Dosage form: injection
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Aminosyn-HBC 7%, Sulfite-Free, (an amino acid injection — high branched chain) is administered intravenously. The total dose depends upon daily protein requirements and the patient's metabolic and clinical response. The determination of nitrogen balance and accurate daily body weights, corrected for fluid balance, is probably the best means of assessing individual protein requirements.
While Recommended Dietary Allowances for oral protein are approximately 0.8 g/kg of body weight for the healthy adult, protein and caloric requirements in traumatized or malnourished patients may be substantially increased. To satisfy protein needs and promote positive nitrogen balance, the daily dosage level of amino acids for adult patients with adequate caloric intake is approximately 1.5 g/kg of body weight. Severely catabolic states may require higher dosage levels. Such higher doses must be accompanied by frequent laboratory evaluation. Fat emulsion may be administered to help meet energy requirements. Fat emulsion coadministration should be considered when prolonged parenteral nutrition is required in order to prevent essential fatty acid deficiency (E.F.A.D.). Serum lipids should be monitored for evidence of E.F.A.D. in patients maintained on fat-free total parenteral nutrition.
For optimum amino acid utilization, sufficient intracellular electrolytes (sodium, magnesium, and phosphate) should be provided. Approximately 60 to 180 mEq of potassium, 10 to 30 mEq of magnesium, and 10 to 40 mM of phosphate/day appear necessary to achieve optimum metabolic response. In addition, sufficient quantities of the major extracellular electrolytes (sodium, calcium and chloride) must be given. In patients with hyperchloremic or other metabolic acidoses, sodium and potassium may be added as the acetate or lactate salts to provide bicarbonate precursors. The electrolyte content of Aminosyn-HBC 7% must be considered when calculating daily electrolyte intake. Serum electrolytes, including magnesium and phosphorus, should be monitored frequently. If a patient's nutritional intake is primarily parenteral, trace metals and vitamins, especially the water-soluble vitamins, should also be provided.
Central Venous Nutrition: For severely catabolic, depleted patients or those who require long-term parenteral nutrition, central venous nutrition should be considered. Total parenteral nutrition may be started with admixtures containing lower concentrations of dextrose; dextrose concentrations may be gradually increased to approximate estimated energy requirements as the patient’s glucose tolerance increases.
In adults, strongly hypertonic admixtures of amino acids and dextrose may be safely administered only by continuous infusion through a central venous catheter with the tip located in the superior vena cava. A mixture containing 500 mL of Aminosyn-HBC 7% with 500 mL of concentrated dextrose supplemented with electrolytes, trace metals and vitamins may be administered over a period of approximately 8 hours. If prescribed administration rates should fall behind schedule, no attemptto “catch up” to planned intake should be made. In addition to meeting protein requirements, the administration is also governed by the patient’s glucose tolerance, especially during the first few days of therapy. The daily intake of the amino acid/dextrose admixture should be increased gradually to the maximum required dose, based on serial determinations of urine and blood sugar levels. To prevent hyperglycemia and glycosuria, certain patients may require exogenous insulin in order to receive adequate calories from hypertonic dextrose. To prevent rebound hypoglycemia, a solution containing 5% dextrose should be administered when hypertonic dextrose infusions are abruptly discontinued.
Peripheral Parenteral Nutrition: For the moderately catabolic, depleted patient in whom aggressive central venous nutrition is not necessary, Aminosyn-HBC 7% may be given by peripheral vein with hypocaloric energy supplements. Dextrose in a final concentration of up to 10% and/or lipid emulsion may be administered.
Fat provides approximately 9 kcal/gram and in long-term therapy (more than 5-7 days) will prevent essential fatty acid deficiency. Parenteral fat emulsion may be administered simultaneously with amino acid-dextrose admixtures via a Y-type administration set to supplement caloric intake. Fat, however, should not provide more than 60% of the total caloric intake.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
WARNING: Do not use flexible container in series connections.