alanine + arginine + calcium chloride dihydrate + 23 other active ingredients: clinical use

Prescribing considerations

• Correct major fluid, electrolyte and metabolic disturbances before starting.
• Assess refeeding risk in severely malnourished patients and introduce nutrition cautiously with close biochemical monitoring.
• Consider total fluid, energy, protein and electrolyte intake from oral, enteral and other intravenous sources.
• Use caution where lipid metabolism is impaired, including renal failure, diabetes, pancreatitis, hepatic impairment, hypothyroidism or sepsis.
• Use only through central venous access with strict aseptic technique and controlled infusion equipment.

Contraindications and cautions

• Hypersensitivity to fish, egg, soya, peanut or corn-derived proteins, or another ingredient.
• Severe hyperlipidaemia, hepatic impairment or coagulation disorder.
• Congenital amino-acid metabolism disorders.
• Severe renal impairment without haemofiltration or dialysis.
• Uncontrolled hyperglycaemia or pathological elevation of an included electrolyte.
• Acute pulmonary oedema, hyperhydration, decompensated heart failure or another listed unstable metabolic or circulatory state.

Monitoring

• Fluid balance, weight and clinical nutritional response.
• Blood glucose, electrolytes, serum osmolarity and acid–base status.
• Serum triglycerides and evidence of impaired lipid clearance.
• Liver and kidney function.
• Full blood count, platelets and coagulation parameters.
• Catheter site, infusion set and emulsion for infection, leakage, separation or precipitates.

Clinical pharmacology

Glucose supplies carbohydrate energy, while infused amino acids enter the systemic circulation for protein synthesis and other metabolic pathways. The lipid emulsion combines soya, medium-chain triglyceride, olive and fish-oil sources, supplying energy and essential fatty acids including EPA and DHA.

Formulation and product differences

• A central-vein, three-chamber bag containing separate glucose, amino-acid/electrolyte and lipid compartments before activation.
• The chambers must be mixed to produce a homogeneous white emulsion before infusion.
• The base formulation contains selected electrolytes and zinc; compatible vitamins, trace elements or additional electrolytes may be added following assessment and compatibility checks.
• Contains egg phospholipids and ingredients derived from fish, soya and corn.