13.6 mg / ml (1.36% w / v), 22.7 mg / ml (2.27% w / v), 38.6 mg / ml (3.86% w / v) peritoneal dialysis fluid
What Physioneal 40 Glucose is and what it is used for
Physioneal 40 Glucose is a peritoneal dialysis fluid. It removes water and waste products from the blood. It also corrects abnormal levels of various components in the blood. Physioneal 40 Glucose is available with different glucose contents (1.36%, 2.27%, and 3.86%). The higher the glucose content of the solution, the more water it will remove from the blood.
Physioneal 40 Glucose can be prescribed to you if you suffer from:
• either temporary or permanent renal failure
• heavy accumulation of water in the body,
• severe disturbances in acidity or alkalinity ( pH ) and salt levels in the blood
• certain types of drug poisoning where no other treatment is available
Physioneal 40 Glucose has an acidity ( pH ) that is close to the blood. Therefore, it can be especially useful if you experience pain or discomfort when ingesting other peritoneal dialysis fluids that are more acidic (have a lower pH ).
What you need to know before you use Physioneal 40 Glucose
Do not use Physioneal 40 Glucose
The first time you use the product, a doctor should monitor the procedure.
-if you are allergic to the active substances or any of the other ingredients of this medicine (listed in section 6).
– if you have problems that affect the abdominal wall or abdominal cavity and that can not be operated on or if you have non-correctable problems that lead to an increased risk of abdominal infections
– if you have documented impaired peritoneal function due to severe scarring of the peritoneum.
Warnings and cautions
Talk to your doctor before using Physioneal 40 Glucose.
Be especially careful:
– If you have problems affecting the abdominal wall or abdominal cavity. For example, if you have a hernia or a chronic infectious or chronic inflammatory condition that affects your intestines.
– If you have a (graft) prosthesis in the large carotid artery.
– If you have severe breathing problems.
– If you experience stomach pain, fever, or notice that the dialysate is cloudy, cloudy, or contains particles. It may be a sign of peritonitis (inflamed peritoneum) or infection. Contact your medical care team immediately. Make a note of the batch number and take it with you to the dialysate bag for your healthcare team. They will decide if the treatment should be stopped or if any other treatment needs to be started. For example, if you have an infection, your doctor may take certain samples to find out which antibiotic is best for you. Until the doctor knows what kind of infection you have, you can get an antibiotic that is effective against a large number of different bacteria. This is called a broad-spectrum antibiotic.
– If you have a high level of lactic acid in your blood. You have a greater risk of lactic acidosis if:
• you have very low blood pressure
• you have an infection in the blood
• you have acute kidney failure
• you have a congenital metabolic disorder
• you are taking metformin (a medicine used to treat diabetes )
• you are taking medicines for HIV, especially medicines called NRTIs.
– If you have diabetes and use this fluid, the dose of one of the medicines used to adjust your blood sugar level (eg insulin ) should be evaluated regularly. Especially when peritoneal dialysis treatment is started or changed, the dose of one of your diabetes medicines may need to be adjusted.
-If you are allergic to corn which can cause hypersensitivity reaction, including a severe allergic reaction, so-called anaphylaxis. Discontinue the infusion immediately and remove the solution from the abdominal cavity.
– If you have a high level of parathyroid hormone in your blood due to your kidney disease. The low level of calcium in Physioneal 40 Glucose may aggravate hyperparathyroidism. Your doctor will monitor the level of parathyroid hormone in your blood.
– You should, possibly in consultation with your doctor, keep a record of fluid balance and body weight. Your doctor will monitor your blood levels at regular intervals. Especially for salts (eg bicarbonate, potassium, magnesium, calcium, and phosphate ), parathyroid hormone, and fats.
– If you have high levels of bicarbonate in your blood.
– Do not use more solutions than your doctor prescribed. Symptoms of over-infusion are a feeling of tension in the abdomen, a feeling of satiety, and shortness of breath.
– Your doctor will measure your potassium levels regularly. If they get too low, you can get potassium chloride to compensate.
– If flushing or opening and closing of clamps is done in the wrong order, it can result in air entering the abdominal cavity, which can cause abdominal pain and/or peritonitis
– If you infuse an unmixed bag, empty the solution immediately and use a freshly mixed bag.
A condition called encapsulating peritoneal sclerosis (EPS) is a known, rare complication of peritoneal dialysis treatment. You should, possibly in consultation with your doctor, be aware of this possible complication. Encapsulating peritoneal sclerosis causes:
• inflammation of the abdomen (stomach)
• thickening of the intestines that can lead to abdominal pain, distended abdomen, or vomiting. EPS can be fatal.
Children and young people
Your doctor will weigh the risk against the benefits of this medicine if you are younger than 18 years old.
Other medicines and Physioneal 40 Glucose
Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines.
If you are taking other medicines, your doctor may need to increase the dose of one of these. This is because treatment with peritoneal dialysis increases the secretion of certain drugs.
• If you are taking heart medicines called cardiac glycosides (eg digoxin ) you can:
• Need potassium and calcium supplements.
• Develop an irregular heartbeat ( arrhythmia )
• Your doctor will monitor your treatment closely, especially your potassium levels.
Pregnancy and breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor for advice before taking this medicine. The doctor decides whether the treatment is appropriate or not.
Driving and using machines
This treatment can cause fatigue, weakness, blurred vision, and dizziness. Do not drive or use any tools or machines if you are affected. You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.
How to use Physioneal 40 Glucose
Physioneal 40 Glucose should be inserted into the abdominal cavity. It is the space in the abdomen (stomach) between the skin and the peritoneum. The peritoneum is the membrane that surrounds the internal organs such as the intestines and liver.
It is not for intravenous use.
Always use this medicine exactly according to the instructions of the care team that specializes in peritoneal dialysis. Consult a doctor if you are unsure.
If the bag is damaged, it must be discarded.
How much and how often
Your doctor will prescribe the appropriate glucose strength and the appropriate number of bags for you to use each day.
Use for children and adolescents
If you are under 18 years of age, your doctor will carefully assess the prescription of this medicine.
If you stop using Physioneal 40 Glucose
Do not stop treatment with peritoneal dialysis without your doctor’s consent. Discontinuation of treatment may have life-threatening consequences.
Method of use
Before use:
• Heat the bag to 37 ° C. Use a hot plate designed for this purpose. Never immerse in water. The bag must not be heated in the microwave.
Use the aseptic technique throughout the administration of one of the solutions, as you have learned.
• Before starting a solution change, wash your hands and the surface where the change is to be made.
• Before opening the outer bag, check that it is the correct solution, expiry date, and quantity (volume). Lift the dialysis bag to check for leaks (excess fluid in the outer bag). Do not use the bag if leakage is detected.
• After the outer bag has been removed, check the container for signs of leakage by pressing the bag firmly. Check that the breaker pin between the chambers is not interrupted. Discard the bag if the breaker pin is already broken. Do not use the bag if leakage is detected.
• Check that the solution is ready. Do not use the bag if the solution is cloudy or contains particles.
• Make sure that all connections are secure before starting the change.
• Mix the contents of the two chambers thoroughly by breaking the brake pin. Wait until the small chamber is completely emptied into the large chamber. Mix gently by pressing with both hands on the walls of the large chamber.
Ask your doctor if you have any questions or concerns about this product or its use.
• Each bag may only be used once. Discard any remaining solution.
• The solution must be used within 24 hours after mixing.
After use, check that the drained liquid is not cloudy.
Compatibility with other drugs
Your doctor may prescribe other injectable medicines to be added directly to the Physioneal 40 Glucose bag. In this case, the drug should be added through the injection port in the small chamber before breaking the broken pin between the two chambers. Use the product immediately after the drug has been added. Ask your doctor if you are unsure.
If you use more Physioneal 40 Glucose bags than you should for 24 hours
If you infuse too much Physioneal 40 Glucose, you may get:
– stretched abdomen
feeling full and/or
– shortness of breath.
Contact your doctor immediately. He/she decides on any action.
If you have any further questions on the use of this product, ask your doctor.
Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Tell your doctor or dialysis clinic immediately if you experience any of the following:
• Hypertension ( blood pressure is higher than usual)
• Swollen ankles and legs, swelling around the eyes, shortness of breath, or chest pain (increased blood volume).
• Abdominal pain.
Chills (chills / flu-like symptoms)
Inflamed peritonitis.
These are serious side effects. You need to get medical attention quickly.
If you get any side effects, talk to your doctor or doctor. This also applies to side effects that are not mentioned in this information.
Common side effects (may affect up to 1 in 10 people)
• Changing your blood tests:
– increase in calcium ( hypercalcemia )
– decrease in potassium ( hypokalaemia ), which can cause muscle weakness, twitching, and abnormal heart rhythm.
– increase in bicarbonate ( alkalosis )
Weakness, fatigue
• Fluid retention ( edema )
• Weight gain
Uncommon side effects (may affect up to 1 in 100 people)
– Reduced fluid secretion during dialysis.
Fainting, tiredness, or headache.
– Turbid dialysate from the abdominal cavity, abdominal pain.
– Bleeding in the abdominal cavity, scarring, swelling, or pain at the starting point of the catheter, stop in the catheter.
– Nausea, decreased appetite, indigestion, flatulence (thirst), thirst, dry mouth
– Stretched abdomen or inflammation in the abdomen, pain in the shoulders, hernia in the abdominal cavity (bulging in the groin).
– Changing your blood tests:
– lactic acidosis
increased carbon dioxide content
– increased sugar content (hyperglycemia)
– increased white blood cell count ( eosinophilia )
– Difficulty sleeping
– Low blood pressure ( hypotension )
– Hosta
– Pain in muscles or legs
– Swelling of the face or neck
Rash
Other side effects associated with peritoneal dialysis treatment:
– infection at the catheter starting point, stop in the catheter.
How to store Physioneal 40 Glucose
• Keep this medicine out of the reach and sight of children
• Store in the original packaging
• Do not store below 4 ° C
• Use before the expiry date which is stated on the carton and the bag after the abbreviation EXP . or EXP and the symbol. The expiration date is the last day of the specified month.
Dispose of Physioneal 40 Glucose according to the instructions given to you.
Contents of the package and other information
Content declaration
This leaflet does not contain all the information about the medicine. Ask your doctor if you have any questions or are unsure.
The active substances in the mixed peritoneal dialysis fluid are:
| 13.6 mg / ml | 22.7 mg / ml | 38.6 mg / ml | |
| Glucose monohydrate (g / l) | 15.0 | 25.0 | 42.5 |
| corresponds to anhydrous glucose (g / l) | 13.6 | 22.7 | 38.6 |
| Sodium chloride (g / l) | 5.38 | 5.38 | 5.38 |
| Calcium chloride dihydrate (g / l) | 0.184 | 0.184 | 0.184 |
| Magnesium chloride hexahydrate (g / l) | 0.051 | 0.051 | 0.051 |
| Sodium bicarbonate (g / l) | 2.10 | 2.10 | 2.10 |
| Sodium (S) -lactate solution (g / l) | 1.68 | 1.68 | 1.68 |
The other ingredients are water for injections and carbon dioxide.
Composition in mmol / l in the mixed solution is:
| 13.6 mg / ml | 22.7 mg / ml | 38.6 mg / ml | |
| Anhydrous glucose (mmol / l) | 75.5 | 126 | 214 |
| Sodium (mmol / l) | 132 | ||
| Calcium (mmol / l) | 1.25 | ||
| Magnesium (mmol / l) | 0.25 | ||
| Chlorides (mmol / l) | 95 | ||
| Bicarbonate (mmol / l) | 25 | ||
| Lactate (mmol / l) | 15 |
What the medicine looks like and the contents of the pack
• Physioneal 40 Glucose is a clear, colorless, sterile solution for peritoneal dialysis.
• Physioneal 40 Glucose is packaged in PVC bags with two chambers. The two chambers are separated by a permanent closure. Physioneal 40 Glucose must not be given until the solutions in the two chambers have been mixed properly.
• Each bag is packed in an outer bag and the bags are delivered in a carton.
| Volume | Number in each box | Pack size | Type of coupling |
| 1.5 l | 5/6 | Single bag (APD) | Screw / Tip |
| 1.5 l | 5/6 | DUO bag ( CAPD ) | Screw / Tip / Lineo |
| 2.0 l | 4/5 | Single bag (APD) | Screw / Tip |
| 2.0 l | 4/5 | DUO bag ( CAPD ) | Screw / Tip / Lineo |
| 2.5 l | 4/5 | Single bag (APD) | Screw / Tip |
| 2.5 l | 4/5 | DUO bag ( CAPD ) | Screw / Tip / Lineo |
The line coupling contains iodine.
Not all pack sizes may be marketed.
Marketing Authorization Holder and Manufacturer
Further information on this medicine can be obtained from the representative of the marketing authorization holder:
| Sweden: Baxter Medical AB Box 63 164 94 KistaTel: 08 – 632 64 00 | Finland: Baxter Oy Box 119 FI-00181 Helsinki tel. 09 – 862 1111 |
Manufacturer:
| Baxter Healthcare SA Moneen Road CastlebarCounty Mayo- Ireland |
Bieffe Medital SpAVia Nuova Provinciale23034 Grosotto, Italy |
Baxter and Physioneal are trademarks of Baxter International Inc.