alanine + arginine + aspartic acid + 24 other active ingredients: clinical use

Prescribing considerations

• Base prescribing on individual energy, amino-acid, electrolyte and fluid requirements; additional nutrients may be needed.
• Correct fluid, electrolyte and acid-base disturbances before initiation and consider refeeding risk.
• Use caution with diabetes, impaired lipid metabolism, pancreatitis, sepsis, metabolic syndrome, and cardiac, hepatic or renal impairment.
• Use strict aseptic technique and verify compatibility before adding medicines, vitamins, trace elements or electrolytes.

Contraindications and cautions

• Hypersensitivity to an active substance, excipient, egg, peanut or soya protein.
• Children younger than two years.
• Inborn amino-acid metabolism disorders, severe hypertriglyceridaemia, severe coagulopathy or uncontrolled hyperglycaemia.
• Acidosis, intrahepatic cholestasis, severe hepatic insufficiency, or severe renal insufficiency without renal replacement therapy.
• Acute thromboembolism, lipid embolism, aggravated bleeding tendency, life-threatening circulatory instability, acute pulmonary oedema, decompensated heart failure, or uncorrected fluid and electrolyte disturbance.

Monitoring

• Serum glucose, triglycerides and electrolytes.
• Fluid balance and acid-base status.
• Blood-cell count, coagulation, hepatic and renal function.
• Temperature, weight, fluid input and output, and catheter condition.

Clinical pharmacology

The intravenous mixture supplies amino acids for protein synthesis, glucose and triglycerides for energy, essential fatty acids, electrolytes and fluid.

Formulation and product differences

• A three-chamber bag separates glucose, lipid and amino-acid/electrolyte solutions until mixed.
• The lipid phase contains refined soya-bean oil and medium-chain triglycerides; egg phospholipids are an excipient.
• It is a high-osmolality formulation intended for central venous infusion only.
• Vitamins and a complete range of trace elements are not inherently provided.
• Use only intact bags with clear aqueous solutions and a homogeneous milky-white lipid emulsion.