Electrolyte rehydration solution with glucose and calcium gluconate Monico: detailed information

Package leaflet: Information for the user

REHYDRATING ELECTROLYTE SOLUTION WITH GLUCOSE

AND MONIC CALCIUM GLUCONATE
Infusion solution
Sodium chloride, potassium acetate, anhydrous dibasic potassium phosphate, calcium gluconate, magnesium sulfate, glucose monohydrate
Equivalent medicine

Please read all of this leaflet carefully before you start using this medicine, as it contains important information for you.

Keep this leaflet. You may need to read it again.
If you have any questions, ask your doctor or nurse.
If you experience any side effects, including those not listed in this leaflet, tell your doctor or nurse. See section 4.

Contents of this leaflet:

What ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO is and what it is used for
What you need to know before using ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO
How to use ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO
Possible side effects
How to store ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO
Contents of the pack and other information

1. What ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO is and what it is used for

ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO is an infusion solution administered directly into a vein (intravenous infusion), containing a combination of active substances: sodium chloride, potassium acetate, anhydrous dibasic potassium phosphate, calcium gluconate, magnesium sulfate, monohydrate glucose.
This medicinal product is indicated to provide water and electrolytes to the body in situations where a caloric intake must be ensured, and for the treatment of mild states of metabolic acidosis, a condition characterized by increased blood acidity.

2. What you should know before using ELETTROLITICA REIDRATANTE CON GLUCOSIO E

CALCIO GLUCONATO MONICO
Do not use ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO

if you are allergic to the active substances or to any of the other ingredients of this medicine (listed in section 6);
if you have high levels of calcium in the blood (hypercalcemia) or in the urine (hypercalciuria);
if you have severe kidney problems (severe renal failure);
if you have high levels of potassium in the blood (hyperkalemia) or reduced ability to excrete potassium and phosphates (potassium or phosphate retention);
if you have a heart rhythm disorder called ventricular fibrillation, because calcium chloride may increase the risk of irregular heartbeat (arrhythmias);
if you have severe liver problems (severe hepatic insufficiency) leading to inability to metabolize the acetate ion;
if you have difficulty urinating (oliguric renal failure);
if you have severe heart problems;
if you have breathing difficulties (respiratory rate less than 16 breaths per minute);
if you have an increased blood pH (metabolic and respiratory alkalosis);
if you have kidney stones, which may worsen with calcium administration;
if you have a chronic systemic disease called sarcoidosis, which may enhance the increase in blood calcium levels (hypercalcemia);
if you have circulatory problems due to a high tendency of blood to clot (hypercoagulability);
if you are taking medications for heart conditions called cardioactive glycosides, or have taken an excessive amount (digitalis toxicity);
if you have severe difficulty urinating (anuria);
if you have bleeding (hemorrhage) occurring at the spinal level (spinal hemorrhage) or within the brain tissues (intracranial hemorrhage);
if you have low fluid levels in the body (dehydration);
if you suffer from mental disorders characterized by hallucinations, tremors, sweating (delirium tremens), especially if you are dehydrated;
if you have a disease of the adrenal glands (Addison's disease) and are not receiving treatment for it;
if you are in a state of coma;
if you experience painful, short-lived muscle cramps (heat cramps);
if the patient is a newborn (up to 28 days of age), ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO (or other calcium-containing solutions) must not be administered simultaneously with ceftriaxone (an antibiotic), even when using separate infusion lines. There is a fatal risk of particle formation in the newborn's bloodstream. Glucose solutions must not be administered through the same infusion catheter as whole blood due to the possible risk of red blood cell aggregation (pseudoagglutination and coagulation).

Warnings and precautions
Talk to your doctor or nurse before using ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO.
This medicine must be administered by very slow intravenous infusion (intravenous infusion), as potassium intoxication may occur, potentially leading to cardiac arrest due to loss of heart function (cardiac depression), irregular heartbeat (arrhythmias), up to cardiac arrest (see section “How to use ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO”).
Due to the presence of sodium, this medicine should be administered with caution in the following cases:

if you have heart problems (congestive heart failure, cardiac insufficiency) or kidney problems (severe renal failure, reduced kidney function);
if you have fluid accumulation (edema with salt retention), either in the lungs (pulmonary edema) or associated with swelling of the legs and ankles (peripheral edema);
if you are taking heart medications (cardiotonic drugs), steroid anti-inflammatory drugs (corticosteroids), or hormonal medications (corticotropins);
if you have high blood pressure (hypertension);
if you have a condition called pre-eclampsia, characterized by high blood pressure, swelling due to fluid retention, and presence of proteins in the urine, or other conditions associated with sodium retention.

Due to the presence of potassium, this medicine should be administered with caution in the following cases:

if you have kidney problems (renal failure), as potassium retention may worsen;
if you have heart problems (cardiac insufficiency) and are taking other heart medications (digitalis);
if you have adrenal gland problems (adrenal insufficiency);
if you have liver problems (hepatic insufficiency);
if a family member suffers from a disorder characterized by sudden attacks of muscle weakness (familial periodic paralysis);
if you have a condition characterized by muscle stiffness (congenital myotonia);
if you have recently undergone surgery (early postoperative phase).

Due to the presence of calcium, this medicine should be administered with caution in the following cases:

if you have kidney problems (renal failure, kidney diseases) or heart problems (cardiac diseases), as this may increase the risk of irregular heartbeat (arrhythmias);
if you have received a blood transfusion, as calcium ion concentrations may differ from expected levels;
if you have kidney problems (kidney diseases) or lung problems causing heart enlargement (pulmonary heart disease), breathing difficulties (respiratory failure), and decreased blood pH due to respiratory problems (respiratory acidosis); these conditions may promote increased calcium levels in the blood (hypercalcemia), thereby increasing blood acidity, which may worsen your clinical condition;
if you have chronic renal failure, low body water levels (dehydration), or an imbalance in mineral levels (electrolyte imbalance);
if you have low blood pressure, because calcium chloride administration may cause vasodilation, leading to further blood pressure reduction. Calcium chloride solution is irritating and must not be administered by intramuscular injection, subcutaneous injection, or into the tissue surrounding blood vessels (peri-vascular tissue), as tissue damage and death (necrosis) may occur. Urinary calcium levels should be monitored frequently to prevent excessive increase (hypercalciuria), as high urinary calcium levels may lead to increased blood calcium levels (hypercalcemia).

Due to the presence of magnesium, the medicine should be administered with caution in the following cases:

if you have kidney problems (renal failure);
if you have heart problems (cardiac insufficiency) and are taking other heart medications (digitalis);
if you have a muscle disease (myasthenia gravis);
if you are being treated with sedatives, hypnotics (central nervous system depressants), or drugs used to block muscles during surgery (neuromuscular blockers). Serum magnesium concentration should be monitored frequently to prevent excessive increase.

Due to the presence of phosphates, the infusion of this medicine may cause reduced calcium levels in the blood (hypocalcemia).
Due to the presence of glucose, the medicine should be administered with caution in individuals with diabetes mellitus or glucose intolerance, and in those taking corticosteroid anti-inflammatory drugs (corticosteroids) or hormonal medications (corticotropin).
During treatment, blood and urine glucose levels should be monitored, and insulin administered if necessary, to minimize the risk of excessively high glucose levels in blood and urine (hyperglycemia and glycosuria). During prolonged use of glucose solutions, fluid accumulation (water overload, congestive state) and deficiency of minerals in the blood (electrolyte deficit) may occur.
Due to the presence of acetate, the medicine should be used cautiously in individuals with increased pH (metabolic and respiratory alkalosis) or elevated acetate levels in the blood, such as in individuals with liver problems (mild or moderate hepatic insufficiency).
This medicine should be administered with caution and under specific monitoring conditions due to the risk of reduced sodium concentration in plasma (acute hyponatremia) if:

you have heart problems (cardiopathies);
you have liver and/or kidney disease (hepatopathies and/or nephropathies);
you are undergoing treatment with vasopressin agonists;
you suffer from diseases of the central nervous system, or have recently undergone surgery, have ongoing infections, burns, or pain.

Children, women of childbearing age, and patients with specific brain diseases are more susceptible to reduced plasma sodium levels.
During treatment with this medicine, your doctor should periodically monitor heart function (via serial electrocardiograms) and blood electrolyte concentrations (plasma osmolarity), particularly sodium levels, as hospital-acquired hyponatremia may develop, as well as blood glucose (glycemia), fluid levels, and blood pH (acid-base balance). It is also advisable to monitor blood pressure and osteotendinous reflexes to detect any potential respiratory muscle paralysis.
This medicine should be used immediately after opening the container. The solution should be clear, colorless or slightly straw-yellow, and free of visible particles, and is intended for single, uninterrupted administration. Any remaining solution must not be used.
Children
This medicine should be administered with caution in children, particularly in newborns and low-birth-weight infants, as blood glucose levels may increase (hyperglycemia). Additionally, in low-birth-weight children, rapid or excessive intravenous infusion may cause increased serum electrolyte concentration (serum osmolarity) and cerebral hemorrhage due to rupture of blood vessels (intracerebral hemorrhage).
As with other calcium-containing solutions, concomitant treatment with ceftriaxone is contraindicated in newborns (up to 28 days of age) due to the fatal risk of precipitation of ceftriaxone-calcium salt in the newborn's bloodstream (see section “Possible side effects”).
Other medicines and ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO
Inform your doctor if you are using, have recently used, or might use any other medicine.
This medicine should be administered with caution if you are taking:

medications used to lower blood pressure such as potassium-sparing diuretics, ACE inhibitors, or other drugs that reduce aldosterone levels, as they may lead to increased potassium in the blood (hyperkalemia) and reduced potassium excretion (potassium retention), especially in individuals with kidney problems (renal dysfunction); in such cases, blood potassium levels must be closely monitored;
steroid anti-inflammatory drugs (corticosteroids) that may cause sodium and water retention, leading to fluid accumulation (edema) and increased blood pressure (hypertension). These drugs are associated with reduced carbohydrate tolerance and possible manifestation of latent diabetes mellitus; therefore, careful monitoring is required when administering glucose concurrently;
drugs that stimulate vasopressin release (e.g., chlorpropamide, clofibrate, carbamazepine, vincristine, selective serotonin reuptake inhibitors, 3,4-methylenedioxy-N-methamphetamine, ifosfamide, antipsychotics, narcotics);
drugs that enhance vasopressin action (e.g., chlorpropamide, NSAIDs, cyclophosphamide);
vasopressin analogs (desmopressin, oxytocin, vasopressin, terlipressin) and other drugs such as diuretics and antiepileptics (e.g., oxcarbazepine), as they may increase the risk of reduced plasma sodium concentration (hyponatremia).

Due to the presence of calcium chloride, be cautious if you are taking the following medicines:

thiazide diuretics, used to treat high blood pressure, as they may increase blood calcium levels due to reduced excretion;
heart medications (cardioactive glycosides, digoxin, digitoxin), as their effects may add to those of calcium, increasing the risk of irregular heartbeat (arrhythmias);
verapamil (and other calcium channel blockers), used to treat high blood pressure (hypertension), as concomitant use may reduce the antihypertensive effect of this medicine;
magnesium-containing drugs, as they may increase the risk of elevated calcium (hypercalcemia) or magnesium (hypermagnesemia), especially in patients with kidney disorders;
drugs used to block muscles during surgery (neuromuscular blockers), as calcium salts may counteract the effect of these drugs;
ceftriaxone (an antibiotic) due to the risk of particle formation in the blood (precipitation of ceftriaxone-calcium salt).

Due to the presence of magnesium chloride, pay special attention if you are taking the following medicines:

central nervous system depressants such as barbiturates, narcotics, or other hypnotics (or systemic anesthetics). In this case, dosage should be carefully adjusted, as magnesium enhances the depressant effect on the central nervous system;
heart medications (cardioactive glycosides, digoxin, digitoxin); if calcium administration is needed to counteract magnesium effects at toxic doses, caution is required, as changes in cardiac conduction may occur, potentially leading to irregular heartbeat (arrhythmias);
drugs used to block muscles during surgery (competitive and depolarizing neuromuscular blockers), such as rocuronium, as their effect may be enhanced by magnesium chloride;
aminoglycoside antibiotics, used against bacterial infections, due to their additive effect on neuromuscular blockade induced by magnesium;
eltrombopag, a medicine used to treat low platelet levels in the blood;
labetalol, a medicine used to treat irregular heartbeat (arrhythmias);
drugs used to treat high blood pressure (isradipine, felodipine, nicardipina, nifedipine), as concomitant use with magnesium may cause a significant drop in blood pressure (hypotension).

Pregnancy and breastfeeding
If you are pregnant, suspect you may be pregnant, planning a pregnancy, or breastfeeding, consult your doctor before this medicine is administered.
This medicine should not be administered during pregnancy or breastfeeding unless absolutely necessary.
If required, ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO should be administered with caution in pregnant women during labor, particularly regarding serum sodium levels, if administered in combination with oxytocin.
Due to the presence of magnesium, this medicine should not be administered within 2 hours before delivery. If magnesium chloride is administered (especially for more than 24 hours before delivery), newborns may show signs of magnesium toxicity, including neuromuscular and respiratory depression.
Driving and use of machinery
This medicine does not affect the ability to drive or operate machinery.

3. How to use ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO

MONICO
This medicinal product will be prepared by a doctor, pharmacist, or nurse and will not be mixed, nor administered simultaneously, with injections containing ceftriaxone or other incompatible medicinal products.
This medicine must be administered directly into a vein (intravenous infusion) by specialized medical personnel. It must not be injected via other routes of administration (intramuscular, subcutaneous, or into perivascular tissues).
The medicine must be administered only if kidney function is normal and at a rate not exceeding 10 mEq of potassium per hour and 0.4–0.8 g of glucose per kilogram of body weight per hour.
After administration of the medicine, remain lying down for a short period of time.
The dose will be adjusted according to age, body weight, and your health condition.
The recommended dose in adults is approximately 2 liters per day, administered at an infusion rate of about 300 ml per hour.
Infusions that are too rapid may cause local pain; the infusion rate should be adjusted according to your needs.
Administration must be stopped if you experience pain or redness at the injection site, as this could be due to leakage of the medicine from the vein (drug extravasation).

Use in children
In children, the safety and efficacy of this medicine have not been established.
The dosage and rate of glucose administration must be determined based on the patient's age, weight, and health condition. Particular caution is required in newborns and underweight children (see section “Children”).

Preparation of the medicine: use immediately after opening the container. The container is intended for single, uninterrupted administration and any remaining solution must not be used.
Shake well before administration. Do not use the medicine if the solution is not clear, colorless or slightly yellowish straw-colored, or if it contains particles. Do not mix with incompatible solutions.
Take all usual precautions to maintain sterility before and during intravenous infusion.

If you use more ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO than you should
Since this medicine will be administered by a doctor or trained healthcare professional, it is unlikely that you will receive an excessive dose. However, if you think you have been given too much ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO, inform your doctor or another healthcare professional immediately.

Following administration of an excessive dose of this medicine, the following may occur:

Increased levels of potassium in the blood (hyperkalemia), which may lead to death due to heart damage (cardiac depression, arrhythmias, or arrest);
Increased levels of sodium (hypernatremia) and increased blood volume (hypervolemia); if sodium levels in the blood rise too much, fluid loss from internal organs (dehydration), particularly from the brain, may occur, along with fluid accumulation affecting the cerebral, pulmonary, and peripheral circulation, leading to fluid buildup around the lung (pulmonary edema) or swelling in the legs and ankles (peripheral edema);
Increased levels of calcium in the blood (hypercalcemia), especially in patients with kidney disease, manifesting with symptoms such as: sensation of thirst, nausea, vomiting, constipation, increased urine production (polyuria), abdominal pain, muscle weakness, mental disturbances, and, in severe cases, cardiac arrhythmia and coma.

Following excessive administration of magnesium chloride, the following symptoms of intoxication may occur: flushing, sweating, decreased blood pressure (hypotension), paralysis of certain muscles such as respiratory muscles (flaccid paralysis), reduced body temperature (hypothermia), circulatory collapse, cardiac and central nervous system depression, which may progress to respiratory paralysis.
Magnesium intoxication manifests as a sudden increase in blood pressure, difficulty breathing (respiratory paralysis), and loss of the leg extension response following a percussion stimulus (patellar reflex).

With prolonged administration of glucose, accumulation of intracellular fluids (overhydration) and solute overload may occur.
In case of overdose, stop the infusion immediately and initiate corrective therapy to reduce elevated blood sugar and ion levels, and restore, if necessary, acid-base balance.
If you have any doubts about the use of this medicine, consult your doctor or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everyone gets them.
The following side effects may occur.
Not known (frequency cannot be estimated from the available data):

allergic reactions and urticaria;
stomach and intestinal disorders and irritation (gastrointestinal disturbances, delayed intestinal transit, and paralytic ileus), nausea, vomiting, diarrhoea, abdominal pain, constipation;
thirst, reduced salivation, metallic taste, chalky taste;
nerve and muscle disorders (neuromuscular disturbances), muscle rigidity, altered sensation in the limbs (paraesthesiae), paralysis of certain muscles such as respiratory muscles (flaccid paralysis), weakness;
mental confusion, headache, dizziness, restlessness, irritability;
seizures, coma, death; drowsiness, confusional states, psychiatric disorders;
irregular heartbeat (arrhythmias), increased heart rate (tachycardia), decreased heart rate (bradycardia), disturbances in cardiac conduction, disappearance of the P wave, widening of the QRS complex on electrocardiogram, syncope, ventricular fibrillation, cardiac arrest;
decrease or increase in blood pressure (hypotension or hypertension), swelling of the legs and ankles (peripheral oedema), vasodilation, hot flushes, sweating, and shock;
increased levels of sodium (hypernatraemia), chloride (hyperchloraemia), and blood volume (hypervolaemia);
reduction in plasma sodium concentration (hyponatraemia) acquired in hospital may cause irreversible brain damage and death due to the development of acute hyponatraemic encephalopathy;
breathing problems (dyspnoea, respiratory arrest);
fluid accumulation in the lungs (pulmonary oedema) and air in the membrane surrounding the lung (pneumothorax);
reduced tear production;
kidney problems (renal failure) and excessive urine production (polyuria);
increased calcium levels in the blood (hypercalcaemia), Burnett's syndrome (milk-alkali syndrome), reduced calcium levels in the blood (hypocalcaemia);
muscle weakness;
increased metabolic rate, increased blood glucose levels (hyperglycaemia), reduced blood glucose levels (hypoglycaemia), increased insulin levels, increased adrenaline levels;
fever, infection at the infusion site, pain or local reaction, redness, skin irritation (rash);
venous irritation, formation of blood clots in the veins (venous thrombosis);
inflammation of the veins (venous phlebitis) extending from the infusion site;
leakage of the injected solution from the vein (extravasation), tissue damage and tissue death (tissue necrosis);
calcium deposits in tissues (cutaneous calcification), inflammation due to pus accumulation (abscess);
kidney problems caused by calcium-ceftriaxone deposits. Pain during urination or reduced urine output may occur.

Reporting of side effects
If you experience any side effect, including those not listed in this leaflet, talk to your doctor or pharmacist.
You can also report side effects directly via the national reporting system at http://www.agenziafarmaco.gov.it/content/come-segnalare-una-sospetta-reazione-avversa.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO

MONIC GLUCONATE
Keep this medicine out of the sight and reach of children.
Medical personnel know how to store this medicine.
Do not use this medicine after the expiry date stated on the pack after “EXP.”.
The expiry date refers to the last day of that month.
Store in the original packaging and in a tightly closed container. Do not refrigerate or freeze.
Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to dispose of
medicines you no longer use. This will help protect the environment.

6. Contents of the pack and other information

What ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO contains
Active substances: sodium chloride, potassium acetate, anhydrous dibasic potassium phosphate, calcium gluconate, magnesium sulfate, glucose monohydrate.
1000 ml of solution contain: 3.38 g sodium chloride, 1.96 g potassium acetate, 0.69 g anhydrous dibasic potassium phosphate, 0.71 g calcium gluconate, 0.98 g magnesium sulfate, 55.0 g glucose monohydrate (equivalent to 50 g glucose).
Each liter of solution contains: 58 mEq sodium, 28 mEq potassium, 3 mEq calcium, 8 mEq magnesium, 58 mEq chloride, 8 mEq phosphate, 8 mEq sulfate, 20 mEq acetate, 3 mEq gluconate and 277 mmol glucose.
pH: 5.0 – 6.0.

Other components: hydrochloric acid, acetic acid, water for injections.

Description of the appearance of ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO and contents of the pack
Glass vials of 50, 100, 250, 500, 1000 ml of infusion solution.
Plastic bags of 50, 100, 250, 500, 1000 ml of infusion solution.

Marketing Authorization Holder and Manufacturer
Monico spa
Via Ponte di Pietra 7, 30173 Venezia Mestre – Italy.

The following information is intended exclusively for healthcare professionals

Warnings and precautions
Monitoring of serum sodium is particularly important for physiologically hypotonic solutions.
ELETTROLITICA REIDRATANTE CON GLUCOSIO E CALCIO GLUCONATO MONICO may become extremely hypotonic after administration due to the metabolism of glucose in the body.
Patients with non-osmotic release of vasopressin (e.g. in the acute phase of illness, pain, post-operative stress, infections, burns, and central nervous system disorders), patients with cardiac, hepatic or renal diseases, and patients treated with vasopressin agonists are particularly at risk of acute hyponatremia following infusion of hypotonic solutions. Acute hyponatremia can cause acute hyponatremic encephalopathy (cerebral edema), characterized by headache, nausea, seizures, lethargy, and vomiting. Patients with cerebral edema are particularly at risk of severe, irreversible, and life-threatening brain injury. Children, women of reproductive age, and patients with reduced cerebral compliance (e.g. meningitis, intracranial hemorrhage, and cerebral contusion) are particularly at risk of severe, life-threatening cerebral edema caused by acute hyponatremia.

Overdose
Treatment
Immediately discontinue the infusion and initiate corrective therapy for hyperglycemia and to reduce plasma levels of excess ions, restoring acid-base balance if necessary.
The patient should be closely monitored for the onset of any signs and symptoms related to the administered drug, with appropriate symptomatic and supportive measures provided as needed.
In case of marked hypernatremia, loop diuretics may be used.
In case of hyperkalemia, intravenous glucose (with or without insulin) or sodium bicarbonate may be administered.
In case of mild calcium chloride overdose, treatment involves immediate discontinuation of the infusion and of any other calcium-containing medication. In case of severe overdose (plasma concentrations >2.9 mmol/l), the following measures should be taken:

Rehydration with administration of 0.9% sodium chloride solution;
Use of non-thiazide diuretics to enhance calcium excretion;
Monitoring of plasma potassium and magnesium levels, with immediate correction to normal values;
Monitoring of cardiac function, and use of beta-blockers to reduce the risk of cardiac arrhythmias;
Hemodialysis if necessary.
In case of magnesium overdose, artificial ventilation may be required. To counteract the effects of hypermagnesemia, intravenous calcium should be administered (10–20 ml of a 5% solution). Subcutaneous administration of 0.5–1 mg of physostigmine may be helpful. Elevated plasma electrolyte levels may require dialysis. In case of excessive glucose administration, reassess the patient's clinical condition and institute appropriate corrective measures.

Incompatibilities
Due to the presence of glucose, the medicinal product is incompatible with:

cyanocobalamin;
kanamycin sulfate;
sodium novobiocin;
sodium warfarin.
Moreover, there are conflicting opinions regarding the compatibility of glucose with hydroxyethyl starch (hetastarch). Ampicillin and amoxicillin are stable in glucose solutions only for a short period.
Due to the presence of calcium chloride, the medicinal product is incompatible with:
magnesium sulfate: formation of a precipitate;
phosphate-containing medicines: formation of calcium phosphate precipitate;
carbonate-containing medicines: formation of calcium carbonate precipitate;
tartrate-containing medicines: formation of calcium tartrate precipitate.
Incompatibilities of calcium chloride have been reported with:
aminophylline: due to precipitate formation;
amphotericin B: due to cloudiness development;
cefamandole: due to the presence of sodium carbonate in the cefamandole formulation;
ceftriaxone sodium: due to precipitate formation; therefore, calcium-containing solutions must not be administered within 48 hours after ceftriaxone;
cephalothin: due to physical incompatibility;
cefradine: due to the presence of sodium carbonate in the cefradine formulation;
chlorpheniramine: due to physical incompatibility;
dobutamine: due to cloudiness development;
fat emulsion: due to flocculation;
sodium heparin;
indomethacin: due to precipitate formation;
sodium nitrofurantoin;
promethazine: due to precipitate formation;
propofol: due to precipitate formation;
streptomycin: because calcium may inhibit streptomycin activity;
tetracyclines: calcium salts may complex with tetracyclines.
Calcium salts may form complexes with many drugs, potentially leading to precipitate formation. Physical incompatibility has been reported with ceftriaxone.

Due to the presence of magnesium, the medicinal product is incompatible with solutions containing alcohol (at high concentrations), heavy metals, carbonates and bicarbonates, sodium hydrocortisone, succinates, phosphates, polymyxin B sulfate, procaine hydrochloride, calcium salicylate, clindamycin phosphate, and tartrates, as precipitates may form.
Potential incompatibility is often influenced by changes in reagent concentrations and solution pH.

For further information, consult the Summary of Product Characteristics.