BNF for Children 2011-2012

464 9.2.2 Parenteral preparations for fluid & electrolyte imbalance BNFC 2011–20129 Nutrition and bloodRenal hyperkalaemia. By slow intravenous injectionNeonate 1 mmol/kg dailyChild 1 month–18 years 1 mmol/kg dailyRenal acidosis section 9.2.1.3Sodium Bicarbonate AIntravenous infusion, usual strength sodium bicarbonate1.26% (12.6 g, 150 mmol each of Na + andHCO 3/litre); various other strengths availableIn hospitals, 500- and 1000-mL packs, and sometimes other sizes,are availableAdministration For peripheral infusion dilute 8.4% solutionat least 1 in 10; for central line infusion dilute 1 in 5 withGlucose 5% or 10% or Sodium Chloride 0.9%. Extravasationcan cause severe tissue damageMinijet c Sodium Bicarbonate (UCB Pharma) AIntravenous injection, sodium bicarbonate in disposablesyringe, net price 4.2%, 10 mL = £11.03; 8.4%,10 mL = £11.10, 50 mL = £12.15TROMETAMOL(Tris(hydroxymethyl)aminomethane, THAM)Cautions see notes above; extravasation can causesevere tissue damageContra-indications anuria; chronic respiratory acidosisRenal impairment use with caution, may causehyperkalaemiaPregnancy limited information available, hypoglycaemiamay harm fetusBreast-feeding no information availableSide-effects respiratory depression; hypoglycaemia;hyperkalaemia in renal impairment; liver necrosisreported following administration via umbilical vein inneonatesLicensed use unlicensed preparationIndication and doseMetabolic acidosis. By intravenous infusionAn amount appropriate to the body base deficitPreparationsAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809WaterWater for Injections A Net price 1-mL amp = 18p;2-mL amp = 20p; 5-mL amp = 36p; 10-mL amp = 37p,10-ml vial = £1.40; 20-mL amp = 92p; 50-mL amp =£1.91; 100-mL vial= £2.019.2.2.2 Plasma and plasma substitutesAlbumin solutions, prepared from whole blood, containsoluble proteins and electrolytes but no clottingfactors, blood group antibodies, or plasma cholinesterases;they may be given without regard to the recipient’sblood group.Albumin is usually used after the acute phase of illnessto correct a plasma-volume deficit; hypoalbuminaemiaitself is not an appropriate indication. The use ofalbumin solutions in acute plasma or blood loss maybe wasteful; plasma substitutes are more appropriate.Concentrated albumin solutions may also be used toobtain a diuresis in hypoalbuminaemic patients (e.g. innephrotic syndrome).Recent evidence does not support the previous viewthat the use of albumin increases mortality.Plasma and plasma substitutes are often used in veryill children whose condition is unstable. Therefore,close monitoring is required and fluid and electrolytetherapy should be adjusted according to the child’scondition at all times.ALBUMIN SOLUTION(Human Albumin Solution)A solution containing protein derived from plasma,serum, or normal placentas; at least 95% of theprotein is albumin. The solution may be isotonic(containing 3.5–5% protein) or concentrated (containing15–25% protein).Cautions history of cardiac or circulatory disease(administer slowly to avoid rapid rise in blood pressureand cardiac failure, and monitor cardiovascularand respiratory function); increased capillary permeability;correct dehydration when administering concentratedsolutionContra-indications cardiac failure; severe anaemiaSide-effects hypersensitivity reactions (includinganaphylaxis) with nausea, vomiting, increased salivation,fever, tachycardia, hypotension and chillsreportedIndication and doseSee notes above and under preparations, belowIsotonic solutionsIndications: acute or sub-acute loss of plasma volumee.g. in burns, pancreatitis, trauma, and complicationsof surgery; plasma exchangeAvailable as: Human Albumin Solution 4.5% (50-,100-, 250- and 400-mL bottles—Baxter); HumanAlbumin Solution 5% (250- and 500-mL bottles—Baxter); Albunorm c 5% (100-, 250-, and 500-mLbottles—Octapharma); Octalbin c 5% (100- and 250-mL bottles—Octapharma); Zenalb c 4.5% (50-, 100-,250-, and 500-mL bottles—BPL)Concentrated solutions (20%)Indications: severe hypoalbuminaemia associatedwith low plasma volume and generalised oedemawhere salt and water restriction with plasma volumeexpansion are required; adjunct in the treatment ofhyperbilirubinaemia by exchange transfusion in thenewborn; paracentesis of large volume ascites associatedwith portal hypertensionAvailable as: Human Albumin Solution 20% (50- and100-mL vials—Baxter); Albunorm c 20% (50- and100-mL bottles—Octapharma); Flexbumin c 20% (50-and 100-mL bags—Baxter); Octalbin c 20% (50- and100-mL bottles—Octapharma); Zenalb c 20% (50-and 100-mL bottles—BPL)