Index of drugs

Parenteral nutrition in adults for whom oral or enteral nutrition is impossible, insufficient or contraindicated.

A three-chamber bag containing in a separate chamber a solution of Glucose, amino acids with electrolytes and a fat emulsion. 1000 ml of the mixture obtained after combining the contents of the chambers contain: 7.1 g of alanine, 6.1 g of arginine, 5.6 g of Glycine, 1.5 g of histidine, 2.5 g of isoleucine, 3.8 g of leucine, 3.4 g lysine (acetate), 2.2 g methionine, 2.6 g phenylalanine, 5.7 g proline, 3.3 g serine, 0.5 g Taurine, 2.2 g threonine, 1 g tryptophan, 0.2 g tyrosine , 3.1 g valine, 0.28 g Calcium chloride (dihydrate) 2.1 g sodium glycerophosphate (monohydrate), 0.61 g Magnesium sulfate (heptane), 2.3 g potassium chloride, 1.7 g sodium acetate ( trihydrate), 0.0066 g of zinc sulphate (heptane), 127 g of Glucose (monohydrate), 11.4 g of purified soya oil, 11.4 g of triglycerides of saturated fatty acids of medium chain length, 9.5 g of purified olive oil, 5.7 g fish oil rich in omega-3 fatty acids. Nitrogen content: 8 g. Osmolality: approx. 1800 mOsm / kg H₂O, osmolarity: about 1500 mOsm / l, pH about 5.6. The total energy value for a 986 ml bag is 1100 kcal.

Emulsion intended for parenteral nutrition, containing a lipid emulsion, a set of amino acids, electrolytes and glucose.

Hypersensitivity to fish, eggs, soy or peanut protein, or any of the excipients. Severe hyperlipidemia. Severe hepatic failure. Severe blood coagulation disorders. Congenital defects in amino acid metabolism. Severe renal failure, without the possibility of hemofiltration or dialysis. A sharp shock. Uncontrolled hyperglycemia. Pathologically increased serum concentration of any of the electrolytes contained in the preparation. General contraindications for intravenous fluid transfer: acute pulmonary edema, conduction, decompensated heart failure. Hemophagocytic syndrome. Unstable general condition (eg severe post-traumatic condition, decompensated diabetes, myocardial infarction, stroke, embolism, metabolic acidosis, severe sepsis, hypotonic dehydration and hyperosmolar coma).

Especially cautiously use in the case of disturbances in lipid metabolism, which may occur in patients with renal failure, diabetes, pancreatitis, abnormal liver function, hypothyroidism, and sepsis. Electrolyte disturbances and fluid balance should be corrected before infusion. The preparation should be used with caution in patients with a tendency to retain fluids - the patient should be observed at the beginning of the infusion, if any abnormal symptoms occur, the infusion should be stopped. In patients with renal insufficiency, the supply of phosphates and potassium should be carefully controlled to prevent hyperphosphatemia and hyperkalemia. Parenteral nutrition should be used with particular caution in patients with lactic acidosis, inadequate supply of oxygen to cells, and increased serum osmolarity. The fats in the preparation may affect the results of some laboratory tests (bilirubin, lactate dehydrogenase, oxygenation, hemoglobin) if blood is collected before fat is removed from the circulation (usually removed within 5-6 h of administration). Intravenous infusion of amino acids is accompanied by increased urinary excretion of some trace elements, in particular copper and zinc; this should be taken into account when setting the dose of these elements, especially in chronic intravenous feeding. In malnourished patients, initiation of parenteral nutrition may cause fluid displacement in the body and as a result lead to pulmonary edema and congestive heart failure, as well as to a decrease in the serum concentration of potassium, phosphorus, magnesium and water-soluble vitamins. These changes may occur within 24-48 h, therefore in this group of patients careful and slow start of parenteral nutrition is recommended, combined with close monitoring and appropriate adjustment of the supply of fluids, electrolytes, mineral salts and vitamins.Do not administer the product simultaneously with blood in the same infusion set, due to the risk of pseudo-agglutination. In patients with hyperglycemia, it may be necessary to administer exogenous insulin. Due to the composition of the amino acid solution, it is not recommended to use the preparation in children under 2 years of age; no experience in children 2-11 years old. Lack of experience with treatment using the lipid component of the preparation for more than 14 days.

The preparation can be given to pregnant women and lactation only after careful consideration of the need to take this treatment.

Common: slight increase in body temperature. Uncommon: lack of appetite, nausea, vomiting, increased liver enzymes, chills, pain and dizziness. Rare: tachycardia, dyspnoea, hypotension, hypertension, hypersensitivity reactions (anaphylactic or anaphylactoid reactions, skin rash, urticaria, hot flushes, headache), hot or cold feeling, pallor, cyanosis, pain in the neck, back, bones, chest and loin.

Intravenous (into the central vein) by drip infusion. Dosage and rate of infusion depend on the patient's ability to eliminate fats and metabolize nitrogen and glucose and the need for nutrients. The dose is selected individually, taking into account the patient's clinical condition and body weight. The dose range is 13-31 ml of the preparation / kg / day, corresponding to 0.1-0.25 g nitrogen / kg / day (0.6-1.6 g amino acids / kg / day) and 14-35 kcal / kg / day of total energy (12-27 kcal / kg / day of non-protein energy). In obese patients, doses should be calculated based on the estimated normal body weight. The demand for nitrogen in patients with normal nutritional status or in a state of mild catabolic stress is 0.1-0.15 g / kg / day (0.6-0.9 g amino acids / kg / day); in patients with moderately or very severe metabolic stress, with accompanying malnutrition or without, the need for nitrogen is 0.15-0.25 g / kg / day (0.9-1.6 g amino acids / kg / day). In some specific conditions (after burns or in case of significant anabolism) the need for nitrogen may be higher.
The maximum glucose infusion rate is 0.25 g / kg / h, amino acids - 0.1 g / kg / h, fats - 0.08 g / kg / h. The recommended duration of infusion is 14-24 h. The recommended maximum daily dose is 35 ml / kg / day. It is recommended to carry out the infusion continuously and well controlled, if possible using a volumetric pump.