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PERI SOLUTION
(Peritoneal Dialysis Solution)
Therapeutic Class
Dialysis solution.
Description and Composition
A clear, colorless solution, each 1000 ml. of which contains:
Calcium Chloride 2H2O : 0.294 grams
Magnesium Chloride 6H2O : 0.153 grams
Sodium Chloride : 5.650 grams
Sodium Lactate : 4.880 grams
Anhydrous Dextrose : 15.0 grams
Water for Injections : q.s.
Pharmacological Effects
- The process of dialysis allows the selective removal of waste substances and excessive fluids from the blood.
- In peritoneal dialysis, the exchange of substances between the patients blood and the dialysis solution is made across the peritoneal membranes.
- The removal of fluid from the patients blood into the peritoneal cavity is facilitated by the high osmolarity of the solution, due to the presence of glucose in the dialysis solution.
- Provides calories for some metabolic needs. Each 100mL provides 1.5 grams of Dextrose and each gram of Dextrose Monohydrate provides 3.4kCal.
- The pH range is 5.1 – 5.3.
Indications
- For peritoneal dialysis whenever hemodialysis is difficult or impossible.
Dosage and Administration
This solution is intended for intraperitoneal administration only.
A careful assessment should be made regarding the mode of therapy (Intermittent Peritoneal Dialysis or Continuous Ambulatory Peritoneal Dialysis), the frequency of treatment, exchange volume and the length of dialysis according to individual patient needs.
Intermittent Peritoneal Dialysis (IPD)
For dialysis of acute renal failure patients and maintenance dialysis of chronic renal failure patients the cycle of instillation and removal of dialysis fluid is repeated sequentially over a period of hours (8 to 36 hours) as many times as indicated by the condition of the patient. For chronic renal failure patients, maintenance dialysis often uses periodic dialysis (3 to 5 times weekly) for shorter time periods (8Continuous Ambulatory Peritoneal Dialysis (CAPD)
For maintenance dialysis of chronic renal failure patients the solution should be used according to individual patient needs as assessed by the attending physician.
Adverse Effects
- Adverse reactions to peritoneal dialysis may be due to mechanical or solution related problems, contamination of equipment or improper technique in catheter placement.
- Complications of the procedure include abdominal pain, bleeding, peritonitis, subcutaneous infection around a chronic peritoneal catheter, catheter blockage, difficulty in fluid removal and ileus.
- Solution related adverse reactions may include fluid and electrolyte imbalances, hypovolemia, hypervolemia, hypotension or hypertension.
- The possible risk of infection should be minimized by the use of aseptic techniques throughout the procedure and its termination.
- Significant amounts of protein, amino acids and water soluble vitamins may be lost during peritoneal dialysis and replacement therapy should be provided as necessary.
- Safety in pregnancy and lactation have not been established.
Contraindications
- To be avoided in pregnancy, excessive obesity and behavioral disturbances rendering co-operation of the patient impossible in a procedure requiring relative but prolonged restriction of movement.
Precautions
- Care is required if peritoneal dialysis is undertaken for patients with certain abdominal conditions such as generalized peritonitis, localized infectious processes of the abdomen, traumatic abdominal lesions, recent abdominal surgery, extensive adhesions, the presence of intra-abdominal masses greatly restricting the volume of the cavity e.g. tumors, polycystic kidneys, bowel distention, undiagnosed abdominal disease, abdominal wall infection, fecal fistula or colostomy.
- Care should also be taken if patients suffer from severe pulmonary disease or have recently undergone aortic graft replacement.
- It is advisable to carefully monitor the weight of the patient in order to avoid fluid overloading or underhydration, which can result in severe complications including congestive heart failure, volume depletion or shock.
- Plasma electrolyte concentration of patients must also be monitored regularly during the dialysis procedure.
- This dialysis solution is potassium-free, because dialysis may be performed to correct hyperkalemia. The addition of potassium chloride (up to 4 meq/L) may therefore be indicated to prevent severe hypokalemia in patients with normal potassium levels or hypokalemia. This should be undertaken only after careful evaluation of serum potassium.
Tonicity and Osmolarity
Isotonic solution having a tonicity of 145.
Hyperosmolar solution (372 mOsm/L)
Caloric Value
54 kCal/Liter
Pharmaceutical Precautions
- Store at room temperature.
- Do not administer unless the dialysis solution is clear and seal is intact.
- Do not use if bottle is leaking, solution is cloudy or contains foreign matter.
- Discard unused portion.
- Keep all medicines out of the reach of children.
Packaging
1000ml. in Plabottle.
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