alanine + arginine + aspartic acid + 20 other active ingredients: clinical use

Prescribing considerations

• Assess individual amino-acid, glucose, energy, electrolyte and fluid requirements.
• Correct fluid, electrolyte and acid–base disturbances and pre-existing thiamine deficiency before infusion.
• Consider refeeding risk in malnourished or depleted patients.
• Provide essential fatty acids, lipids, vitamins and trace elements separately where required.
• Use strict aseptic technique and confirm compatibility before adding other components.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient
• Inborn errors of amino-acid metabolism
• Hyperglycaemia unresponsive to insulin
• Acidosis
• Intracranial or intraspinal haemorrhage
• Severe hepatic insufficiency
• Severe renal insufficiency without renal replacement therapy
• Newborn infants and children younger than 2 years
• Unstable circulatory or metabolic states in which parenteral nutrition is contraindicated

Monitoring

• Blood glucose
• Serum electrolytes, especially potassium, phosphate and magnesium during refeeding
• Fluid and acid–base balance
• Renal and hepatic function
• Blood counts and coagulation during prolonged administration
• Clinical signs of catheter infection and fluid overload

Clinical pharmacology

Intravenous nutrients are immediately bioavailable. Amino acids enter circulating and intracellular pools for protein synthesis and metabolism; glucose is oxidised for energy or used in biosynthesis, while electrolytes support physiological processes.

Formulation and product differences

• Clear, aqueous two-chamber bag separating the amino-acid/electrolyte and glucose solutions until mixing
• For central venous infusion only because of its hyperosmolar formulation
• Does not itself provide lipid, vitamins, trace elements or all essential fatty-acid requirements
• Compatible supplements may be added aseptically through the additive port; unverified mixtures must not be used