Indications And Dose
Fluid and electrolyte loss in diarrhoea ▶BY MOUTH ▶Adult: 200–400 mL, to be given after every loose motion, dose according to fluid loss
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Drug reference
Fluid and electrolyte loss in diarrhoea ▶BY MOUTH ▶Adult: 200–400 mL, to be given after every loose motion, dose according to fluid loss
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Flavours of oral powder formulations may include apricot, black currant, or raspberry.
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Reconstitute 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.
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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 gram Dioralyte Relief oral powder sachets raspberry sugar-free | 6 sachet G £2.50 Dioralyte Relief oral powder sachets blackcurrant sugar-free | 20 sachet p £7.13 Calcium imbalance 1.1 Calcium imbalance 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, and in old age, due to impaired absorption. In osteoporosis, a calcium intake which is double the recommended amount reduces the rate of bone loss. If the actual dietary intake is less than the recommended amount, a supplement of as much as 40 mmol is appropriate. In severe acute hypocalcaemia or hypocalcaemic tetany, an initial slow intravenous injection of calcium gluconate injection 10% p. 1108 should be given, with plasma-calcium and ECG monitoring (risk of arrhythmias if given too rapidly), and either repeated as required or, if only temporary improvement, followed by a continuous intravenous infusion to prevent recurrence. Calcium chloride injection p. 1107 is also available, but is more irritant; care should be taken to prevent extravasation. Oral supplements of calcium and vitamin D may also be required in persistent hypocalcaemia. Concurrent hypomagnesaemia should be corrected with magnesium sulfate p. 1112. See the role of calcium gluconate in temporarily reducing the toxic effects of hyperkalaemia. Severe hypercalcaemia Severe hypercalcaemia calls for urgent treatment before detailed investigation of the cause. Dehydration should be corrected first with intravenous infusion of sodium chloride 0.9% p. 1101. Drugs (such as thiazides and vitamin D compounds) which promote hypercalcaemia, should be discontinued and dietary calcium should be restricted. If severe hypercalcaemia persists drugs which inhibit mobilisation of calcium from the skeleton may be required. The bisphosphonates are useful and pamidronate disodium p. 769 is probably the most effective. Corticosteroids are 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. 772 can be used 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 treatment is 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. Hypercalciuria Hypercalciuria should be investigated for an underlying cause, which should be treated. Where a cause is not identified (idiopathic hypercalciuria), the condition is managed by increasing fluid intake and giving bendroflumethiazide p. 177. Reducing dietary calcium intake may be beneficial but severe restriction of calcium intake has not proved beneficial and may even be harmful. Hyperparathyroidism Hyperparathyroidism, primary Primary hyperparathyroidism is a disorder of the parathyroid glands—most commonly caused by a non-cancerous tumour (adenoma) in one of the glands. The resulting excess secretion of parathyroid hormone leads to hypercalcaemia, hypophosphataemia and hypercalciuria. The main symptoms are a result of hypercalcaemia and include thirst, increased urine output, constipation, fatigue and memory impairment. Long term effects include cardiovascular disease, kidney stones, osteoporosis, and fractures. Primary hyperparathyroidism is one of the leading causes of hypercalcaemia, and one of the most common endocrine disorders. It affects twice as many women than men and can develop at any age—with diagnosis most common in women aged 50 to 60 years. Aims of treatment Treatment is focussed on cure through surgery; other treatment options aim to reduce long-term complications and improve quality of life. Non-drug treatment g Information regarding the advantages and disadvantages of available treatments, ongoing monitoring, and advice on how to reduce the symptoms of primary hyperparathyroidism, should be given to all patients. Parathyroidectomy surgery is the recommended first-line treatment of primary hyperparathyroidism, with unsuccessful surgery requiring multidisciplinary team review at a specialist centre. For all patients with primary hyperparathyroidism, Cardiovascular disease risk assessment and prevention p. 201, and assessment of Osteoporosis p. 764 and fracture risk should be carried out. h For further information on fracture risk assessment see NICE clinical guideline: Osteoporosis (see Useful resources). Women of childbearing age g For women with primary hyperparathyroidism who are considering pregnancy, parathyroid surgery should be offered; and for pregnant women the management and monitoring of primary hyperparathyroidism should be discussed with a multidisciplinary team at a specialist centre. Women with primary hyperparathyroidism are at increased risk of hypertensive disease in pregnancy. h For information on diagnosis and management see NICE clinical guideline: Hypertension in pregnancy (see Useful resources). Drug treatment g Treatment with cinacalcet below may be considered for patients with primary hyperparathyroidism if surgery has been unsuccessful [unlicensed indication], is unsuitable, or has been declined; and they have an elevated albumin- adjusted serum calcium level with or without symptoms of hypercalcaemia. In secondary care, vitamin D levels should be measured and supplementation with vitamin D (see Vitamins p. 1139) offered for people with a probable diagnosis of primary hyperparathyroidism if needed. To reduce fracture risk for people with primary hyperparathyroidism who have an increased fracture risk, a bisphosphonate can be considered. Do not offer bisphosphonates for chronic hypercalcaemia of primary hyperparathyroidism. h Useful Resources Hyperparathyroidism (primary): diagnosis, assessment and initial management (NG132). www.nice.org.uk/guidance/ng132 Osteoporosis: assessing the risk of fragility fracture (CG146). www.nice.org.uk/guidance/cg146 Hypertension in pregnancy: diagnosis and management (NG133) www.nice.org.uk/guidance/ng133 1.1a Hypercalcaemia and hypercalciuria CALCIUM REGULATING DRUGS › BONE RESORPTION INHIBITORS
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Patients and carers should be advised how to reconstitute Dioralyte ® 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.
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200–400 mL, to be given after every loose
First-line fragment. Read the complete Indications and Dose section above.
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