BNF for Children (BNFC) 2018-2019

lUNLICENSED USEDioralyte Relief®not licensed for use in

children under 3 months.

lDIRECTIONS FOR ADMINISTRATIONReconstitute 1 sachet

with 200 mL of water (freshly boiled and cooled for

infants); 5 sachets when reconstituted with 1 litre of water

provide Na+ 60 mmol, K+ 20 mmol, Cl– 50 mmol and citrate

10 mmol.

lPRESCRIBING AND DISPENSING INFORMATIONFlavours of

oral powder formulations may include apricot, black

currant, or raspberry.

lPATIENT AND CARER ADVICEPatients and carers should be

advised how to reconstituteDioralyte®Relief oral powder.

After reconstitution any unused solution should be

discarded no later than 1 hour after preparation unless

stored in a refrigerator when it may be kept for up to

24 hours.

Medicines for Children leaflet: Oral rehydration salts

http://www.medicinesforchildren.org.uk/oral-rehydration-salts

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Powder

EXCIPIENTS:May contain Aspartame

▶Dioralyte Relief(Sanofi)

Potassium chloride 300 mg, Sodium chloride 350 mg, Sodium

citrate 580 mg, Rice powder pre-cooked 6 gramDioralyte Relief

oral powder sachets raspberry sugar-free| 6 sachetG£ 2. 50

Dioralyte Relief oral powder sachets blackcurrant sugar-free|

20 sachetp£ 7. 13

2.1 Calcium imbalance

Calcium

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. Hypocalcaemia

may be caused by vitamin D deficiency (see Vitamin D under

Vitamins p. 623 ), impaired metabolism, a failure of secretion

(hypoparathyroidism), or resistance to parathyroid hormone

(pseudohypoparathyroidism).

Mild asymptomatic hypocalcaemiamay be managed with

oral calcium supplements.Severe symptomatic hypocalcaemia

requires an intravenous infusion of calcium gluconate 10 %

p. 594 over 5 to 10 minutes, repeating the dose if symptoms

persist; in exceptional cases it may be necessary to maintain

a continuous calcium infusion over a day or more. Calcium

chloride injection p. 593 is also available, but is more

irritant; care should be taken to prevent extravasation.

See the role of calcium gluconate in temporarily reducing

the toxic effects ofhyperkalaemia.

Persistent hypocalcaemia requires oral calcium

supplements and either a vitamin D analogue (alfacalcidol

p. 630 or calcitriol p. 631 ) for hypoparathyroidism and

pseudohypoparathyroidism or natural vitamin D (calciferol)

if due to vitamin D deficiency. It is important to monitor

plasma and urinary calcium during long-term maintenance

therapy.

Severe hypercalcaemia

Severe hypercalcaemia calls for urgent treatment before

detailed investigation of the cause. Dehydration should be

correctedfirst with intravenous infusion of sodium chloride

0. 9 %p. 589. Drugs (such as thiazides and vitamin D

compounds) which promote hypercalcaemia, should be

discontinued and dietary calcium should be restricted.

Ifsevere hypercalcaemia persistsdrugs which inhibit

mobilisation of calcium from the skeleton may be required.

Thebisphosphonatesare useful and pamidronate disodium

p. 469 is probably the most effective.

Corticosteroidsare widely given, but may only be useful

where hypercalcaemia is due to sarcoidosis or vitamin D

intoxication; they often take several days to achieve the

desired effect.

Calcitonin (salmon) p. 471 can be used by specialists for

the treatment of hypercalcaemia associated with

malignancy; it is rarely effective where bisphosphonates

have failed to reduce serum calcium adequately.

After treatment of severe hypercalcaemia the underlying

cause must be established.Further treatmentis governed by

the same principles as for initial therapy. Salt and water

depletion and drugs promoting hypercalcaemia should be

avoided; oral administration of a bisphosphonate may be

useful. Parathyroidectomy may be indicated for

hyperparathyroidism.

Hypercalciuria

Hypercalciuria should be investigated for an underlying

cause, which should be treated. Reducing dietary calcium

intake may be beneficial but severe restriction of calcium

intake has not proved beneficial and may even be harmful.

Neonates

Calcium supplements

Hypocalcaemia is common in thefirst few days of life,

particularly following birth asphyxia or respiratory distress.

Late onset at 4 – 10 days after birth may be secondary to

vitamin D deficiency, hypoparathyroidism or

hypomagnesaemia and may be associated with seizures.

2.1a Hypocalcaemia

ELECTROLYTES AND MINERALS›CALCIUM

Calcium salts f

lCONTRA-INDICATIONSConditions associated with

hypercalcaemia (e.g. some forms of malignant disease).

conditions associated with hypercalciuria (e.g. some forms

of malignant disease)

lCAUTIONSHistory of nephrolithiasis.sarcoidosis

lSIDE-EFFECTS

▶UncommonConstipation.diarrhoea.hypercalcaemia.

nausea

lRENAL IMPAIRMENTUse with caution. Risk of

hypercalcaemia and renal calculi.

eiiiiFabove

Calcium carbonate

lINDICATIONS AND DOSE

Phosphate binding in renal failure and hyper-

phosphataemia

▶BY MOUTH

▶Child 1–11 months: 120 mg 3 – 4 times a day, dose to be

adjusted as necessary, to be taken with feeds

▶Child 1–5 years: 300 mg 3 – 4 times a day, dose to be

adjusted as necessary, to be taken prior to or with

meals

▶Child 6–11 years: 600 mg 3 – 4 times a day, dose to be

adjusted as necessary, to be taken prior to or with

meals

▶Child 12–17 years: 1. 25 g 3 – 4 times a day, dose to be

adjusted as necessary, to be taken prior to or with

meals

592 Fluid and electrolyte imbalances BNFC 2018 – 2019

Blood and nutrition

9