alanine + arginine + calcium chloride + 18 other active ingredients: clinical use

Prescribing considerations

• Individualise against nutritional, energy, fluid and electrolyte requirements and concurrent oral or enteral intake.
• Correct severe fluid, electrolyte and metabolic disturbances before starting.
• Assess refeeding risk in severely undernourished patients.
• Consider renal, hepatic, cardiac and glucose-metabolism impairment.
• Supplementation requires documented compatibility and aseptic preparation.
• This highly osmolar formulation generally requires central venous administration.

Contraindications and cautions

• Hypersensitivity to an active substance, excipient or container component.
• Amino-acid metabolism disorders.
• Severe hyperglycaemia.
• Metabolic acidosis or hyperlactataemia.
• Hyperkalaemia, hypernatraemia or pathologically raised magnesium, calcium or phosphorus concentrations.
• Concomitant ceftriaxone in newborns aged 28 days or younger.

Monitoring

• Clinical status, fluid balance and signs of circulatory overload.
• Serum electrolytes, renal and liver function.
• Blood and urine glucose.
• Catheter site, temperature and evidence of infection.
• Infusion solution, tubing and catheter for precipitates.

Clinical pharmacology

After intravenous administration, amino acids, glucose and electrolytes are distributed, metabolised and excreted in the same general manner as equivalent constituents given in separate intravenous solutions.

Formulation and product differences

• A dual-compartment bag separates the amino-acid/electrolyte solution from the glucose/calcium solution until activation.
• The mixed product contains no lipid, vitamins or trace elements as supplied.
• It is not recommended for preterm or term neonates or children younger than 2 years.