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

Prescribing considerations

• Assess whether the fixed nutrient and electrolyte composition meets the individual infant’s needs; an individualised formulation may be more appropriate.
• Confirm compatibility and stability before adding vitamins, trace elements, electrolytes or other substances.
• Use a central vein unless the activated preparation has been sufficiently diluted and its final osmolarity assessed for peripheral administration.
• Protect the bag and administration set from ambient light until administration is complete.
• Maintain strict aseptic line care and guard against rapid over-infusion.

Contraindications and cautions

• Hypersensitivity to egg, soya or peanut proteins, any active ingredient, excipient or container component
• Congenital amino-acid metabolism disorders
• Pathologically raised sodium, potassium, magnesium, calcium or phosphate concentrations
• Severe hyperglycaemia
• Concurrent ceftriaxone treatment
• For lipid-containing administration: severe hyperlipidaemia or severe lipid-metabolism disorders with hypertriglyceridaemia

Monitoring

• Fluid balance, electrolytes including magnesium, serum osmolarity and acid–base balance
• Blood glucose and triglycerides
• Liver and kidney function
• Full blood count, platelets and coagulation parameters
• Infusion line, catheter and preparation for infection, extravasation or precipitates

Clinical pharmacology

A combined parenteral-nutrition formulation supplying amino-acid nitrogen and energy from glucose and triglycerides, together with electrolytes, to support cellular function, protein synthesis and growth.

Formulation and product differences

• Three-chamber bag containing amino-acid/electrolyte, glucose and lipid compartments.
• The amino-acid/electrolyte and glucose chambers can be activated without opening the lipid chamber when lipid administration is undesirable.
• The mixed three-chamber preparation is a milky-white emulsion; the lipid-free two-chamber preparation is clear, colourless or slightly yellow.