Consumer medicine information

Plasma-Lyte 148 (approx. pH 7.4) IV infusion

Sodium chloride; Sodium gluconate; Sodium acetate; Potassium chloride; Magnesium chloride hexahydrate

BRAND INFORMATION

Brand name

Plasma-Lyte 148

Active ingredient

Sodium chloride; Sodium gluconate; Sodium acetate; Potassium chloride; Magnesium chloride hexahydrate

Schedule

Unscheduled

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Plasma-Lyte 148 (approx. pH 7.4) IV infusion.

What is in this leaflet

This leaflet answers some common questions about Plasma-Lyte 148 (approx. pH 7.4) Infusion. It does not contain all of the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you using this medicine against the benefit they expect it will have for you.

If you have any concerns about being given this medicine, ask your doctor or pharmacist.

Keep this leaflet. You may need to read it again.

What Plasma-Lyte 148 (approx. pH 7.4) Infusion is used for

Plasma-Lyte 148 (approx. pH 7.4) Infusion is a clear sterile solution used as a source of water and electrolytes (salts).

Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed it for another reason.

Before you start Plasma-Lyte 148 (approx. pH 7.4) Infusion

When you must not be given it

Plasma-Lyte 148 (approx. pH 7.4) Infusion must not be given to you if:

  • you have an allergy to any ingredients contained in this product (listed at the end of this leaflet).
Some of the symptoms of an allergic reaction may include: rash, itching or hives on the skin; swelling of the face, lips, tongue or other parts of the body; shortness of breath, wheezing or trouble breathing.
  • the expiry date printed on the bag container has passed; the bag container is damaged in any way; or the solution is not clear.

You must tell your doctor if you have any of the following medical conditions:

  • metabolic acidosis, or metabolic/respiratory alkalosis (abnormal blood pH)
  • heart, kidney and/or liver disorders
  • conditions that may cause retention of fluid or sodium in the body and oedema (build up of fluid under the skin, particularly around the ankles, feet or legs)
  • abnormal blood levels of calcium, chloride, magnesium, potassium and/or sodium
  • aldosteronism (a disease that causes high levels of hormone called aldosterone);
  • eclampsia or pre-eclampsia (high blood pressure during pregnancy)
  • myasthenia gravis (a disease that causes progressive muscle weakness)
  • conditions that may cause high blood levels of potassium (hyperkalaemia) such as kidney failure, adrenocortical insufficiency, dehydration or extensive tissue damage or burns.

Before you are given it

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor if you are pregnant or plan to become pregnant or are breast-feeding. Your doctor can discuss with you the risks and benefits involved.

If you have not told your doctor about any of the above, tell them before you start being given Plasma-Lyte 148 (approx. pH 7.4) Infusion.

Taking other medicines

Tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Plasma-Lyte 148 (approx. pH 7.4) Infusion may interfere with each other. These include:

  • corticosteroids (anti-inflammatory medicines)
  • medicines that may increase the concentration of potassium in your blood, such as:
    - potassium-sparing diuretics (amiloride, spironolactone, triamterene)
    - angiotensin converting enzyme inhibitors or angiotensin II receptor antagonist (used in treatment of high blood pressure)
    - tacrolimus and cyclosporin (used to prevent rejection of a transplant)
  • aspirin/salicylates (anti-inflammatory medicines)
  • barbiturates (used to treat epilepsy)
  • lithium (used to treat psychiatric illnesses)
  • sympathomimetics e.g. phenylephrine and pseudoephedrine (used in cough and cold preparations), dexamphetamine (for treatment of ADHD).

These medicines may be affected by Plasma-Lyte 148 (approx. pH 7.4) or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while being given this medicine.

How Plasma-Lyte 148(approx. pH 7.4) Infusion is given

How much is given

Your doctor will decide how much Plasma-Lyte 148 (approx. pH 7.4) Infusion will be used, depending on your need and condition.

How it is given

Plasma-Lyte 148 (approx. pH 7.4) Infusion will be given to you as a slow injection into one of your veins (as an intravenous infusion) by your doctor or specially trained nurse.

Ask your doctor if you wantto know more about the Plasma-Lyte 148 (approx. pH 7.4) Infusion you receive.

If you are given too much (overdose)

As Plasma-Lyte 148 (approx. pH 7.4) Infusion is given to you by a doctor or nurse, it is unlikely that you will be given an overdose. However, in case of an overdose, the infusion will be discontinued and another treatment may be needed. You may experience some of the effects listed under “Side effects” below.

Side effects

Tell your doctor, pharmacist or nurse as soon as possible if you do not feel well while you are being given Plasma-Lyte 148 (approx. pH 7.4) Infusion.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Do not be alarmed by the following list of side effects. You may not experience any of them.

Tell your doctor, nurse or pharmacist as soon as possible if you notice any of the following:

  • local pain, burning sensation, inflammation or redness at the site of injection
  • fast/irregular heart beats
  • chest discomfort/pain
  • increased breathing rate
  • flushing
  • redness of eye
  • feeling of weakness
  • fever / chills
  • swelling of hands, ankles or feet

Tell your doctor immediately if you notice any of the following:

  • rash, itching or hives on the skin
  • swelling of the face, lips, tongue or other parts of the body
  • shortness of breath, wheezing or trouble breathing.

These may be symptoms of an allergic reaction and urgent medical attention may be required.

Tell your doctor, nurse or pharmacist if you notice anything that is making you feel unwell.

Other side effects not listed above may occur in some people.

Discuss any concerns you have with your doctor.

After using Plasma-Lyte 148 (approx. pH 7.4) Infusion

Storage

Plasma-Lyte 148 (approx. pH 7.4) Infusion will be stored in the pharmacy or the hospital ward. It is recommended that the product be stored below 30°C. Do not freeze.

Product description

What it looks like

Plasma-Lyte 148 (approx. pH 7.4) Infusion is a clear solution in VIAFLEX (plastic) bags. It is available in the following pack sizes:

  • 500 mL (AUST R 231424)
  • 1000 mL (AUST R 231425)

Ingredients

Plasma-Lyte 148 (approx. pH 7.4) Infusion contains the following active ingredients:

  • Sodium Chloride
  • Sodium Gluconate
  • Sodium Acetate
  • Potassium Chloride
  • Magnesium Chloride

Other ingredients include sodium hydroxide and Water for Injections.

Sponsor

Baxter Healthcare Pty. Ltd.
1 Baxter Drive
Old Toongabbie NSW 2146

Date of preparation:

December 2014.

PLASMA-LYTE and VIAFLEX are trademarks of Baxter International Inc.

Published by MIMS November 2017

BRAND INFORMATION

Brand name

Plasma-Lyte 148

Active ingredient

Sodium chloride; Sodium gluconate; Sodium acetate; Potassium chloride; Magnesium chloride hexahydrate

Schedule

Unscheduled

 

Name of the medicine

Sodium chloride 5.26 g/L, sodium gluconate 5.02 g/L, sodium acetate 3.68 g/L, potassium chloride 370 mg/L, magnesium chloride 300 mg/L.

Excipients.

Sodium hydroxide (pH adjustment), water for injections to 1000 mL.

Description

Plasma-Lyte 148 (approx. pH 7.4) IV Infusion is a sterile, clear, nonpyrogenic isotonic solution in a single dose container for intravenous administration.
Each 1000 mL of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion contains: sodium chloride 5.26 g, sodium gluconate 5.02 g, sodium acetate 3.68 g, potassium chloride 370 mg, magnesium chloride 300 mg, sodium hydroxide (pH adjustment), water for injections q.s. to 1000 mL; pH range 6.5 to 8.0; approximate osmolality 271 mOsm/kg, approximate kilojoules 66 kJ.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion when administered intravenously is a source of water, electrolytes, and calories. It contains no antimicrobial agents. The osmolality is 271 mOsm/kg. An injection with an osmolality within the range of 250 to 350 mOsm/kg is considered to be isotonic. Administration of substantially hypertonic solutions may cause vein damage.
Each 1000mL of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion has an ionic concentration of: sodium 140 mmol, potassium 5 mmol, magnesium 1.5 mmol, chloride 98 mmol, acetate 27 mmol, gluconate 23 mmol.

Pharmacology

Plasma-Lyte 148 (approx pH 7.4) IV Infusion is a source of water and electrolytes. It is capable of inducing diuresis depending on the clinical condition of the patient.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion produces a metabolic alkalinising effect. Acetate and gluconate ions are metabolised ultimately to carbon dioxide and water, which requires the consumption of hydrogen cations.

Indications

Plasma-Lyte 148 (approx. pH 7.4) IV Infusion is indicated as a source of water and electrolytes or as an alkalinising agent.

Contraindications

Plasma-Lyte 148 (approx. pH 7.4) IV infusion is contraindicated in patients with a known hypersensitivity to the product.

Precautions

Plasma-Lyte 148 (approx. pH 7.4) IV Infusion is not indicated for:
the treatment of hypochloremic hypokalaemic alkalosis and should be used with caution, in patients with hypochloremic hypokalaemic alkalosis;
the primary treatment of severe metabolic acidosis;
hypomagnesaemia.
Although Plasma-Lyte 148 (approx. pH 7.4) IV Infusion has a potassium concentration similar to the concentration in plasma, it is insufficient to produce a useful effect in case of severe potassium deficiency; therefore, it should not be used for correction of severe potassium deficiency.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency and in clinical states in which there exists oedema with sodium retention.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be administrated with particular caution, if at all to patients with conditions that may cause sodium retention, fluid overload and oedema.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be used with caution if at all, in patients with hyperkalaemia or conditions predisposing to hyperkalaemia (such as severe renal impairment or adrenocortical insufficiency, acute dehydration or extensive tissue injury or burns) and in patients with cardiac disease and in conditions where potassium retention is present.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be used with great care in patients with metabolic or respiratory alkalosis. The administration of acetate or gluconate ions should be done with great care in those conditions in which there is an increased level or an impaired utilisation of these ions, such as severe hepatic insufficiency.
Depending on the volume and rate of infusion, intravenous administration of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration/ hypervolemia, congested states, including pulmonary congestion and oedema, and clinically relevant electrolyte disturbances and acid-base imbalance. The risk of dilutional states is inversely proportional to the electrolyte concentrations of the infusion. The risk of solute overload causing congested states with peripheral and pulmonary oedema is directly proportional to the electrolyte concentrations of the infusion.
In patients with diminished renal function, administration of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion may result in sodium and/or potassium or magnesium retention.
Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations and acid base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be used with particular caution, if at all, in patients with alkalosis or at risk for alkalosis. Excess administration may result in metabolic alkalosis.
Hypersensitivity/ infusion reactions, including anaphylactoid reactions, have been reported with Plasma-Lyte 148 (approx. pH 7.4) IV Infusion. The infusion must be stopped immediately if any signs or symptoms of a suspected hypersensitivity reaction develop. Appropriate therapeutic countermeasures must be instituted as clinically indicated.
Solutions containing magnesium should be used with caution, if at all, in patients with:
hypermagnesaemia or conditions predisposing to hypermagnesaemia including, but not limited to, severe renal impairment or magnesium therapy such as eclampsia;
myasthenia gravis.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be administered with particular caution, if at all, to hypervolemia or overhydrated patients.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be administered with particular caution, if at all, to patients with conditions that may cause sodium retention, fluid overload and edema, such as patients with primary hyperaldosteronism, secondary hyperaldosteronism (associated with, for example, hypertension, congestive heart failure, renal artery stenosis, or nephrosclerosis), or preeclampsia.
Plasma-Lyte 148 (approx. pH 7.4) IV Infusion contains no calcium and an increase in plasma pH due to its alkalinising effect may lower the concentration of ionised (not protein bound) calcium. Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be administered with particular caution, if at all, to patients with hypocalcaemia.
Do not connect flexible plastic containers in series in order to avoid air embolism due to possible residual air contained in the primary container. Pressurising intravenous solutions contained in flexible plastic containers to increase flow rates can results in air embolism if the residual air in the container is not fully evacuated prior to administration.
Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers.

Use in pregnancy.

(No category)
There are no adequate data from the use of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in pregnant women. The potential risks and benefits for each specific patient should be carefully considered before using Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in pregnant women.

Use in lactation.

There are no adequate data from the use of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in lactating women. The potential risks and benefits for each specific patient should be carefully considered before using Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in lactating women.

Paediatric use.

Safety and effectiveness of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in paediatric patients have not been established by adequate or well controlled trials, however, the use of electrolyte solutions in the paediatric population is referenced in the medical literature. The precautions and adverse reactions identified in this document should be observed in the paediatric population.

Use in the elderly.

Clinical studies of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or medicine therapy.
When selecting the type of infusion solution and the volume/ rate of infusion for an elder patient, consider that elderly patients are generally more likely to have cardiac, renal, hepatic and other diseases or concomitant drug therapy.

Carcinogenicity.

Studies with Plasma-Lyte 148 (approx. pH 7.4) IV Infusion have not been performed to evaluate carcinogenic potential.

Genotoxicity.

Studies with Plasma-Lyte 148 (approx. pH 7.4) IV Infusion have not been performed to evaluate mutagenic potential.

Effects on fertility.

Studies with Plasma-Lyte 148 (approx. pH 7.4) IV Infusion have not been performed to evaluate effect on fertility.

Effect on laboratory tests.

There have been reports of false positive test results using the Bio Rad Laboratories Platelia Aspergillus EIA test in patients receiving Baxter gluconate containing Plasma-Lyte solutions. These patients were subsequently found to be free of Aspergillus infection. Therefore, positive test results for this test in patients receiving Baxter gluconate containing Plasma-Lyte solutions should be interpreted cautiously by other diagnostic methods.

General.

The Viaflex plastic container is fabricated from a specially formulated polyvinyl chloride (PL 146 Plastic) The amount of water that can permeate from inside the container into the overwrap is insufficient to affect the solution significantly. Solutions in contact with the plastic container can leach out certain chemical components from the plastic in very small amounts, however, biological testing was supportive of the safety of the plastic container materials.

Interactions

Caution must be exercised in the administration of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion to patients treated with drugs that may increase the risk of sodium and fluid retention such as corticosteroids or corticotropin.
Caution is advised when administering Plasma-Lyte 148 (approx. pH 7.4) IV Infusion to patients treated with drugs for which renal elimination is pH dependent. Due to its alkalinising effect (formation of bicarbonate), Plasma-Lyte 148 (approx. pH 7.4) IV Infusion may interfere with the elimination of such drugs.
Renal clearance of acidic drugs such as salicylates, barbiturates and lithium may be increased.
Renal clearance of alkaline drugs such as sympathomimetics (e.g. ephedrine, pseudoephedrine, quinidine or dextroamphetamine (dexamphetamine) sulfate may be decreased.
Because of its potassium content, Plasma-Lyte 148 (approx. pH 7.4) IV Infusion should be administered with caution in patients treated with agents or products that can cause hyperkalaemia or increase the risk of hyperkalaemia, such as potassium sparing diuretics (amiloride, spironolactone, triamterene) with ACE inhibitors, angiotensin II receptor antagonists or the immunosuppressants tacrolimus and cyclosporine.

Adverse Effects

Reactions that may occur because of the solution or the technique of administration include febrile response or infection at the site of infusion. Other reactions that may occur include circulatory effects: extravasation, hypervolaemia, venous thrombosis, phlebitis extending from the site of injection.
If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.
The following adverse reactions have been reported in the postmarketing experience with unspecified Plasma-Lyte products and Plasma-Lyte products without glucose, listed by MedDRA system organ class (SOC), then by preferred term in order of severity, where feasible.

Immune system disorders.

Hypersensitivity/ infusion reactions including anaphylactoid reaction and the following manifestations: tachycardia, palpitations, chest pain, chest discomfort, dyspnoea, respiratory rate increased, flushing, hyperaemia, asthenia, feeling abnormal, piloerection, oedema peripheral and pyrexia.

General disorders and administration site conditions.

Infusion site reactions e.g. infusion site pain and burning sensation.
Other adverse reactions reported with Plasma-Lyte products with glucose are: other manifestations of hypersensitivity/ infusion reactions including hypotension, wheezing, urticaria, cold sweat and chills; hyperkalaemia.

Dosage and Administration

Dosage.

As directed by the physician. Dosage is dependent on age, weight and clinical condition of the patient as well as laboratory determinations. Dosage, rate, and duration of administration are to be individualised and depend upon the indication for use, the patient's age, weight, clinical condition, and concomitant treatment, and on the patient's clinical and laboratory response to treatment.
Each Viaflex container is for single patient use only.
Parenteral medicine products should be inspected visually for particulate matter and discolouration prior to the administration whenever solution and container permit.
All injections in Viaflex plastic containers are intended for intravenous administration using sterile equipment.
Additives may be incompatible. Complete information is not available. As with all parenteral solutions, compatibility of the additives with the solution must be assessed before addition. Before adding a substance or medication, verify that it is soluble and/or stable in water and that the pH range of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion is appropriate. After addition, check for possible colour change and/or the appearance of precipitates, insoluble complexes or crystals. The instructions for use of the medication to be added and other relevant literature must be consulted.
Those additives known to be incompatible should not be used. Consult with a pharmacist, if available. If, in the informed judgment of the physician, it is deemed advisable to introduce additives, use aseptic technique. Mix thoroughly when additives have been introduced. Do not store solutions containing additives.

Directions for use.

Warning.

Do not use plastic containers in series connections. Such use could result in air embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete.
Do not administer unless solution is clear and seal is intact.

To open.

Tear overwrap down side at slit and remove solution container. Some opacity of the plastic due to moisture absorption during the sterilisation process may be observed. This is normal and does not affect the solution quality or safety. The opacity will diminish gradually. Check for minute leaks by squeezing the inner bag firmly. If leaks are found, discard solution, as sterility may be impaired. If supplemental medication is desired, follow the directions below.

Preparation for administration.

1. Suspend container from eyelet support.
2. Remove plastic protector from outlet port at bottom of container.
3. Attach administration set. Refer to complete directions accompanying set.

To add medication.

Warning.

Additives may be incompatible.

To add medication before solution administration.

1. Prepare medication site.
2. Using a syringe with a 0.63 to 0.80 mm needle, puncture resealable medication port and inject.
3. Mix solution and medication thoroughly. For high density medication such as potassium chloride, squeeze ports while ports are upright and mix thoroughly.

To add medication during solution administration.

1. Close clamp on the set.
2. Prepare medication site.
3. Using a syringe with a 0.63 to 0.80 mm needle, puncture resealable medication port and inject.
4. Remove container from IV pole and turn to an upright position.
5. Evacuate both ports by squeezing them while container is in the upright position.
6. Mix solution and medication thoroughly.
7. Return container to in use position and continue administration.
After opening the container, the contents should be used immediately and should not be stored for a subsequent infusion. Do not reconnect any partially used containers.

Overdosage

If overdosage is suspected (through the monitoring of electrolytes, especially sodium and potassium), administration of the medicine should be discontinued and the patient observed closely.
Excessive administration of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion may lead to metabolic alkalosis. Metabolic alkalosis may be accompanied by hypokalaemia as well as a decrease in ionised serum calcium and magnesium. (See Precautions.)
An excessive volume of Plasma-Lyte 148 (approx. pH 7.4) IV Infusion may lead to fluid and sodium overload with a risk of oedema (peripheral and/or pulmonary) particularly when renal sodium excretion is impaired. (See Precautions.)
Excessive administration of potassium may lead to the development of hyperkalaemia, especially in patients with severe renal impairment. (See Precautions.)
Excessive administration of magnesium many lead to hypermagnesaemia. (See Precautions.)
When assessing an overdose, any additives in the solution must be also be considered. The effect of overdose may require immediate medical attention and treatment.

Presentation

Plasma-Lyte 148 (approx. pH 7.4) IV Infusion in Viaflex plastic containers is available as shown in Table 1.

Storage

Store product below 30°C.
Do not freeze.

Poison Schedule

Unscheduled.