alanine + arginine + aspartic acid + 25 other active ingredients: clinical use

Prescribing considerations

• Confirm that oral or enteral nutrition is impossible, insufficient or contraindicated.
• Correct fluid, electrolyte and acid–base disturbances before starting.
• Consider diabetes, impaired lipid metabolism, sepsis, pancreatitis and cardiac, hepatic or renal impairment.
• Account for the product's electrolytes and high sodium content when prescribing additional fluids or electrolytes.
• Provide vitamins and additional trace elements according to individual requirements.
• Use strict aseptic technique and add only substances with documented compatibility.

Contraindications and cautions

• Hypersensitivity to an ingredient or to egg, fish, peanut or soya protein.
• Age under two years.
• Inborn errors of amino-acid metabolism, severe hypertriglyceridaemia, severe coagulopathy, uncontrolled hyperglycaemia or acidosis.
• Severe hepatic failure, intrahepatic cholestasis or severe renal failure without renal replacement therapy.
• Acute thromboembolism, lipid embolism, acute pulmonary oedema or decompensated cardiac failure.
• Life-threatening circulatory instability, inadequate tissue oxygenation or an unstable metabolic state.

Monitoring

• Serum triglycerides and blood glucose.
• Electrolytes, fluid balance and acid–base status.
• Blood-cell counts and coagulation.
• Hepatic and renal function.
• Clinical signs of infection, hypersensitivity, fluid overload and metabolic intolerance.

Clinical pharmacology

This combination supplies amino acids for protein synthesis alongside glucose and medium- and long-chain triglycerides for energy. Soya and fish-oil lipids provide omega-6 and omega-3 fatty acids; electrolytes and zinc contribute to metabolic and fluid balance.

Formulation and product differences

• A three-chamber bag separates glucose, lipid and amino-acid/electrolyte solutions until activation.
• The mixed product is a high-osmolality emulsion intended only for central venous infusion.
• It contains electrolytes and zinc but does not by itself provide every required vitamin or trace element.
• Multiple bag volumes exist, and not all pack sizes may be marketed.