Amino acids for parenteral nutrition - instructions for use, doses, side effects, contraindications

The source of amino acids is intended for parenteral nutrition of patients with various pathologies with a low, normal or increased protein requirement, when enteral nutrition is ineffective or impossible. Participation in the processes of metabolism and protein synthesis.

Like amino acids that come from food and are obtained by splitting proteins, parenterally introduced amino acids enter the pool of free amino acids of the blood plasma, and from it into cells for protein synthesis and into various metabolic pathways.

Pharmacokinetics:

Amino acids are included in the pool of free amino acids of the body, distributed in the interstitial fluid and the intercellular space.Assimilation of essential amino acids - 99%, replaceable - 97%. The total and renal clearance of essential amino acids is 0.5 l / min and 1.5 ml / min, for most interchangeable amino acids - 0.6 l / min and 3 ml / min.

The elimination half-life depends on the age. Biotransformation in the liver by deamination of α-amino groups. Arginine almost completely reabsorbed in the renal tubules. Elimination in the form of urea is carried out by the kidneys (5% of amino acids - unchanged).

Indications:

Parenteral nutrition in the inability or inferiority of oral and probe nutrition.

Prophylaxis and treatment of protein deficiency: pre- and postoperative periods, trauma, burns, radiation sickness, operations on the esophagus and stomach, stenosis of various parts of the gastrointestinal tract, diffuse peritonitis, osteomyelitis, hypoparathyroidism, malabsorption syndrome, prolonged diarrhea, vomiting, anorexia, cachexia, prolonged febrile syndrome, poisoning, toxic diseases of the digestive tract, shigellosis, dyspepsia, salmonellosis, stroke, coma, nephrosis, amyloidosis, hemorrhage, liver cirrhosis, trauma.

Children:

Parenteral nutrition in case of inability or inferiority of oral and probe nutrition; prevention and treatment of protein deficiency.

ICD-10

I.A30-A49.A41.9 Septicemia, unspecified

IV.E40-E46.E44 Protein-energy insufficiency of moderate and weak degree

IV.E40-E46.E46 Protein-energy insufficiency, unspecified

XI.K55-K63.K63.9 Bowel disease, unspecified

XI.K70-K77.K72 Hepatic failure, not elsewhere classified

XVII.Q38-Q45.Q45.9 Disorder of digestive system, unspecified

XVIII.R50-R69.R50 Fever of unknown origin

XVIII.R50-R69.R63.3 Feeding and feeding difficulties

XVIII.R50-R69.R64 Cachexia

XIX.T08-T14 Injuries to the unspecified part of the trunk, limb or body region

XIX.T20-T32.T30 Thermal and chemical burns, unspecified

XX.X40-X49 Accidental poisoning and exposure to toxic substances

Contraindications:Violation of the metabolism of amino acids; metabolic acidosis; hypoxia; hypersensitivitynost; acute violations of hemodynamics (traumatic, surgical or burn shock, massive blood loss and others), decompensation of cardiac activity, hemorrhages in the brain. Acute and subacute hepatic and renal failure, thromboembolicies diseases and conditions in which it is impossible to drip the drug for a long time (sharp arousal, etc.).

Carefully:Decompensatedchronic heart failure, hemorrhagic stroke, thrombophlebitis.

Pregnancy and lactation:

The category of FDA recommendations is not defined. Adequate and well-controlled studies on humans and animals have not been conducted.

There is no information on the penetration into breast milk. Amino acids of the mother penetrate into breast milk.

Dosing and Administration:

Enter intravenously drip at a rate of 20 drops per minute, with good tolerability - up to 40-60 drops per minute. With a faster administration, a feeling of heat, hyperemia of the face, difficulty breathing. The daily dose of 0.4 liters (partial parenteral nutrition) to 1.5-2.0 liters (total parenteral nutrition), depending on the need. The solution must be heated to the temperature before introduction.

Children:

The maximum daily dose to 1 year: 1,5-2,5 g of amino acids per 1 kg of mass per day (15-25 ml / kg per day 10% solution, 25-40 ml / kg per day 6% solution). 2-5 years: 1.5 g of amino acids per 1 kg of body weight per day (15 ml / kg per day of 10% solution, 25 ml / kg per day of 6% solution). 6-14 years: 1.0 g of amino acids per 1 kg of body weight per day (10 ml / kg per day of 10% solution).

Side effects:

If you follow the recommendations for these precautions for specific preparations, the rate of administration and dosage,There are no side effects, but allergic reactions are possible.

A frequent complication is the infection of the catheter site with the possible development of septicemia.

Thrombophlebitis (the probability of development decreases with the infusion of hyperosmolar solutions through central access).

Embolism of the pulmonary artery and right ventricular thrombosis (more often in children and adolescents who receive parenteral nutrition for a long period through the central catheter).

Extravasation with severe tissue damage.

Atrophy of the mucous membranes and changes in the enzymatic activity of the gastrointestinal tract; possibly the development of increased permeability, bacteremia and endotoxemia (due to the lack of glutamine, which breaks down in solution).

Complications from the liver and bile ducts (with prolonged parenteral nutrition, especially in children): cholelithiasis, cholestasis (probably due to contamination of the solution with aluminum) with the possible development of liver failure.

Feeling of heat, flushing of the face, headache, nausea, vomiting, pain along the vein, dyspnea (with rapid intravenous injection).

Overdose:

Impaired lung and liver function.

Treatment: discontinue drug administration, symptomatic therapy. With giperkaliemii - 200-500 ml of 5% solution of dextrose with the addition of 1-3 IU of insulin for every 3-5 g of dextrose.

Interaction:Clinically significant interactions with other drugs not described.

Special instructions:

When decompensation of cardiac activity drugs are administered in reduced doses, with a hemorrhage in the brain, the total volume of the injected liquid is no more than 2 liters per day. With thrombophlebitis, drugs are injected through the central veins.

It is necessary to have eight essential amino acids (L-valine, L-isoleucine, L-leucine, L-lysine, L-methionine, L-threonine, L-phenylalanine, L-tryptophan) and conditionally-replaceable amino acids (in some pathophysiological states synthesized in insufficient amounts) - L-arginine and L-histidine.

L-form of amino acids provides the possibility of their direct participation in protein biosynthesis.

L-arginine promotes the conversion of ammonia into urea, binds toxic ammonium ions produced by the catabolism of proteins in the liver.

L-alanine and L-proline reduce the body's need for glycine.

L-isoleucine, L-leucine, L-valine (irreplaceable amino acids with branched side chains) are directly absorbed by peripheral tissues (their metabolism does not depend on the degree of liver damage);reduce the absorption and intake of aromatic amino acids in the central nervous system, reducing the signs of hepatic encephalopathy, normalize the energy and nitrogen balance in the body.

Instructions

Amino acids for parenteral nutrition (Aminoacids for parenteral nutrition)