IONOMAX Therapy Solution
Registered Trademark of Richmond Veterinaria S.A.
Ionic Balanced Solution
Ionomax. New hydroelectrolytic therapy for maintenance, support and fluid replacement. Developed specifically for use in intensive care.
Ionomax is a balanced hydroelectrolyte solution, ideal for fluid and electrolyte replenishment in rehydration, maintenance and support therapy.
In patients who need special medical care, the need for fluid therapy depends on the state of dehydration of the patient.
For patients undergoing surgical treatment, additional indications for fluid therapy include maintaining a permeable pathway, replacing fluid losses through evaporation and/or bleeding, and maintaining optimal renal perfusion during anesthesia.
Hydration status in animals is determined by the evaluation of their medical history, physical examination and laboratory results (hematocrit, total protein concentration and urine density).
The veterinary professional will estimate the hydration deficit by evaluating skin elasticity (fold maneuver), mucous membrane moisture, eye position within the orbit, heart rate, peripheral pulse characteristics, capillary filling time and the existence of peripheral venous distension.
Nutrient Medium concentration
Sodium 140 meq/L
Potassium 5 meq/L
Magnesium 3 meq/L
Chloride 98 meq/L
Gluconate 23 meq/L
Acetate 27 meq/L
Dextrose 5.0 g/100 mL
Sodium gluconate: 0.502 g; Sodium acetate: 0.222 g; Sodium chloride: 0.526 g; Potassium chloride: 0.128 g; Magnesium Chloride: 0.021 g; Dextrose: 5.000 g; Formulation agents and Water for Injectables qsf .100 mL.
Ionomax, is widely distributed although not all electrolytes do so in the same way. It depends on the individual ionic charge, the electroionic state of the internal medium (plasma, extracellular and intracellular fluids), the acid-base state of the internal medium, the volume of water in each of the different compartments, the protein content of the plasma and the energy status of the patient. The removal of the ions takes place at the renal level. The glucose is biotransformed into ATP for immediate use or used in glycogenogenesis for storage. At a concentration of 2.5% glucose it is almost impossible to exceed the renal threshold for glucose, which is 120 mg/dl in plasma in dogs and cats. Sodium acetate is biotransformed in liver and muscle to bicarbonate, acting as a precursor of it and contributing to the correction of acid-base imbalances of the internal environment. The unused sodium acetate is eliminated through the kidney.
Pharmacodynamics of the product
Solutes that do not pass through the membranes freely are responsible for generating the osmotic pressure. This osmotic pressure will generate the movement of water molecules within the internal environment
Sodium: Sodium is considered the osmotic skeleton of the extracellular fluid. Ionomax contains both electrolytes and non-electrolytes, these components pass into the intracellular fluid. The movement of these ions, governed by biophysical and biochemical principles, will tend to restore the quantities, volumes and ionic charges of the different body compartments.
Chloride: Chloride is the most abundant anion in the internal environment (extracellular fluid) and therefore of vital importance in replacement fluids.
Magnesium: Although its concentration is low, magnesium (Mg) is an important element in the composition of the solution. The dietary intake of both magnesium and potassium is restricted.
Functions of Magnesium in the internal environment:
– It is vital for cellular homeostasis.
– It intervenes in the synthesis of ATP.
– It intervenes in the functioning of the Na/K pump (ATPase Pump).
– It is a potassium (K) intracellular regulator.
– It intervenes in the functioning of the calcium pump (ATPase Pump).
– It acts in the synthesis of nucleic acids and proteins.
– Regulates the proton pump.
– It intervenes as a second messenger in the transduction of intracellular signals.
– Regulates the tone of the vascular musculature.
– Enzymatic co-factor of more than 70% of intracellular enzymes.
Scientific reports indicate that 54% of critical patients are hypomagnesemic.
Between 36% and 61% of hypokalemic patients are refractory to treatment if the correction of hypomagnesaemia is not considered.
Magnesium losses occur due to:
– Digestive diseases (short bowel syndrome, diarrhea, malabsorption, intestinal inflammation, liver cholestasis, anorexia): in these cases the intake is reduced.
– Alterations in the distribution of magnesium, such as parenteral or enteral nutrition without trace element supplementation, septic states, trauma, hypothermia, pancreatitis, massive transfusions, dilation syndrome, gastric torsion, etc.
Magnesium losses: Primary renal tubular disease, glomerulonephritis, acute tubular necrosis, post-obstructive or compensatory diuresis after acute or chronic renal failure; tubular damage by aminoglycosides, amphotericin B, carbenicillin, cisplatin, cyclosporine, etc. Or by extrarenal factors: diuretics such as thiazides, furosemide or mannitol.
Other causes: use of digitalis, hyperthyroidism, primary hyperparathyroidism.
Mg supplementation drastically reduces the frequency of the appearance of arrhythmias in traumatized patients and those with dilation, torsion, gastric volvulus syndrome (G.D.V.)
Potassium is the most important cation inside the cell. The only source of income to the organism is represented by the ingestion and its excression is done by the renal and fecal way.
Alterations in the acid-base balance can cause considerable changes in the concentration of potassium in the internal environment. Hypokalemia occurs in patients with diarrhea, vomiting, intestinal inflammation, pancreatitis, polyuria, anorexia, etc. Potassium supplementation can be carried out tactically when the deficit of potassium in the internal environment is known or strategically when only the alterations from the clinical and physiopathological point of view are known. In the latter case, potassium supplementation up to 40 meq/L of solution is indicated.
Sodium acetate is biotransformed in liver and muscle to sodium bicarbonate, whose action is fundamental in the correction of acidosis.
The sodium acetate content of Ionomax provides a bicarbonate concentration similar to that of plasma.
The glucose content of the solution does not attempt to provide energy in order to replace the nutritional intake. It only satisfies the energy needs for the operation of the membrane pumps essential for the homeostatic restoration of the internal medium.
Instructions for use
Ionomax, is a medicine recommended for use in dogs, cats, calves and foals exclusively.
It is formulated for use in the following cases:
It is indicated to provide maintenance fluids in anorexic patients, with inadequate fluid consumption, subjected to situations of stress and as a contribution of fluids in the pre, trans and post surgery.
Replacement of extracellular fluid losses:
Ionomax is indicated for fluid replacement in patients with polyuric phase, renal failure, acute or chronic vomiters, with diarrheal processes, third space fluid losses, traumatized patients or with gastric dilatation-torsion-volvulus syndrome. The fluid replacement provided by Ionomax, improves renal and hepatic function contributing to the correction of plasma pH.
For being a crystalloid solution it contributes to the maintenance of the plasmatic volume in an effective way.
The sodium acetate content of the solution provides an effective precursor of sodium bicarbonate in concentrations similar to those of plasma, achieving an effective alkalinization of the same in patients with mild and moderate acidosis.
Dilution of the extracellular fluid:
Ionomax provides an effective means of diluting extracellular fluid after shock resuscitation with 7.5% sodium chloride hypertonic solution.
Replacement of contemporary losses:
It is effective for the replenishment of contemporary losses caused by evaporation or perspiration, vomiting, diarrhea, third space losses (pancreatitis, peritonitis) and internal fluid redistribution.
Support therapy in calves rearing:
Ionomax is effective as a supportive treatment for diarrhea in calves of complex etiology (infectious and non-infectious), which occurs both in dairy and calf raising herds during the first sixty days of life and causes significant economic losses, either by the deaths it produces, the cost of treatments and the decrease in production.
Therapy of support in foals:
Ionomax, is the maintenance therapy of choice for dehydrated foals as a result of neonatal diarrhea produced by infectious, parasitic agents, hormonal, nutritional and/or physiological causes. The problem of loss of electrolytes doubles with the advent of diarrhea syndrome, when osmolarity decreases; resulting in a net loss of electrolytes to the small intestine.
Young animals are especially predisposed to a hydration deficit due to increased extracellular fluid. The capacity to conserve water decreases; the relationship between body weight and surface area is large, and the loss of fluid through immature skin is also very considerable.
Acute diarrhea in calves and foals is the main cause of neonatal morbidity and mortality, producing a considerable hydration deficit, difficult to compensate without good hydroelectrolytic therapy.
Indicative average dosage
Species Maintenance Dose Speed Infusion
Dogs and Cats 50-70 mL/kg/day 7 mL/kg/hour
Calves and Foals 60-80 mL/kg/day 7 mL/kg/hour
Dehydrated patients: the volume required to correct dehydration and contemporary losses should be added to the maintenance dose.
These volumes will depend on the decision of the acting veterinary to use Ionomax only or to combine it with other solutions, according to the requirements of the patient to be treated.
In puppies, volumes should be increased by up to 50% due to their higher total body water content.
It is recommended to administer 30% of the total calculated dose in the first hour and the remaining 70% in the following 4 hours.
Interval between doses: it depends largely on the evolution of the underlying disease. Fluid therapy can be given continuously or in 2 or 3 daily sessions on an outpatient basis.
Duration of treatment: it is very variable. In general terms, fluid therapy of more than 5 days without nutritional support is not recommended.
Fluid therapy should be discontinued when hydration is restored and the animal can maintain fluid balance through food and drink.
Routes of administration
Ionomax, should be administered intravenously, intraosseous or intraperitoneal.
Ionomax is contraindicated in the following cases: Severe hemolysis, oliguria, diabetic ketoacidosis, diabetes insipidus, extensive burns, salt poisoning, hyperaldosteronism and hyperadrenocorticism.
Precautions and warnings
The temperature of the solution should be between 18 to 20°C at the time of administration.
Control the vital parameters of the animal before and during administration. It should be discontinued if adverse reactions are noted.
Careful monitoring of vital signs (cardiac, pulmonary, renal function, ionogram) should be performed during infusion.
If fluid administration is too rapid, signs of overhydration may appear, evidenced by the presence of: nasal serous discharge, tachycardia, cough, altered respiratory pattern, ascites, polyuria, exophthalmos, diarrhea, vomiting, and conjunctival edema.
In case of catheterization, the site where it is performed must be periodically controlled and maintained in a hygienic way, as well as the patient’s temperature must be controlled.
If any septic problem is verified, the catheter should be removed and another permeable route placed.
If the solution is accidentally administered perivascularly, mild phlebitis may occur because the solution is slightly hypertonic.
During infusion of the solution, heart function should be monitored for bradyarrhythmias. If bradyarrhythmias appear, the rate of infusion should be reduced.
If they persist, administration should be discontinued.
Such arrhythmias are attributed to intolerance to the administration of the potassium-enriched solution.
The maximum recommended dose of potassium is 0.5 mEq/kg/hour.
Signs of hyperkalaemia occur when plasma potassium exceeds 8 mEqA.
In case the patient presents any sign of hyperkalemia, such as bradycardia or compatible electrocardiographic changes (shortening of the QT interval, prolongation of the PR interval, reduction of the P wave or atrial arrest) the administration of the solution should be interrupted and immediately begin the treatment of hyperkalemia (Ca gluconate at 10% 1 to 2 cc/kg/slow iv, dextrose at 5 or 10% in water + 0.55 to 1.1 IU/kg of regular insulin or 2g of Dextrose for each IU of regular insulin, furosemide 2 to 4 mg/kg).
Caution should be exercised when using in patients who are receiving any of the following drugs: propanolol, enalapril, captopril, spironolactone, amiloride, indomethacin, heparin. These drugs can cause hypernatremic states.
In all cases, the dosage and frequency of administration is the responsibility of the veterinarian involved.
Verify that the inviolability system of the product and its storage conditions prior to use are adequate.
The aluminium seal should not be removed. Only the flap on the seal should be removed (flip-off).
Under no circumstances should the product be uncovered, transferred or exposed to the environment, as these manoeuvres put at risk the correct conservation of the product and the inviolability of the packaging.
Keep the product between 15 and 30°C, away from direct sunlight and in a hygienic place. Keep out of reach of children and pets.
Mon a Fri: 08:00-17:00
Where we are
Fragata Heroína 4988 (B1615ICH)
Grand Bourg, Buenos Aires, Argentina.