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

Prescribing considerations

• Individualise total nutritional, fluid and electrolyte provision; the fixed bag composition may not meet every requirement simultaneously.
• Correct severe fluid, electrolyte and metabolic disturbances before starting.
• Assess refeeding risk in severely malnourished patients and ensure appropriate vitamins, trace elements and electrolytes.
• Use only through central venous access because of high osmolarity.
• Confirm compatibility and emulsion stability before adding supplements or co-administering other infusions.

Contraindications and cautions

• Premature neonates, infants and children younger than 2 years
• Hypersensitivity to egg, soya, peanut, corn or corn products, or another ingredient
• Congenital amino-acid metabolism disorders
• 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 triglycerides
• Liver and kidney function; consider ammonia when hepatic insufficiency is suspected
• Full blood count, platelets and coagulation
• Central-line site, catheter function and evidence of infection
• Signs of refeeding disturbance, extravasation, hypersensitivity and fat overload

Clinical pharmacology

The formulation combines glucose, 17 L-amino acids and an olive-oil-predominant lipid emulsion containing some soya-bean oil. These substrates are distributed, metabolised and eliminated as when administered separately, supporting energy and nitrogen balance.

Formulation and product differences

• The three-compartment emulsion does not contain a full electrolyte complement, allowing electrolytes to be tailored separately.
• It contains purified egg phospholipids and glucose derived from corn, relevant to allergy assessment.
• Vitamins and trace elements are not present in amounts sufficient to meet full requirements and generally require supplementation.