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

Prescribing considerations

• Use as part of an individualised paediatric parenteral-nutrition prescription with appropriate energy and other required nutrients.
• Correct severe fluid, electrolyte or metabolic disorders before starting.
• Assess refeeding risk in severely undernourished patients.
• Select central or peripheral access according to final osmolarity; the undiluted solution is intended for central administration.
• Use strict aseptic catheter and compounding technique, and inspect the solution, line and catheter for precipitates.
• Protect containers and administration sets from ambient light during administration in neonates and children under 2.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient.
• Congenital abnormality of amino-acid metabolism.

Monitoring

• Fluid balance, electrolytes, serum osmolarity and acid-base status.
• Blood glucose and evidence of catheter infection.
• Blood ammonia, particularly in newborns and infants.
• Renal function, nitrogen tolerance and blood urea nitrogen.
• Liver function and signs of cholestasis or other hepatobiliary disease.
• Infusion site, catheter and administration set for irritation, extravasation or precipitates.
• Growth, weight and nutritional response.

Clinical pharmacology

An electrolyte-free mixture of L-amino acids for paediatric parenteral nutrition, immediately available after intravenous administration for protein synthesis and metabolic use.

Formulation and product differences

• Clear, colourless solution containing amino acids, malic acid and water for injections.
• Provides no intrinsic energy source or electrolytes.
• Route depends on whether it is used alone or in an admixture and on final osmolarity.
• Supplied for single use; discard unused solution.