/ Patient label
Christchurch Hospital
Haematology Department
IV Fluid Hyperhydration for High Dose Methotrexate
Suitable for:
UKALL12, CODOX M, HYPER CVAD, and COG ALL TRIALS / ADVERSE DRUG REACTION:
·  D4S (4% dextrose and 0.18% saline) with 30mmol KCl/L and 50mmol NaHCO3/L is the sole fluid infused apart from the Methotrexate (see chemotherapy prescription chart).
·  D4S + KCl + NaHCO3 is infused at a rate of 125mL/m2/hr
·  Calculate the rate of infusion appropriate to the patient’s surface area and prescribe this in the space provided.
·  Urine pH must be >7.5 before starting Methotrexate. Adjust NAHCO3 to keep pH between 7 and 8.
Height ______cm /
Weight______kg
/ BSA______m2 / Infusion rate for this protocol is 125mL/m2/hr
INFUSION RATE REQUIRED FOR THIS PATIENT = 125 X BSA = 125 X ______= / mL/hr

Date

/ Time /

IV Fluid and Additives

/ Rate of infusion / Prescribers Signature / Time Batch No. / Initials
Check
Day -1 / 2200 /

Give one Ural Sachet® orally in 20mL water

/ STAT
0400 / 1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
0900 / Methotrexate infusion to start as per chemotherapy chart
ml/hr
Following the completion of the first litre of D4S, further IV fluids for the next 48 hours need to be charted. The frequency of each litre will be dictated by the infusion rate. i.e. infusion rate 250mL/hr = 4 hourly, 200mL/hr = 5 hourly etc.
Only the infusion rate needs to be charted.
1L D4S + 30mmol KCl + 50mmol NaHCO3
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
Suitable for
UKALL12, CODOX M, HYPER CVAD, and COG ALL TRIALS / ADVERSE DRUG REACTION:
Height ______cm
/ Weight______kg / BSA______m2 / Infusion rate for this protocol is 125mL/m2/hr
INFUSION RATE REQUIRED FOR THIS PATIENT = 125 X BSA = 125 X ______= / mL/hr

Date

/ Time /

Fluid Volume and Additives

/ Duration/Rate / Prescribers Signature / Time Batch No. / Initials
Check
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
1L D4S + 30mmol KCl + 50mmol NaHCO3.
ml/hr
The rate of infusion may need to be modified if
·  There is evidence of fluid overload – consider frusemide
·  The pH falls below 7. Give bolus doses of 50 – 100mmol NaHCO3 as required.
·  Continue D4S + KCl + NAHCO3 for 48 hours from the start of the methotrexate infusion (0900 Day 1 to 0900 Day 3) and at the same rate of infusion as indicated above.
·  After 48 hours i.e. after 0900 on Day 3, prescribe any further IV fluids needed on the normal fluid prescription chart QMR004B.

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Ref: 2069 Authorised by CD Haematology 17 April 08