak acid that may increase the risk of metabolic acidosis (too much acid accumulating in the blood). Acid-base balance must be monitored closely.
• Blood sugar changes: Treatment can cause blood glucose to rise or fall depending on which formulation is used. Regular glucose monitoring is required, and antidiabetic therapy or other corrective steps may be needed.
• Drug removal during CRRT: The hemofilter can remove other medications from the blood, reducing their effectiveness. Blood levels of affected drugs may need to be checked and doses adjusted.

Because CRRT physically filters the blood, it can affect how other drugs behave in the body:

• Dialyzable drugs: Any drug that can be removed by the hemofilter may have lower blood levels during CRRT — potentially reducing effectiveness. Your care team may need to monitor levels and adjust doses of affected medications.
• Citrate (used as an anticoagulant): When citrate is used to prevent clotting in the CRRT circuit, it adds to the overall buffer load and can lower plasma calcium levels. The choice of PRISMASOL or PHOXILLUM formulation should take this into account.

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Allergy to any ingredient: PRISMASOL and PHOXILLUM are contraindicated if you have a known hypersensitivity to any component.
• Pregnancy: Appropriate use with proper monitoring is not expected to harm the baby. Maintaining normal acid-base balance is especially important for fetal health during CRRT.
• Breastfeeding: Components pass into breast milk, but appropriate use is not expected to harm a nursing infant.
• Children (including newborns): Safety and effectiveness are established for pediatric patients, including newborns through age 17, based on clinical studies.
• Older adults: No novel safety concerns have been identified in geriatric patients, though careful monitoring still applies as with all patients.

How these solutions behave in the body depends heavily on each patient's own situation. The distribution of electrolytes, bicarbonate, and dextrose is shaped by the patient's clinical condition, metabolic status, and any remaining kidney function. How quickly water, electrolytes, and buffer are removed or retained depends on the patient's electrolyte and acid-base balance, metabolism, residual kidney function, and ongoing losses through the intestines, breathing, and skin.

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15ºC to 30ºC (59ºF to 86ºF). Do not freeze or expose to excessive heat.