alanine + arginine + aspartic acid + 22 other active ingredients: clinical use

Prescribing considerations

• Confirm that oral or enteral nutrition is impossible, insufficient or contraindicated.
• Assess the complete nutrient, fluid and electrolyte contribution; a fixed multi-chamber composition may not meet every individual requirement.
• Correct severe fluid, electrolyte or metabolic disturbances before initiation.
• Use controlled central-venous administration and strict aseptic catheter care.
• Consider additional vitamins and trace elements because intrinsic quantities are insufficient.
• Use caution in hepatic or renal impairment, diabetes, hyperlipidaemia, coagulation disorders, anaemia, heart failure, pulmonary dysfunction and patients at risk of refeeding-related shifts.

Contraindications and cautions

• Premature neonates, infants and children younger than 2 years
• Hypersensitivity to egg, soya-bean, peanut or corn products, or another ingredient
• Congenital amino-acid metabolism abnormalities
• Severe hyperlipidaemia or severe lipid-metabolism disorder with hypertriglyceridaemia
• Severe hyperglycaemia
• Pathologically elevated sodium, potassium, magnesium, calcium or phosphorus concentrations

Monitoring

• Fluid and electrolyte balance, serum osmolarity and acid–base status
• Blood glucose and, where relevant, urine glucose and ketones
• Serum triglycerides and lipid clearance
• Liver and kidney function; consider ammonia if hepatic impairment is suspected
• Full blood count, platelets and coagulation tests
• Catheter site, line integrity and signs of infection, sepsis, extravasation or precipitate formation

Clinical pharmacology

This combination supplies amino-acid nitrogen for protein synthesis, glucose and olive/soya triglycerides for energy, and electrolytes for physiological balance. Its constituents follow their usual individual metabolic and elimination pathways.

Formulation and product differences

• Three-compartment bag containing an amino-acid/electrolyte solution, glucose with calcium, and an olive-oil/soya-bean-oil lipid emulsion.
• The mixed product is a high-osmolarity, homogeneous milky emulsion intended only for central-venous administration.
• Contains electrolytes; their existing contribution must be considered before compatible additions are made.
• Contains purified egg phospholipids and corn-derived glucose as well as refined soya-bean oil.