"DIAL-FARMLEND 1,25" with glucose

General characteristics. Structure:

Active agent: 5,38 g of sodium of chloride, 4,48 g of sodium a lactate in the form of sodium (S) of a lactate of solution, 0,274 g of Calcii chloridum of hexahydrate, 0,102 g of magnesium of chloride of hexahydrate, 15 g, 25 g or 42,5 g of glucose anhydrous.

Excipients: 0,1 M Acidum hydrochloricum solution to рН 4,0-6,5, water for injections to 1000 ml.

Ionic structure: Na + 132mmol/l; Ca2 + 1,25 mmol/l; Mg2 + 0,5mmol/l; Mmol/l Cl-95; Mmol/l Lactate-ion-40.

Solution for peritoneal dialysis.

Pharmacological properties:

Pharmacodynamics. Solutions for peritoneal dialysis – sterile, depyrogenized solutions of glucose and electrolytes in water for injections with the structure as close as possible to electrolytic composition of plasma.

Solutions differ in different degree of osmotic activity (hypertonicity, osmolarity) depending on the content of glucose (dextrose) – solution, giperosmolyarny in relation to plasma, promotes filtering of liquid from plasma in an abdominal cavity and electrolytes in plasma. Solutions differ in also different content of calcium that is caused by need of prevention of a hypercalcemia at separate groups of patients at development of a secondary hyper parathyroidism. All solutions contain identical amounts of sodium of chloride, magnesium of chloride and sodium of a lactate.

The lactate is entered into solutions for peritoneal dialysis for the purpose of correction of a metabolic acidosis as comes to blood and in an organism of the patient turns into bicarbonate.

Pharmacokinetics. Penetration of ions through a peritoneal membrane is caused by the phenomena of osmosis and diffusion. The absorbed electrolytes join in cellular metabolism. Glucose is metabolized in various ways: by glycolysis – to pyruvate, in a cycle of tricarboxylic acids – to carbon dioxide and water. At peritoneal dialysis the peritoneum is used for removal from an organism of nitrogenous metabolites, water and excess of electrolytes which collect in blood of the patients having an acute and chronic renal failure in an end-stage.

From blood of the capillaries which are in a peritoneum, products of metabolism and water diffuse in a dialysis fluid which is removed and replaced on fresh through a certain interval of time. Drug provides also removal of the toxic substances which are usually removed with urine and maintenance of water and electrolytic balance.

Indications to use:

Continuous out-patient peritoneal dialysis (peritoneal dialysis) is applied according to clinical protocols at: a terminal chronic renal failure and an acute renal failure of various genesis, a liquid delay in an organism, disturbance of electrolytic balance, intoxication medicines, corrections of a hyperpotassemia, intoxication xenobiotics.

Route of administration and doses:

Solutions for peritoneal dialysis are used only for intraperitoneal infusion on doctor's orders. The procedure has to be performed with observance of rules of an asepsis. The solution which is warmed up up to the temperature of 37 °C is entered intraperitoneally through a peritoneal catheter. Introduction time – 5–20 min.

Solution is left in an abdominal cavity on 4–8 h and then removed (the time spent of solution in an abdominal cavity the doctor according to a condition of the patient defines). The volume of solution entered in each cycle depends on the body weight of the patient: adult usually from 2000 to 2500 ml of solution, to children from 500 to 1500 ml depending on age of the child (30–40 ml/kg on the procedure). If at the beginning of introduction the painful phenomena or tension of an abdominal wall appear, then lower a solution dose at each introduction by 500 – 1500 ml.

For patients with excess body weight and/or steady against large volumes of filling – 2,5–3 l. Most of patients needs 3–5 daily shifts of solution on 2 l. The doctor selects and appoints solution with a certain content of glucose (1,5%, 2,5% or 4,25%) and calcium (1,25 mmol/l or 1,75 mmol/l) individually depending on a state, body weight and age of the patient wished concentration of calcium and osmotic activity of solution.

Applying solutions with various osmotic activity it is possible to regulate individually a water balance of an organism and to delete the set liquid volume from an organism. Use duration – on doctor's orders. Administration of residual solution if it was spent not completely, is not allowed.

Features of use:

It is necessary to control carefully a water balance and body weight of the patient (hyper - or a hydropenia can lead to congestive heart failure, decrease in volume of the circulating blood and shock), to periodically estimate biochemical and hematologic indicators, level of calcium, magnesium and hydrocarbonate. It is not necessary to apply to dialysis 5 l and more solution for one procedure.

During the procedure special attention has to be paid to rules of an asepsis for the prevention of developing of peritonitis. It is not necessary to apply solution at disturbance of integrity of system and/or in case of detection of leak of solution. It is necessary to pay attention to volume and outward of the removed solution. If the removed solution muddy, there were abdominal pains and fervescence, then carrying out dialysis should be stopped immediately.

At prolonged use of peritoneal dialysis the diet with the high content of protein (not less than 1.2-1.5 g/kg/days) for the purpose of compensation of its excess loss is recommended. At long use of peritoneal dialysis increase in body weight is possible that it is connected with absorption of a dextrose from a dialysis fluid, in that case it is necessary to adhere to a low-calorie diet.

At patients with sugar diabetes peritoneal dialysis is applied under control of level of a glycemia. When holding a procedure of dialysis it is necessary to estimate the maintenance of a hydrocarbonate, to control the body weight and balance of the entered and removed liquid.

Side effects:

Hypopotassemia and other disturbances of water and electrolytic exchange, hypoproteinemia, abdominal pain, feeling of stretching in an abdominal cavity, pain in a shoulder girdle, an asthma (owing to a diaphragm raising), bleedings, peritonitis, intestinal impassability, hypo - or a hypervolemia, increase or a lowering of arterial pressure, spasms, disturbance of the acid-base state (ABS) of blood.

Interaction with other medicines:

When mixing various HP it is necessary to pay attention to PH value and presence of salts, before mixing it is obligatory to check their compatibility. Strengthens aritmogenny effect of cardiac glycosides - correction of electrolytic balance dialysis can aggravate digitalis intoxication. Let's combine with heparin.

Contraindications:

Hypersensitivity, hypopotassemia; perforation of hollow abdominal organs and a peritoneum, state with possible disturbance of integrity of a peritoneum – recently undergone an abdominal cavity operation, an intra belly tumor, the localized and diffuse peritonitis, the closed injury of abdominal organs (unless probable advantages of treatment exceed risk), extensive commissural process in an abdominal cavity, inflammatory diseases of intestines, a gryzhanediagnostirovannoyezabolevaniye of an abdominal cavity; diseases of lungs (especially pneumonia), cachexia.

With care: blindness, tetraplegia, arthritis (heavy current), delay of intellectual development, psychosis, kolostoma, lipidemia, pregnancy, lactation period.

Overdose:

Symptoms: asthma.

Treatment: at excess introduction make removal of solution from an abdominal cavity at any time.

Storage conditions:

In the place protected from light at a temperature from + 5 °C to +25 °C. Period of validity 2 years.

Issue conditions:

According to the recipe

Packaging:

On 1000, 2000 and 2500 ml in system for peritoneal dialysis for continuous out-patient peritoneal dialysis or on 5000 ml in containers polymeric for hardware dialysis.