Amino acids for parenteral nutrition + Other drugs [Dextrose + Minerals] - instructions for use, dose, side effects, contraindications

Clinical and pharmacological group: & nbsp

Means for enteral and parenteral nutrition

Included in the formulation

АТХ:

B.05.B.A.10 Combined preparations for parenteral nutrition

Pharmacodynamics:

Source of amino acids and dextrose. Dextrose - participation in the metabolism in the body in the form of glucose-6-phosphate. Participation in the processes of metabolism and protein synthesis.

Normalization of the electrolyte balance (regulation of the concentration of sodium, chlorine, acetate ions).

Pharmacokinetics:

Applied intravenously, so the bioavailability is 100%. 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. Half-life depends on age.

Biotransformation in the liver by deamination of the α-amino group to urea. Arginine almost completely reabsorbed in the renal tubules. Excretion of urea is carried out by the kidneys, 5% of amino acids - in unchanged form.

Dextrose is completely metabolized, the kidneys are not excreted (detection in the urine - pathology).Biotransformation occurs in the liver through the formation of pyruvate or lactic acid to water and carbon dioxide with the release of energy. Calcium and magnesium ions penetrate the placental barrier and into breast milk. Elimination is carried out by the kidneys (potassium ions - in the distal tubules in exchange for sodium or hydrogen ions), a small amount is excreted with sweat. 25-30% of magnesium binds to plasma proteins.

Indications:Parenteral nutrition: preoperative preparation, conditions after extensive surgical interventions, traumas of moderate to severe severity, burns; inflammatory-deStructural bowel diseases (including Crohn's disease, intestinal fistula), malabsorption syndrome, cachexia, oncological diseases, sepsis, peritonitis, acute pancreatitis.

ICD-10

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

IV.E50-E64.E61.7 Insufficiency of many cells

Contraindications:Hypersensitivity, pulmonary edema, disorders of amino acid metabolism, hyperkalemia, hyponatremia, metabolic disorders, coma of unclear etiology, hyperglycemia, uncontrolled doses of insulin up to 6 U / hour, acidosis,severe hepatic and / or renal failure without hemodialysis, collapse, shock, severe tissue hypoxia, hypervolemia, water-electrolyte balance disorders, chronic heart failure in decompensation stage, lactation period, children's age (up to 2 years).

Carefully:Pregnancy, increased blood osmolarity.

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. The use is contraindicated.

Dosing and Administration:

Intravenously infuzionalno. Immediately before the start of administration, solutions of amino acids, glucose and electrolytes should be mixed. The maximum daily dose is 40 ml / kg, which corresponds to 1.6 g of amino acids and 3.2 g of glucose.

The maximum infusion rate is 2 ml / kg / h, which corresponds to 0.08 g of amino acids and 0.16 g. The course of treatment is no more than 7 days.

Side effects:

Infection of the catheter site, with the development of septicemia.

Thrombophlebitis (the likelihood of developing less when infusing 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 time through the central catheter).

Extravasation with severe tissue damage.

Atrophy of the mucous membranes and a change in the enzymatic activity of the gastrointestinal tract with a possible increase in permeability and an increased risk of bacteremia and endotoxemia (due to the absence of glutamine that breaks down in solution).

Complications from the liver and bile ducts (with prolonged parenteral nutrition, especially in children): cholelithiasis, cholestasis (possibly).

Allergic reactions, chills, nausea, vomiting, increased diuresis.

Overdose:

Symptoms: hypertonic hyperhydration, disturbances of water-electrolyte balance, pulmonary edema; loss of amino acids in the urine with the development of violations of the amino acid balance, vomiting, tremor; hyperglycemia, glucosuria, dehydration, hyperosmolarity of the plasma, hyperglycemic or hyperosmolar coma.

Treatment: the introduction of the solution is stopped. Further therapy is selected individually depending on the severity of the symptoms.Infusion can be resumed later at a lower rate with frequent monitoring.

Interaction:Compatibility is necessary when adding other solutions or lipid emulsion to the preparation.

Special instructions:

If necessary, lipid emulsions can be added to the preparation through a special port located on the bag from above (other ingredients are injected through an additional port located at the bottom, all ingredients should be added, following aseptic rules and taking into account compatibility).

During the period of treatment, it is necessary to control glucose concentration, water-electrolyte balance and acid-base state of blood, liver function indicators (when developing hyperglycemia, reduce the rate of administration of the solution or introduce insulin).

Intravenous introduction of amino acid solutions is accompanied by increased release of urine microelements, especially Cu2+ and Zn2+ (it is necessary to adjust the content of microelements, especially with long-term treatment).

Because of the risk of pseudoagglutination, it is not recommended to use the same infusion systems for the administration of blood products and multicomponent amino acid solutions.

It should be used immediately after mixing glucose and amino acid solutions (unused preparation is not to be stored and must be destroyed).

Plastic double containers are designed for a single use (can not be used for damage to the container, a violation of transparency or tightness).

Instructions

Amino acids for parenteral nutrition + Other drugs [Dextrose + Minerals] (Aminoacids for parenteral nutrition + Other medicines [Dextrose + Multimineral])