Sodium Chloride + Potassium Chloride + Sodium Acetate

• Approved Indications:
• Correction and maintenance of electrolyte imbalances, including hypokalemia, hyponatremia, and metabolic acidosis.
• Intravenous fluid therapy in patients requiring replenishment of sodium, potassium, and bicarbonate equivalents.
• Restoration of acid-base balance in metabolic acidosis, especially in critically ill or surgical patients.
• Volume expansion in cases of extracellular fluid loss due to trauma, burns, surgery, or dehydration.
• Off-label/Clinically Accepted Uses:
• Management of renal tubular acidosis.
• Electrolyte supplementation in total parenteral nutrition.
• Correction of chronic metabolic acidosis under medical supervision.

• Adults:
• Individualized dosing based on serum electrolyte levels and acid-base status.
• Typical infusion rates range from 1 to 2 liters per day for maintenance or correction.
• Potassium chloride concentrations should not exceed 40 mEq/L in peripheral veins; higher concentrations require central venous access.
• Pediatrics:
• Dose calculated by weight and electrolyte needs.
• Careful monitoring to prevent electrolyte imbalances.
• Elderly:
• Lower starting doses recommended due to potential renal impairment.
• Special Populations:
• Renal impairment: Dose adjustments essential; monitor electrolytes closely.
• Hepatic impairment: Monitor acid-base status; no specific dose changes generally required.
• Route: Intravenous infusion, via peripheral or central line.
• Frequency and Duration: Continuous or intermittent infusion as per clinical judgment and laboratory values.

Sodium chloride replenishes extracellular sodium and chloride ions critical for maintaining fluid balance and cellular function. Potassium chloride provides potassium ions essential for cardiac and neuromuscular function. Sodium acetate serves as a bicarbonate precursor, metabolized in the liver to bicarbonate ions, which buffer excess hydrogen ions, correcting metabolic acidosis. The combination restores electrolyte balance and acid-base homeostasis, improving cellular and systemic physiological functions.

• Absorption: Immediate systemic availability upon intravenous administration.
• Distribution: Electrolytes distribute predominantly in the extracellular fluid.
• Metabolism: Sodium acetate is rapidly metabolized in the liver to bicarbonate.
• Elimination: Sodium and potassium are primarily excreted by the kidneys. Acetate metabolism produces carbon dioxide and water.
• Onset: Immediate upon infusion.
• Half-life: Variable depending on renal function and metabolic status.

• Pregnancy: No known teratogenic effects; use only if clearly indicated with monitoring.
• Lactation: Electrolytes are naturally present in breast milk; considered safe.

• Electrolyte and Acid-Base Replacement Therapy.
• Subclass: Crystalloid intravenous fluids with potassium supplementation and bicarbonate precursors.

• Known hypersensitivity to components.
• Hyperkalemia or severe renal failure without dialysis.
• Hypernatremia or fluid overload conditions.
• Metabolic alkalosis.
• Anuria.

• Monitor electrolytes and acid-base balance regularly.
• Caution in renal impairment, heart failure, and predisposition to hyperkalemia.
• Risk of arrhythmias with potassium imbalance.
• Avoid rapid infusion to prevent volume overload or electrolyte disturbances.

• Common: Injection site discomfort, mild electrolyte shifts.
• Serious but rare: Cardiac arrhythmias, hyperkalemia-induced paralysis, volume overload.

• Potassium-sparing diuretics, ACE inhibitors, ARBs increase hyperkalemia risk.
• Digitalis toxicity risk altered by potassium levels.
• Lithium clearance affected by sodium levels.
• No significant CYP450 involvement.

• Increased emphasis on cautious potassium administration.
• Use in balanced electrolyte solutions preferred to minimize chloride-associated acidosis.

• Store at 20°C to 30°C, protect from freezing and light.
• Use aseptically; discard if compromised.