HDB-San (Sodium Bicarbonate)

Adult dosage

1. When using the specified acetate-containing dialysis fluid (Solution A), this preparation can create about 180L of bicarbonate-type hemodialysis fluid containing 38mEq/L of HCO3-. 2. It is used as a dialysis fluid for hemodialysis utilizing a supply device for bicarbonate type dialysis fluid with a dilution ratio of 1:34 (this drug + purified water) of acetate-containing dialysis fluid (Solution A). 3. The dialysis fluid dosage for one patient (based on 6 hours) is prepared as follows.

This medication should not be used in patients with low blood pressure or rapid heart rate. Patients with pulmonary edema, abnormal electrocardiograms, high blood potassium levels, and those with bleeding problems should also not be administered this medication. Caution is advised in patients with severe liver disease or diabetes that complicates acetic acid metabolism, as this may result in symptoms of low blood pressure. Furthermore, patients on digitalis medications may experience symptoms of toxicity due to decreased serum potassium levels. Patients showing elevated serum calcium and phosphorus levels prior to hemodialysis should be cautious as this drug may lead to ectopic calcification. Hypoglycemic symptoms may arise in patients with inadequate caloric intake or among diabetic patients with dietary restrictions or using blood glucose-lowering agents. This drug may induce hypoglycemia during or after dialysis; if hypoglycemic symptoms occur, appropriate measures such as glucose injections or sugar supplementation should be taken. Additionally, serum calcium levels may rise, and if hypercalcemia occurs, it may be necessary to switch to a dialysis fluid with lower calcium concentration. Osteoporotic, osteomalacic, and fibrous osteitis complications may occur, necessitating appropriate treatment such as the administration of active vitamin D3 preparations. Phosphate binders may also be used to maintain serum phosphate levels within normal ranges. Dialysis disequilibrium syndrome may occur, leading to symptoms such as headache, nausea, vomiting, seizures, and altered consciousness, in which case it is necessary to reduce the dialysis speed or take other measures. Cardiovascular side effects may present as low blood pressure or shock; these symptoms necessitate discontinuation of dialysis or reducing dialysis efficiency, along with administering fluids or pressor agents. In rare cases, blood pressure may rise, in which case it is preferable to administer antihypertensive agents or switch to acetate dialysis solutions. This medication is utilized in the hemodialysis of chronic renal failure patients and is used when metabolic acidosis is not improving or when dialysis disequilibrium syndrome or significant low blood pressure occurs. It is also used for patients with difficulty managing blood sugar levels due to high blood sugar, employing a dialysis solution that does not contain glucose. Regular blood tests to check electrolytes, acid-base balance, blood urea nitrogen, creatinine, uric acid, blood glucose, etc., are recommended to monitor the patient's condition. Pregnant women or those who may become pregnant should use this medication only when the benefits outweigh the risks, as its safety has not been established. Safety has not been confirmed for pediatric patients, hence caution is advised, and elderly patients should use this medication considering its characteristics, alongside regular checks and appropriate measures for potential bone complications with long-term use. Dialysis diluents must utilize purified water, and precautions should be taken for potential bleeding tendencies caused by anticoagulant administration or damage to dialysis membranes. During preparation, do not use the electrolyte solution for artificial kidney dialysis alone with this drug solution; it must be precisely prepared with the specified diluent. Be cautious of excessive or insufficient diluent concentration, as it may lead to symptoms such as headache, palpitations, blood pressure abnormalities, and altered consciousness. It is advisable to confirm the electrolyte concentration and pH of the dialysis fluid before use, and the prepared dialysis fluid should be used immediately. Furthermore, it should not be used for injections or peritoneal lavage. The balance between serum osmotic pressure in dialysis patients and the osmotic pressure in the dialysis fluid must be maintained, with an optimal usage temperature around body temperature. The cartridge used for this medication is only compatible with specific dialysis systems and should be protected from excessive pressure or negative pressure.

Serious side effects

• Altered consciousness
• seizures
• rapid decrease in blood pressure.

Mild side effects

Hypoglycemia, hypercalcemia, osteoporosis, osteomalacia, fibrous osteitis, symptoms of dialysis disequilibrium syndrome (headache, nausea, vomiting, seizures, altered consciousness, discomfort, fatigue), low blood pressure, shock symptoms, elevated blood pressure, headache, palpitations, altered consciousness, sensation of limb paralysis, generalized fatigue, chest discomfort, rapid decrease in blood pressure.

This medication should be stored in a tightly closed container to prevent air or humidity from entering, ideally at room temperature between 1 to 30 degrees Celsius. Proper storage ensures the maintenance of the drug's effectiveness and prevents degradation.

Appearance

White crystals or crystalline powder in a polypropylene container, odorless with a distinct salty taste.

Package unit

Container - 650 grams/container, Container - 720 grams/container