alanine + arginine + aspartic acid + 17 other active ingredients: clinical use

Prescribing considerations

• Assess total nutritional, fluid and metabolic requirements, including concurrent oral or enteral intake.
• Correct severe fluid, electrolyte or metabolic disturbances before starting.
• Use a central venous route because of the formulation's high osmolarity.
• Confirm additive and Y-site compatibility; excessive calcium and phosphate can produce dangerous precipitates.
• Use strict aseptic technique and inspect the bag, infusion set and catheter for separation or precipitates.

Contraindications and cautions

• Premature neonates, infants and children younger than 2 years
• Hypersensitivity to egg, soya-bean, peanut or corn products, active substances or excipients
• Congenital amino-acid metabolism abnormalities
• Severe hyperlipidaemia or severe lipid-metabolism disorders with hypertriglyceridaemia
• Severe hyperglycaemia

Monitoring

• Fluid and electrolyte balance, serum osmolarity and acid–base status
• Blood glucose and metabolic tolerance
• Serum triglycerides
• Liver and kidney function; consider ammonia if hepatic insufficiency is suspected
• Full blood count, platelets and coagulation
• Catheter integrity, extravasation and evidence of infection or sepsis

Clinical pharmacology

The L-amino acids support protein synthesis and nitrogen balance; glucose and olive-oil/soya-bean-oil triglycerides provide non-protein energy. Components are distributed, metabolised and eliminated in the same manner as when administered separately.

Formulation and product differences

• Three-compartment bag containing separate amino-acid, glucose and lipid components that must be mixed before administration.
• The selected formulation is substantially electrolyte-free, allowing individual electrolyte adjustment; it contains small inherent amounts of phosphate and acetate.
• The lipid emulsion uses refined olive oil and refined soya-bean oil and contains purified egg phospholipids.
• Vitamins, trace elements and compatible electrolytes may be added by qualified personnel under aseptic conditions.