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PrismaSol Dosage

Generic name: CALCIUM CHLORIDE 0.139g in 1L, MAGNESIUM CHLORIDE 0.071g in 1L, DEXTROSE MONOHYDRATE 1g in 1L, LACTIC ACID 0.270g in 1L, SODIUM CHLORIDE 6.137g in 1L, SODIUM BICARBONATE 2.936g in 1L
Dosage form: intravenous solution

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Administration Instructions

Visually inspect PRISMASOL and PHOXILLUM for particulate matter and discoloration prior to administration.

Administration should only be under the direction of a physician competent in intensive care treatment including CRRT. Use only with extracorporeal dialysis equipment appropriate for CRRT.

The prepared solution is for single patient use only.

Aseptic technique should be used throughout administration to the patient.

Discard any unused solution.

Dosing Considerations

PRISMASOL replacement solutions contain 4 different combinations of active ingredients (8 different products with varying ingredient amounts). PHOXILLUM replacement solutions contain 2 different combinations of active ingredients (2 different products with varying ingredient amounts). PRISMASOL and PHOXILLUM are supplied in a two-compartment bag that must be mixed immediately prior to use [see Dosage and Administration (2.3)]:

Small compartment A (250 mL) containing an electrolyte solution, and
Large compartment B (4750 mL) containing the buffer solution.

See Table 1 for the concentrations of the active ingredients (after mixing) in these 10 different replacement solutions (total volume is 5 Liters).

Table 1: Concentrations of Active Ingredients in the 8 PRISMASOL and 2 PHOXILLUM Replacement Solutions after Mixing
Ca2+
mEq/L
HCO3-
mEq/L
K+
mEq/L
Mg2+
mEq/L
Na+
mEq/L
HPO42-
mmol/L
Cl-
mEq/L
Lactate
mEq/L
Dextrose
mg/dL
Osmolarity
mOsm/L
Ca2+ = calcium, HCO3- = bicarbonate, K+ = potassium, Mg2+ = magnesium, Na+ = sodium, HPO42- = phosphate, Cl- = chloride; osmolarity is estimated

PRISMASOL Replacement Solutions

BGK0/2.5

2.5

32

0

1.5

140

0

109

3

100

292

BGK4/2.5

2.5

32

4

1.5

140

0

113

3

100

300

BGK4/3.5

3.5

32

4

1

140

0

113.5

3

100

300

BGK2/3.5

3.5

32

2

1

140

0

111.5

3

100

296

BGK2/0

0

32

2

1

140

0

108

3

100

291

B22GK4/0

0

22

4

1.5

140

0

120.5

3

100

296

BGK4/0/1.2

0

32

4

1.2

140

0

110.2

3

100

295

BK0/0/1.2

0

32

0

1.2

140

0

106.2

3

0

282

PHOXILLUM Replacement Solutions

BK4/2.5

2.5

32

4

1.5

140

1

114.5

0

0

294

B22K4/0

0

22

4

1.5

140

1

122

0

0

290

Select the mode of therapy, solute formulation, flow rates, and length of PRISMASOL and PHOXILLIUM replacement therapy in CRRT based on the patient's clinical condition, and fluid, electrolyte, acid-base, glucose balance. Administer either PRISMASOL or PHOXILLUM into the extracorporeal circuit:

Before (pre-dilution) the hemofilter or hemodiafilter,
After (post-dilution) the hemofilter or hemodiafilter, or
Before and after the hemofilter or hemodiafilter.

Preparing the Solution

Use only if the overwrap is not damaged, all seals are intact, and the solution is clear. Press bag firmly to test for any leakage. Do not use if container is damaged or leaking.

The solution may be heated to no more than 40°C/104°F inside of the overwrap. After heating, verify that the solution remains clear and contains no particulate matter.

The solutions are supplied in two different two-compartment bags, one made of polyvinyl chloride with a frangible pin separating compartment A and B (see Figure 1) and one made of polyolefin with a peel seal separating compartment A and B (see Figure 6).

Follow the instructions below when connecting the solution bags for correct use of the access ports.

Instructions for preparing solutions supplied in a two-compartment, polyvinyl chloride (PVC) bag with a red frangible pin:

Figure 1

Figure 1

Figure 2Figure 2

Step 1 Immediately before use, remove the overwrap from the bag and mix the solutions in the two different compartments. As soon as the overwrap is removed, the reconstitution of compartments A and B should be done and the mixed solution should be used immediately.
After removal of the overwrap, the solution is stable for 24 hours including the duration of the treatment.
Open the seal by breaking the red frangible pin between the two compartments of the bag. The frangible pin will remain in the bag. (See Figure 2 beside)

Figure 3 Figure 3

Step 2 Make sure all the fluid from the small compartment A is transferred into the large compartment B. (See Figure 3 beside)

Step 3 Rinse the small compartment A twice by pressing the mixed solution back into the small compartment A and then back into the large compartment B. (See Figure 3 beside)

 

Figure 4Figure 4

Step 4 When the small compartment A is empty, shake the large compartment B so that the contents mix completely. (See Figure 4 beside)
The solution is now ready to use and the bag can be hung on the equipment.

Figure 5aFigure 5a

Step 5 The replacement line may be connected to the bag through either the luer connector or the injection connector (spike connector).
Step 5a The luer connector is a needle-less and swabbable connector. Remove the cap with a twist and pull motion, and connect the male luer lock on the replacement line to the female luer receptor on the bag. (See Figure 5a beside)
Ensure that the connection is fully seated and tighten. The connector is now open. Verify that the fluid is flowing freely during use.
When the replacement line is disconnected from the luer connector, the connector will close and the flow of the solution will stop.

Figure 5bFigure 5b

Step 5b If the injection connector (spike connector) is used, first remove the snap-off cap. Then introduce the replacement line spike through the rubber septum of the bag connector. (See Figure 5b beside)
Ensure that the spike is fully inserted and verify that the fluid is flowing freely during use.

Instructions for preparing solutions supplied in a two-compartment, polyolefin bag with a peel seal:

Figure 6

Figure 7

Figure 7Figure 7

Step 1 Immediately before use, remove the overwrap from the bag and mix the solutions in the two different compartments. As soon as the overwrap is removed, the reconstitution of compartments A and B should be done and the mixed solution should be used immediately.
After removal of the overwrap, the solution is stable for 24 hours including the duration of the treatment.
Hold the small compartment with both hands and squeeze it until an opening is created in the peel seal. (See Figure 7 beside)

Figure 8Figure 8

Step 2 Squeeze with both hands on the large compartment until the peel seal between the two compartments is entirely open. Shake gently to mix. (See Figure 8 beside)

The solution is now ready to use and the bag can be hung on the equipment.

 

Figure 9aFigure 9

Step 3 The replacement line may be connected to the bag through either of the luer connector or the injection connector (spike connector).

Step 3a The luer connector is a needle-less and swabbable connector. Remove the cap with a twist and pull motion, and connect the male luer lock on the replacement line to the female luer receptor on the bag. (See Figure 9a beside)

 

Ensure that the connection is fully seated and tighten. The connector is now open. Verify that the fluid is flowing freely during use.

 

When the replacement line is disconnected from the luer connector, the connector will close and the flow of the solution will stop.

 

Figure 9bFigure 9b

Step 3b If the injection connector (spike connector) is used, first remove the snap-off cap. Then introduce the replacement line spike through the rubber septum of the bag connector. (See Figure 9b beside)

Ensure that the spike is fully inserted and verify that the fluid is flowing freely during use.

 

Adding Drugs to the Solutions

After mixing, additional drugs may be added to the bag via injection connector (spike connector) in large compartment B. In general, drugs other than phosphate should be administered through a different access line. When introducing additives, use aseptic techniques.

PRISMASOL Solutions:

Phosphate: Phosphate up to 1.2 mmol/L may be added to the solution. If potassium phosphate is added, the total potassium concentration should not exceed 4 mEq/L.

PHOXILLUM Solutions:

Phosphate: Phosphate up to 0.2 mmol/L may be added to the solution. Use sodium phosphate if adding phosphate to bag. The total phosphate concentration should not exceed 1.2 mmol/L.

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