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ENAP 20 HL

ENAP 20 HL

Ask a doctor about a prescription for ENAP 20 HL

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Doctor

Anna Biriukova

General medicine5 years of experience

Dr Anna Biriukova is an internal medicine doctor with clinical experience in cardiology, endocrinology, and gastroenterology. She provides online consultations for adults, offering expert medical support for heart health, hormonal balance, digestive issues, and general internal medicine.

Cardiology – Diagnosis and treatment of:

  • High blood pressure, blood pressure fluctuations, and cardiovascular risk prevention.
  • Chest pain, shortness of breath, arrhythmias (tachycardia, bradycardia, palpitations).
  • Leg swelling, chronic fatigue, reduced exercise tolerance.
  • EKG interpretation, lipid profile evaluation, cardiovascular risk assessment (heart attack, stroke).
  • Post-COVID-19 cardiac monitoring and care.
Endocrinology – Diabetes, thyroid, metabolism:
  • Diagnosis and management of type 1 and type 2 diabetes, and prediabetes.
  • Individual treatment plans including oral medications and insulin therapy.
  • GLP-1 therapy– modern pharmacological treatment for weight management and diabetes control, including drug selection, monitoring, and safety follow-up.
  • Thyroid disorders – hypothyroidism, hyperthyroidism, autoimmune thyroid diseases (Hashimoto’s, Graves’ disease).
  • Metabolic syndrome – obesity, lipid disorders, insulin resistance.
Gastroenterology – Digestive health:
  • Abdominal pain, nausea, heartburn, gastroesophageal reflux (GERD).
  • Stomach and intestinal conditions: gastritis, irritable bowel syndrome (IBS), indigestion.
  • Management of chronic digestive disorders and interpretation of tests (endoscopy, ultrasound, labs).
General internal medicine and preventive care:
  • Respiratory infections – cough, colds, bronchitis.
  • Lab test analysis, therapy adjustments, medication management.
  • Adult vaccinations – planning, contraindications assessment.
  • Cancer prevention – screening strategies and risk assessment.
  • Holistic approach – symptom relief, complication prevention, and quality of life improvement.
Dr Biriukova combines internal medicine with specialist insight, offering clear explanations, personalised treatment plans, and comprehensive care tailored to each patient.
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This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.
About the medicine

How to use ENAP 20 HL

INSTRUCTIONS for medical use of the medicinal product Balance 4.25% glucose 1.25 mmol/l calcium

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INSTRUCTIONS for medical use of the medicinal product Balance 4.25% glucose 1.25 mmol/l calcium

Balance 4.25% glucose 1.25 mmol/l calcium

Composition:

active substances: calcium chloride dihydrate; sodium chloride; sodium (S)-lactate solution (sodium (S)-lactate); magnesium chloride hexahydrate; glucose monohydrate (anhydrous glucose).

Description:

"Balance 4.25% glucose 1.25 mmol/l calcium" is supplied in a two-chamber bag. One chamber contains an alkaline lactate solution, and the other chamber contains an electrolyte solution based on glucose. Mixing of the solutions of both chambers occurs by opening the middle seam between the two chambers, resulting in the formation of a neutral ready-to-use solution.

Before mixing:

1 liter of acidic electrolyte solution based on glucose contains:

Calcium chloride dihydrate0.3675 g
Sodium chloride11.279 g
Magnesium chloride hexahydrate0.2033 g
Glucose monohydrate (anhydrous glucose)93.5 g (85.0 g)

1 liter of alkaline lactate solution contains: sodium (S)-lactate solution 15.69 g (sodium (S)-lactate 7.85 g)

After mixing:

1 liter of neutral, ready-to-use solution contains:

Calcium chloride dihydrate0.1838 g
Sodium chloride5.640 g
Sodium (S)-lactate solution (sodium (S)-lactate)7.85 g (3.925 g)
Magnesium chloride hexahydrate0.1017 g
Glucose monohydrate (anhydrous glucose)46.75 g (42.5 g)

ions:

Ca2+1.25 mmol
Na+134 mmol
Mg2+0.5 mmol
Cl-100.5 mmol
(S)-lactate35 mmol
Glucose235.8 mmol

Excipients:

water for injection, hydrochloric acid, sodium hydroxide, sodium bicarbonate.

Pharmaceutical form.

Solution for peritoneal dialysis.

Main physical and chemical properties:

A two-chamber bag containing a clear colorless aqueous solution.

Ready-to-use solution:
Theoretical osmolality509 mOsm/l
pH ≈7.0

Pharmacotherapeutic group.

Solution for peritoneal dialysis. Hypertonic solutions.

ATC code V05D B.

Pharmacological properties.

Pharmacodynamics.

"Balance 4.25% glucose 1.25 mmol/l calcium" is an electrolyte solution containing glucose and lactate buffer, intended for intraperitoneal use in the treatment of terminal stage renal failure of various genesis using continuous ambulatory peritoneal dialysis (CAPD).

Pharmacokinetics.

Uremic products (such as urea, creatinine, and uric acid), inorganic phosphates, and electrolytes such as sodium, potassium, calcium, and magnesium are removed from the body into the dialysis solution by diffusion and convection.

Non-clinical data on safety.

Non-clinical studies on the toxicity of the "Balance 4.25% glucose 1.25 mmol/l calcium" solution were not conducted.

Clinical characteristics.

Indications.

Terminal (decompensated) stage of chronic renal failure of various origins, subject to treatment with peritoneal dialysis.

Contraindications.

The "Balance 4.25% glucose 1.25 mmol/l calcium" solution should not be used in patients with lactic acidosis, severe hypokalemia, severe hypocalcemia, hypovolemia, and arterial hypotension.

Special precautions for use.

Before using the "Balance 4.25% glucose 1.25 mmol/l calcium" solution for peritoneal dialysis, it is necessary to familiarize yourself with the instructions for medical use.

Interaction with other medicinal products and other types of interactions.

The use of this solution for peritoneal dialysis may lead to a decrease in the effectiveness of other medicinal products, as they may penetrate into the dialysate and be excreted from the body together with it.

Special features of use.

The solution for peritoneal dialysis should not be administered intravenously.

Method of administration and dosage.

This solution is intended exclusively for intraperitoneal use.

Continuous ambulatory peritoneal dialysis (CAPD):

Adults: If there are no other prescriptions, the patient is prescribed 2000 ml of solution per exchange, four times a day.

Automated peritoneal dialysis (APD):

If an apparatus (slip-safe cyclator) is used for intermittent or continuous cyclic peritoneal dialysis, it is recommended to use bags of a larger volume, which allows for more than one exchange of the solution.

Handling (operation method)

The ready-to-use solution should be used immediately.

"Stay-safe" system for continuous ambulatory peritoneal dialysis (CAPD)

The bag with the solution is preheated to body temperature.

"Slip-safe" system for automated peritoneal dialysis (APD)

To start the treatment procedure, it is necessary to insert the slip-safe system connectors with the prescribed solution into the free ports of the cyclator tray.

Adverse reactions.

"Balance 4.25% glucose 1.25 mmol/l calcium" is an electrolyte solution, the composition of which is similar to that of blood.

Potential adverse reactions associated with the peritoneal dialysis solution

Endocrine system disorders: secondary hyperparathyroidism with possible bone metabolism disorders (unknown).

Potential adverse reactions of peritoneal dialysis as a method

Infections and invasions: peritonitis (very common), indicated by clouding of the dialysate being drained.

Shelf life.

The shelf life in the original packaging for sale is 2 years.

Storage conditions.

Store at a temperature not below 4 °C.

Incompatibility.

The medicinal product should be used only as prescribed by a doctor to avoid the risks of incompatibility and contamination.

Packaging.

2000 ml or 2500 ml in a two-chamber bag "stay-safe" system; 4 bags in a cardboard box with a sticker in Ukrainian or with labeling in Ukrainian and other languages;

Release category.

By prescription.

Manufacturer.

Fresenius Medical Care Deutschland GmbH.

Location of the manufacturer and address of the place of its activities.

Frankfurter Strasse 6-8, 66606 St. Wendel, Germany.

Applicant.

Fresenius Medical Care Deutschland GmbH.

Location of the applicant.

Else-Kroener-Strasse 1, 61352 Bad Homburg v.d.H., Germany.

Online doctors for ENAP 20 HL

Discuss dosage, side effects, interactions, contraindications, and prescription renewal for ENAP 20 HL – subject to medical assessment and local rules.

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Doctor

Eteri Tabeshadze

Cardiology32 years of experience

Dr. Eteri Tabeshadze is a cardiologist with the highest qualification category and over 32 years of clinical experience. She also practises functional diagnostics, offering a comprehensive approach to cardiovascular care. Dr. Tabeshadze provides online consultations for adults with a wide range of heart-related conditions, from preventive screenings to acute and chronic disease management.

Areas of expertise include:

  • Diagnosis and treatment of hypertension, coronary artery disease, and chronic heart failure
  • Management of arrhythmias and conduction disorders, including paroxysmal events
  • Emergency care: myocardial infarction, acute left ventricular failure, acute pulmonary heart disease
  • Post-thromboembolism care and evaluation of cardiomyopathies
  • Treatment of vegetative dysfunction and autonomic disorders
  • Interpretation of cardiovascular tests: ECG, Holter monitoring, ambulatory blood pressure monitoring (ABPM), echocardiography (including transesophageal echo), stress echocardiography, exercise testing (VEM, treadmill test)
Dr. Tabeshadze combines extensive diagnostic experience with personalised care. She helps patients understand their cardiovascular health, navigate symptoms and diagnoses, and create tailored treatment plans to improve quality of life and reduce long-term risks.
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Doctor

Svetlana Kolomeeva

Cardiology17 years of experience

Dr. Svetlana Kolomeeva is a general practitioner and internal medicine doctor providing online consultations for adults. She helps patients manage acute symptoms, chronic conditions, and preventive care. Her clinical focus includes cardiovascular health, hypertension control, and managing symptoms like fatigue, weakness, sleep issues, and overall low energy.

Patients commonly seek her help for:

  • High blood pressure, headaches, dizziness, swelling, palpitations.
  • Diagnosis and management of hypertension, arrhythmias, and tachycardia.
  • Metabolic syndrome, excess weight, high cholesterol.
  • Chronic fatigue, insomnia, poor concentration, anxiety.
  • Respiratory symptoms: colds, flu, sore throat, cough, fever.
  • Digestive issues: heartburn, bloating, constipation, IBS symptoms.
  • Chronic conditions: diabetes, thyroid disorders.
  • Interpretation of lab tests and medical reports, therapy adjustment.
  • Second opinion and decision-making support.
  • Cardiovascular disease prevention and metabolic risk reduction.
  • Long-term follow-up and dynamic health monitoring.

Dr Kolomeeva combines clinical expertise with personalised care. She clearly explains diagnoses, guides patients through symptoms and treatment options, and provides actionable plans. Her consultations are designed not only to address current complaints but also to stabilise chronic conditions and prevent future complications. She supports patients through every stage of care – from first symptoms to ongoing health management.

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