Fluids and electrolytes

Fluids and electrolytes

Oral preparations for fluid and electrolyte imbalance

Oral Potassium

POTASSIUM CHLORIDE:

Indications: For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxication, and in patients with hypokalemic familial periodic paralysis. If hypokalemia is the result of diuretic therapy, consideration should be given to the use of a lower dose of diuretic, which may be sufficient without leading to hypokalemia. For the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop, eg, digitalized patients or patients with significant cardiac arrhythmias.

Contraindications: Acute Dehydration, Acute Epiglottitis, Hyperchloremia, Hyperkalemia, Hyperkalemic Familial Periodic Paralysis.

Dose and Administration: Dosage must be adjusted to the individual needs of each patient. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day. Doses of 40-100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose.

POTASSIUM GLUCOHEPTONATE:

Indications: Hypokalemia, Hypokalemia Prevention.

Contraindications: Acute Dehydration, Acute Epiglottitis, Hyperchloremia,

Hyperkalemia, Hyperkalemic Familial Periodic Paralysis.

Dose and Administration: Adult Min/Max Dose: 2.0meq/150.0meq

Pediatric Min/Max Dose: 1.0meq/kg/6.0meq/kg.

Potassium Removal

Ion-exchange resins may be used to remove excess potassium in mild hyperkalaemia or in moderate hyperkalaemia when there are no ECG changes. Severe hyperkalaemia calls for urgent treatment with 10–30 mL of calcium gluconate 10% by intravenous injection to temporarily protect against myocardial excitability. An intravenous injection of soluble insulin (5–10 units) with 50 mL glucose 50% given over 5–15 minutes, reduces serum-potassium concentration; this is repeated if necessary or a continuous infusion instituted; occasionally haemodialysis is needed.

CALCIUM POLYSTYRENE SULPHONATE RESINS:

Indications: hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients.

 

Contraindications: obstructive bowel disease; oral administration or reduced gut motility in neonates; avoid calcium-containing resin in hyperparathyroidism, multiple myeloma, sarcoidosis, or metastatic carcinoma.

Dose and Administration: By mouth, 15 g 3–4 times daily in water (not fruit squash which has a high potassium content) or as a paste; child 0.5–1 g/kg daily in divided doses.

Oral Bicarbonate

SODIUM BICARBONATE:

Indications: by mouth for chronic acidotic states such as uraemic acidosis or renal tubular acidosis, Where hyperchloraemic acidosis is associated with potassium deficiency, as in some renal tubular and gastro-intestinal disorders it may be appropriate to give oral potassium bicarbonate.

Contraindications: Chronic Heart Failure, Edema, Oliguria, And Severe Renal Disease.

Dose and Administration: sodium bicarbonate 4.8 g daily (57 mmol each of Na⁺ and HCO3 –) or more may be required. For severe metabolic acidosis.

Parenteral preparations for fluid and  electrolyte imbalance

Electrolytes and water

Solutions of electrolytes are given intravenously, to meet normal fluid and electrolyte requirements or to replenish substantial deficits or continuing losses, when the patient is nauseated or vomiting and is unable to take adequate amounts by mouth. When intravenous administration is not possible, fluid (as sodium chloride 0.9% or glucose 5%) can also be given by subcutaneous infusion (hypodermoclysis).

SODIUM CHLORIDE:

Indications: indicated as a source of water and electrolytes. 0.9% Sodium Chloride Injection, USP is also indicated for use as a priming solution in hemodialysis procedures.

Contraindications: restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary oedema, and toxaemia of pregnancy Dose and Administration: as per directed by treating physician.

 

GLUCOSE (Dextrose Monohydrate):

Indications: fluid replacement (see notes above), provision of energy; hypoglycaemia

Contraindications: In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do.

Dose and Administration: 1.5 to 2.5 litres daily and this is needed to balance unavoidable losses of water through the skin and lungs and to provide sufficient for urinary excretion.

Side effects;injection hypertonic glucose have a low ph may cause venoues  irritation and thrombophlebitis.

POTASSIUM CHLORIDE:

Indications: electrolyte imbalance

Contraindications: plasma-potassium concentration above 5 mmol/litre.

Dose and Administration: By slow intravenous infusion, depending on the

deficit or the daily maintenance requirements.

SODIUM BICARBONATE:

Indications: Metabolic Acidosis, Severe Diarrhea, and Urine Alkalinization. Contraindications: Alkalosis, Hypocalcemia, Hypochloremia, Metabolic Alkalosis, Respiratory Alkalosis.

Dose and Administration: Adult Min/Max Dose: 0.5meq/kg/15.0meq/kg Pediatric Min/Max Dose: 0.5meq/kg/8.0meq/kg.

Plasma and plasma substitutes

Plasma and plasma substitutes (‘colloids’) contain large molecules that do not readily leave the intravascular space where they exert osmotic pressure to maintain circulatory volume. Compared to fluids containing electrolytes such as sodium chloride and glucose (‘crystalloids’), a smaller volume of colloid is required to produce the same expansion of blood volume, thereby shifting salt and water from the extravascular space. If resuscitation requires a volume of fluid that exceeds the maximum dose of the colloid then crystalloids can be given.

HUMAN ALBUMIN:

Indications: severe hypoalbuminaemia associated with low plasma volume and generalised oedema where salt and water restriction with plasma volume expansion are required; adjunct in the treatment of hyperbilirubinaemia by

 

exchange transfusion in the newborn; paracentesis of large volume ascites

associated with portal hypertension.

Contraindications: cardiac failure; severe anaemia.

Dose and Administration: The daily dose should not exceed 2 g of Albumin

(Human) 20% per kg of body weight.

HETASTARCH:

Indications: treatment of hypovolemia when plasma volume expansion is desired. It is not a substitute for blood or plasma.

Contraindications: Hetastarch injection is contraindicated in patients with known hypersensitivity to hydroxyethyl starch or with bleeding disorders or with congestive heart failure where volume overload is a potential problem. Hetastarch injection should not be used in renal disease with oliguria or anuria not related to hypovolemia.

Dose and Administration: 500–1000 mL; usual daily max. 1500 Ml.

 

Intravenous nutrition

When adequate feeding through the alimentary tract is not possible, nutrients may be given by intravenous infusion. This may be in addition to ordinary oral or tube feeding—supplemental parenteral nutrition, or may be the sole source of nutrition—total parenteral nutrition (TPN). Indications for this method include preparation of undernourished patients for surgery, chemotherapy, or radiation therapy; severe or prolonged disorders of the gastro-intestinal tract; major surgery, trauma, or burns; prolonged coma or refusal to eat; and some patients with renal or hepatic failure.

SODIUM ACETATE:

Adult         Min/Max        Dose: 0.5meq/kg/4.0meq/kg,        Pediatric          Min/Max
Dose: 0.5meq/kg/4.0meq/kg

POTASSIUM ACETATE:

Adult         Min/Max        Dose: 0.5meq/kg/4.0meq/kg,        Pediatric          Min/Max
Dose: 0.5meq/kg/4.0meq/kg

 

TRACE ELEMENTS:

traces of Fe³⁺, Zn²⁺, Mn²⁺, Cu²⁺, Cr³⁺, Se⁴⁺, Mo⁶⁺, F^–, I^–. For adults and children

over 40 kg.

CERNEVIT:VITAMIN B-COMPLEX WITH VIT-C

Solution, dl-alpha tocopherol 11.2 units, ascorbic acid 125 mg, biotin 69 micrograms, colecalciferol 220 units, cyanocobalamin 6 micrograms, folic acid 414 micrograms, glycine 250 mg, nicotinamide 46 mg, pantothenic acid (as dexpanthenol) 17.25 mg, pyridoxine hydrochloride 5.5 mg, retinol (as palmitate) 3500 units, riboflavin (as dihydrated sodium phosphate) 4.14 mg, thiamine (as cocarboxylase tetrahydrate) 3.51 mg. Dissolve in 5 mL water for injections.

SOLIVITO-N: VITAMIN B-COMPLEX WITH VIT-C

Solution, powder for reconstitution, biotin 60 micrograms, cyanocobalamin 5 micrograms, folic acid 400 micrograms, glycine 300 mg, nicotinamide 40 mg, pyridoxine hydrochloride 4.9 mg, riboflavin sodium phosphate 4.9 mg, sodium ascorbate 113 mg, sodium pantothenate 16.5 mg, thiamine mononitrate 3.1 mg.

PROTEIN:

is given as mixtures of essential and non-essential synthetic L-amino acids. Ideally, all essential amino acids should be included with a wide variety of non­essential ones to provide sufficient nitrogen together with electrolytes. Solutions vary in their composition of amino acids; they often contain an energy source (usually glucose) and electrolytes.

FAT:

emulsions have the advantages of a high energy to fluid volume ratio, neutral pH, and iso-osmolarity with plasma, and provide essential fatty acids. Several days of adaptation may be required to attain maximal utilisation. Reactions include occasional febrile episodes (usually only with 20% emulsions) and rare anaphylactic responses. Interference with biochemical measurements such as those for blood gases and calcium may occur if samples are taken before fat has been cleared. Daily checks are necessary to ensure complete clearance from the plasma in conditions where fat metabolism may be disturbed.

 

Oral nutrition

The body’s reserves of protein rapidly become exhausted in severely ill patients, especially during chronic illness or in those with severe burns, extensive trauma, pancreatitis, or intestinal fistula. Much can be achieved by frequent meals and by persuading the patient to take supplementary snacks of ordinary food between the meals. However, extra calories, protein, other nutrients, and vitamins are often best given by supplementing ordinary meals with sip or tube feeds of one of the nutritionally complete foods. When patients cannot feed normally at all, for example, patients with severe facial injury, oesophageal obstruction, or coma, a diet composed solely of nutritionally complete foods must be given. This is planned by a dietitian who will take into account the protein and total energy requirement of the patient and decide on the form and relative contribution of carbohydrate and fat to the energy requirements.

ENSURE:

Liquid, protein 4 g, fat 3.4 g, carbohydrate 13.6 g, energy 423 kJ (100 kcal)/100 mL with minerals and vitamins, lactose- and gluten-free. Flavours: chocolate, vanilla, coffee, eggnog, nut, chicken, mushroom, and asparagus. A sole source of nutrition or nutritional supplement for standard ACBS indications and dysphagia. Not to be prescribed for any child under 1 year; use with caution for children up to 5 years.

ENSURE PLUS:

Liquid, protein 6.3 g, fat 4.9 g, carbohydrate 20.2 g, with vitamins and minerals, lactose- and gluten-free, energy 632 kJ (150 kcal)/100 mL. Vanilla flavour, (formulations may vary slightly).  Nutritional supplement for standard ACBS indications and dysphagia, continuous ambulatory peritoneal dialysis (CAPD), or haemodialysis. Not to be prescribed for any child under 1 year; use with caution for children up to 5 years.

JEVITY:

Liquid, protein 4 g, fat 3.5 g, carbohydrate 14.1 g, dietary fibre 1.8 g, energy 441 kJ (106 kcal)/100 mL, with vitamins and minerals. Gluten-, lactose-, and sucrose-free. A sole source of nutrition or nutritional supplement for standard ACBS indications and dysphagia. Not to be prescribed for any child under 2 years; use with caution for children up to 5 years.

OSMOLITE:

Liquid, protein 4 g, carbohydrate 13.56 g, fat 3.4 g, energy 424 kJ (100 kcal)/100 mL with vitamins and minerals. Gluten- and lactose-free. A sole source of nutrition or nutritional supplement for standard ACBS indications and dysphagia. Not to be prescribed for any child under 1 year; use with caution for children up to 5 years.

 

PAEDIASURE:

Liquid, protein 2.8 g, carbohydrate 11 g, fat 5 g, energy 422 kJ (101 kcal)/100 mL with vitamins and minerals. Gluten-free, clinically lactose-free. For use as the sole source of nutrition or as a nutritional supplement prescribed on medical grounds for children aged 1 to 10 years for short-bowel syndrome, intractable malabsorption, pre-operative preparation of undernourished patients, dysphagia, bowel fistulas, and disease-related malnutrition and/or growth failure. Not to be prescribed for any child under 1 year.

RESOURCE PROTEIN:

Liquid, protein 9.4 g, carbohydrate 14 g, fat 3.5 g, energy 530 kJ (125 kcal)/100 mL with vitamins, minerals and trace elements. Gluten-free; low lactose. Flavours: apricot, chocolate, forest fruits, strawberry, or vanilla. Not to be prescribed for any child under 3 years; use with caution for children up to 5 years.

MCT OIL:

Triglycerides from medium chain fatty acids. For steatorrhoea associated with cystic fibrosis of the pancreas; intestinal lymphangiectasia; surgery of the intestine; chronic liver disease and liver cirrhosis; other proven malabsorption syndromes; in a ketogenic diet in the management of epilepsy; in type I hyperlipoproteinaemia.

NEPRO:

Liquid, protein 7 g, carbohydrate 20.6 g, fat 9.6 g, fibre 1.56g, energy 840 kJ

(200 kcal)/100 mL with vitamins and minerals. Gluten- and lactose-free. For patients with chronic renal failure who are on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD), or patients with cirrhosis or other conditions requiring a high energy, low fluid, low electrolyte diet.

SUPLENA:

Liquid, protein 3 g, carbohydrate 25.5 g, fat 9.6 g, energy 841 kJ

(201 kcal)/100 mL. For patients with chronic or acute renal failure who are not undergoing dialysis; chronic or acute liver disease with fluid restriction; other conditions requiring a high-energy, low-protein, low-electrolyte, low-volume enteral feed.

PULMOCARE:

PULMOCARE is a high-calorie, low-carbohydrate formula designed to help reduce carbon dioxide production, which may be helpful for patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or respiratory failure. Provides complete and balanced nutrition. Contains 20% of fat as MCT to enhance fat absorption. Meets or exceeds 100% of the RDI for 24 essential vitamins and minerals in 1420 Cal (947 mL). Fortified with the antioxidants all-natural vitamin E, beta-carotene and vitamin C.

GLUCERNA:

Is a healthy addition to an overall program for people with diabetes that includes a nutritious diet, exercise, and weight management. Unique, slowly digested carbohydrate system helps manage control of glucose levels. Complete, balanced

 

nutrition for overall good health. High-MUFA (mono unsaturated fatty acids), low-SFA (saturated fatty acids) fat blend helps improve lipid levels and helps manage glucose levels. Gluten and lactose-free Liquid, for people with diabetes and other dietary restrictions. Fortified with vitamins E and B6, chromium, and folic acid, which may be important for people with diabetes.

NOVASOURCE RENAL:

Liquid, protein 7 g, carbohydrate 20.6 g, fat 9.6 g, fibre 1.56g, energy 840 kJ (200 kcal)/100 mL with vitamins and minerals. Gluten- and lactose-free. For patients with chronic renal failure who are on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD), or patients with cirrhosis or other conditions requiring a high energy, low fluid, low electrolyte diet.

 

 

Minerals

Calcium supplements

Calcium supplements are usually only required where dietary calcium intake is deficient. This dietary requirement varies with age and is relatively greater in childhood, pregnancy, and lactation, due to an increased demand, and in old age, due to impaired absorption. In osteoporosis, a calcium intake which is double the recommended amount reduces the rate of bone loss. If the actual dietary intake is less than the recommended amount, a supplement of as much as 40 mmol is appropriate. In hypocalcaemic tetany an initial intravenous injection of 10 mL of calcium gluconate injection 10% (providing approximately 2.25 mmol of calcium) should be followed by the continuous infusion of about 40 mL daily (providing approximately 9 mmol of calcium), but plasma calcium should be monitored. This regimen can also be used immediately to temporarily reduce the toxic effects of hyperkalaemia.

CALCIUM GLUCONATE:

Indications: Cardiac Arrest, Disorder of Electrolytes, Hyperkalemia, Hypermagnesemia, Hypocalcemia, Hypocalcemia Prevention, and Hypocalcemic Tetany.

Contraindications: Digitalis Toxicity, Humoral Hypercalcemia of Malignancy, Hypercalcemia, Kidney Stone, Ventricular Fibrillation, Chronic Renal Failure, Hypercalcinuria.

Dose and Administration: By slow intravenous injection, acute hypocalcaemia, calcium gluconate 1–2 g (Ca²⁺ 2.25–4.5 mmol).

CALCIUM CARBONATE:

Indications: Hypocalcemia, Hypocalcemia Prevention, Osteoporosis, Post-Menopausal Osteoporosis Prevention.

 

Contraindications: Hypercalcemia, Hyperparathyroidism, Osteolytic Neoplasm, Sarcoidosis, Constipation, Dehydration, and Kidney Stone.

Dose and Administration: Adult Min/Max Dose: 1250.0mg/7500.0mg Pediatric Min/Max Dose: 112.5mg/kg/162.5mg/kg.

CALCIUM GLUBIONATE:

Indications: Hypocalcemia, Hypocalcemia Prevention, Osteoporosis, Post-Menopausal Osteoporosis Prevention.

Contraindications: Hypercalcemia, Hyperparathyroidism, Osteolytic Neoplasm, Sarcoidosis, Constipation, Dehydration, and Kidney Stone.

Dose and Administration: Each 5ml contains 1.2gm calcium glubionate equivalent to 78mg elemental calcium. Dose for children up to 3 years 1-2 teaspoon 3 times daily, more than 3 years 15ml 2 times daily and adults 15ml 3 times daily.

CALCIUM CARBONATE WITH VITAMIN-D:

Indications: Hypocalcemia, Hypocalcemia Prevention, Osteoporosis, Post-Menopausal Osteoporosis Prevention.

Contraindications: Hypercalcemia, Hypercalcemia associated with Sarcoidosis, Hyperparathyroidism, Hypervitaminosis D, Malabsorption States, Osteolytic Neoplasm, Sarcoidosis, Arteriosclerosis Obliterans, Constipation, Dehydration, Hyperphosphatemia, Kidney Stone, Metastatic Calcification.

Dose and Administration: Daily intake should not exceed 1500mg calcium and 600iu vitamin-D.

CALCIUM, MAGNESIUM, ZINC & VITAMIN-D:

Indications: Hypocalcemia, Hypocalcemia Prevention, Osteoporosis, Post-Menopausal Osteoporosis Prevention and pregnant women.

Contraindications: Hypercalcemia, Hypercalcemia associated with Sarcoidosis, Hyperparathyroidism, Hypervitaminosis D, Malabsorption States, Osteolytic Neoplasm, Sarcoidosis, Arteriosclerosis Obliterans, Constipation, Dehydration, Hyperphosphatemia, Kidney Stone, Metastatic Calcification.

Dose and Administration: Daily intake should not exceed 1500mg calcium and 600iu vitamin-D for adults. Infants (6-12) months 1/2 teaspoon twice daily. Children 1-2 teaspoon 2-3 times’ daily.

 

Hyperparathyrodism

CINACALCET:

Indications: Secondary hyperparathyroidism in patients with end-stage renal disease on dialysis, Hypercalcaemia of parathyroid carcinoma. Contraindications: Seizure Disorder, pregnancy, Adynamic Bone Disease, Chronic Heart Failure, Disease of Liver, Hypocalcemia, Hypophosphatemia, Hypotension.

Dose and Administration: Secondary hyperparathyroidism in patients with end-stage renal disease on dialysis, adult over 18 years, 30 mg once daily, adjusted every 2–4 weeks to max. 180 mg daily. Hypercalcaemia of parathyroid carcinoma, adult over 18 years, initially 30 mg twice daily, adjusted every 2–4 weeks according to response up to max. 90 mg 4 times daily.

Magnesium

Magnesium is an essential constituent of many enzyme systems, particularly those involved in energy generation; the largest stores are in the skeleton. Magnesium salts are not well absorbed from the gastro-intestinal tract, which explains the use of magnesium sulphate as an osmotic laxative. Magnesium is excreted mainly by the kidneys and is therefore retained in renal failure, but significant hypermagnesaemia (causing muscle weakness and arrhythmias) is rare.

MAGNESIUM SULPHATE:

Indications: Hypomagnesaemia, Prevention of seizure recurrence in eclampsia, Prevention of seizures in pre-eclampsia.

Contraindications: Hypermagnesemia, Severe Renal Disease.

Dose and Administration: Prevention of seizure recurrence in eclampsia, initially by intravenous injection over 5–15 minutes, 4 g, followed by intravenous infusion, 1 g/hour for at least 24 hours after last seizure; if seizure recurs, additional dose by intravenous injection, 2 g (4 g if body-weight over 70 kg). Prevention of seizures in pre-eclampsia [unlicensed indication], initially by intravenous infusion over 5–15 minutes, 4 g followed by intravenous infusion,

1 g/hour for 24 hours; if seizure occurs, additional dose by intravenous injection,

2 g. For intravenous injection concentration of magnesium sulphate should not exceed 20% (dilute 1 part of magnesium sulphate injection 50% with at least 1.5 parts of water for injections).

MAGNESIUM OXIDE:

Indications: Hypomagnesaemia.

Contraindications: Hypermagnesemia, Severe Renal Disease.

 

Dose and Administration: 400 mg by oral route 2 times perone  tablet a day

Phosphate-binding agents

SEVELAMER:

Indications: hyperphosphataemia in patients on haemodialysis or peritoneal dialysis.

Contraindications: bowel obstruction.

Dose and Administration: adult over 18 years, initially 2.4–4.8 g daily in 3 divided doses with meals, then adjusted according to plasma-phosphate concentration (usual dose range 2.4–12 g daily in 3 divided doses).

Vitamins

Vitamins are used for the prevention and treatment of specific deficiency states or where the diet is known to be inadequate; they may be prescribed in the NHS to prevent or treat deficiency but not as dietary supplements. Their use as general ‘pick-me-ups’ is of unproven value and, in the case of preparations containing vitamin A or D, may actually be harmful if patients take more than the prescribed dose. The ‘fad’ for mega-vitamin therapy with water-soluble vitamins, such as ascorbic acid and pyridoxine, is unscientific and can be harmful.

Vitamin A

VITAMIN A (Retinol):

Indications: Deficiency of vitamin A (retinol) is associated with ocular defects (particularly xerophthalmia) and an increased susceptibility to infections. Contraindications: pregnancy and breast-feeding.

Dose and Administration: maximum 5000units per day.

Vitamin B Group

PYRIDOXINE HYDROCHLORIDE (Vitamin B6):

Indications: Deficiency states, Isoniazid neuropathy, Idiopathic sideroblastic

anaemia, Premenstrual syndrome.

Contraindications: Lactation, Pregnancy.

Dose and Administration: 100 to 200 mg/day for 3wk; follow with 25 to 100

mg/day.

 

VITAMIN-B COMPLEX:

Indications: neurotic pains; acute or chronic neuritis and polyneuritis. Neuralgia, toxic damages of the nerve tissue. Alcoholism, diabetic polyneuropathy, drug intoxication.

Contraindications: allergic to any ingredient in Vitamin B Complex.

Dose and Administration: 1-2 tablets daily. One ampule I.M. every day or every second day.

Vitamin C (Ascorbic acid)  VITAMIN-C:

Indications: prevention and treatment of scurvy, Alcaptonuria, Hawkinsinuria, Homocystinuria, Methemoglobinemia, Transient Tyrosinemia of the Newborn, Tyrosinemia Type III.

Contraindications: Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies.

Dose and Administration: Prophylactic, 25–75 mg daily; therapeutic, not less than 250 mg daily in divided doses.

Vitamin D

COLECALCIFEROL (Cholecalciferol, vitamin D3):

Indications: Glucocorticoid Induced Osteoporosis, Hypoparathyroidism, Osteomalacia, Osteoporosis, Rickets, Vitamin D Deficiency, Vitamin D Dependent Rickets, Anticonvulsant-induced Osteomalacia, Prevention of Vitamin D Deficiency, Renal Osteodystrophy.

Contraindications: Hypercalcemia, Hypercalcemia associated with Sarcoidosis, Hypervitaminosis D, Malabsorption States, Arteriosclerosis Obliterans, Hyperphosphatemia, Kidney Stone, Metastatic Calcification.

Dose and Administration: Adult Min/Max Dose: 200.0u/5000.0u Pediatric Min/Max Dose: 100.0u/400.0u

ALFACALCIDOL (1α-Hydroxycholecalciferol):

Indications: A derivative of vitamin D used in the treatment of hypoparathyroidism, vitamin D-dependent rickets, and rickets associated with malabsorption syndromes.
Contraindications: Hypercalcemia, Hypercalcemia associated with Sarcoidosis,

 

Hypervitaminosis D, Malabsorption States, Arteriosclerosis Obliterans, Hyperphosphatemia, Kidney Stone, Metastatic Calcification.

Dose and Administration: By mouth or by intravenous injection over 30 seconds, adult and child over 20 kg, initially 1 microgram daily (elderly 500 nanograms), adjusted to avoid hypercalcaemia; maintenance, usually 0.25– 1 microgram daily; neonate and preterm neonate initially 50–100 nanograms/kg daily, child under 20 kg initially 50 nanograms/kg daily.

Vitamin E

ALPHA TOCOPHERYL ACETATE:

Indications: Vitamin E Deficiency, Abetalipoproteinemia, Anemia of Prematurity, Cholestasis, Cystic Fibrosis, Intraventricular Hemorrhage In Newborn, Neonatal Bronchopulmonary Dysplasia, Retinopathy of Prematurity, Sickle Cell Disease Anemia, Thalassemia Anemia.

Contraindications: Vitamin K Deficiency Induced Hypoprothrombinemia.

Dose and Administration: Malabsorption in cystic fibrosis, 100–200 mg daily; child 1 month–1 year 50 mg daily; 1–12 years, 100 mg daily. Malabsorption in abetalipoproteinaemia, adult and child 50–100 mg/kg daily.

Vitamin K

PHYTOMENADIONE (Vitamin K1):

Indications: hemorrhage or risks of hemorrhage as a result of sever hypoprothrombinemia of various etiologies.

Contraindications: hypersensitivity to phytomendione or any of the ingredients.

Dose and Administration: Prophylaxis of Hemorrhagic Disease of the Newborn a single intramuscular dose of Vitamin K1 Injection 0.5 to 1 mg within one hour of birth is recommended. Treatment of Hemorrhagic Disease of the Newborn Empiric administration of vitamin K1 should not replace proper laboratory evaluation of the coagulation mechanism. A prompt response (shortening of the prothrombin time in 2 to 4 hours) following administration of vitamin K1 is usually diagnostic of hemorrhagic disease of the newborn, and failure to respond indicates another diagnosis or coagulation disorder. Anticoagulant-Induced Prothrombin Deficiency in Adults To correct excessively prolonged prothrombin time caused by oral anticoagulant therapy—2.5 to 10 mg or up to 25 mg initially is recommended. In rare instances 50 mg may be required. Frequency and amount of subsequent doses should be determined by prothrombin time response or clinical condition. Hypoprothrombinemia Due to

 

Other Causes in Adults A dosage of 2.5 to 25 mg or more (rarely up to 50 mg) is recommended, the amount and route of administration depending upon the severity of the condition and response obtained.

Multivitamin preparations, mineral supplements and adjuncts

CENTRUM

Centrum is a multivitamin/multimineral supplement that includes all antioxidants, the vitamins that strengthen the body’s natural defenses against cell damage. Multivitamins are nutritional supplements for people whose diet may be deficient in certain vitamins and minerals. You may need a supplement if you are on a special diet, or don’t eat the right foods. A supplement may also be necessary if you are a strict vegetarian, take medications that prevent the body from using certain nutrients, or have an illness that affects your appetite. The usual dose is 1 tablet daily.

STRESSTABS WITH ZINC

Multivitamins and minerals are used to provide vitamins and minerals that are not taken in through the diet. Multivitamins and minerals are also used to treat vitamin or mineral deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, certain medications, and many other conditions. Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin. The recommended adult dose is one tablet daily.

MATERNA

The prenatal products contain vitamins and minerals including iron, calcium, zinc, and folic acid. The tablets are given during pregnancy and after childbirth to ensure an adequate supply of these critical nutrients. They may also be prescribed to improve a woman’s nutritional status before she becomes pregnant. Nutritional supplementation is especially important during pregnancy. The recommended dose is one tablet daily.

DYNAMISAN

Multivitamin preparation with minerals, amino acids and ginseng. Dynamisan represents a revolutionary combination of substances essential for the optimum functioning of the human body. As distinct from other preparations, Dynamisan contains amino acids besides other components: Arginine stimulates the production of the growth hormone, increases the number of spermatozoa, and

 

enhances the formation of muscle tissues. Glutamine is a “brain fuel” enhancing the concentration and promoting the ability to learn and remember.

Dynamisan also contains ginseng: Ginseng strengthens the nervous system, supports cell reproduction and prevents aging. Besides the amino acids and ginseng, Take one Dynamisan tablet a day – preferably in the morning.

CAL-C-VITA

vitamin C, D3, B6 and calcium preparation. Vitamin C is required for the growth and repair of tissues in all parts of your body. It is necessary to form collagen, an important protein used to make skin, scar tissue, tendons, ligaments, and blood vessels. Vitamin C is essential for the healing of wounds, and for the repair and maintenance of cartilage, bones, and teeth. Vitamin D is a fat soluble vitamin that is found in food and can also be made in your body after exposure to ultraviolet (UV) rays from the sun. Sunshine is a significant source of vitamin D because UV rays from sunlight trigger vitamin D synthesis in the skin. Vitamin B6 is a water-soluble vitamin that was first isolated in the 1930’s. There are six forms of vitamin B6: pyridoxal (PL), pyridoxine (PN), pyridoxamine (PM), and their phosphate derivatives: pyridoxal 5′-phosphate (PLP), pyridoxine 5′- phosphate (PNP), and pridoxamine 5′-phospate (PMP). PLP is the active coenzyme form, and has the most importance in human metabolism. Calcium, a mineral, is used for building bones and teeth and in maintaining bone strength. Calcium is also used in muscle contraction, blood clotting, and maintenance of cell membranes.

OMACOR

Omega-3 polyunsaturated fatty acids are found in oil from certain types of fish, vegetables, and other plant sources. These fatty acids are not made by the body and must be consumed in the diet. Omacor works by lowering the body’s production of triglycerides. High levels of triglycerides can lead to coronary artery disease, heart disease, and stroke. Omacor is used together with diet and exercise to help lower triglyceride levels in the blood.

FEROGLOBIN

Feroglobin B12 (Iron, Folic Acid, Vitamin B12, Vitamin B6, Zinc, Copper) is Nutrients for Haemoglobin Formation To Help Maintain Energy and Vitality and may be beneficial during pregnancy and for women during the monthly cycle. May also benefit athletes, children, over 50’s, and slimmers as an extra blood-forming nutrient. Provides an effective source of vital nutrients for the formation of Haemoglobin for Red Blood Cells. Including organic iron, folic acid and vitamin B12.

 

MULTI-SANOSTOL

Multi-Sanostol provides all 9 vitamins essential during child growth and development as well as calcium. It prevents rickets as well as disturbance in child growth development, promotes the formation of both bone and teeth.