Amino Acid Formulations for High Metabolic Stress

Pronunciation: a-MEE-noe AS-id
Class: Amino acid combinations

Trade Names

Aminosyn-HBC 7%
- Injection, solution 7%

FreAmine HBC 6.9%
- Injection, solution 6.9%

Pharmacology

Promotes protein synthesis.

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Indications and Usage

IV nutritional therapy to prevent nitrogen loss or treat negative nitrogen balance in catabolic or depleted patients.

Contraindications

Anuria; hepatic coma; inborn errors of amino acid metabolism; severe, uncorrected electrolyte or acid-base imbalance; hyperammonemia or other disorders involving impaired nitrogen utilization ( Aminosyn-HBC only); hypersensitivity to 1 or more amino acids in the solution.

Dosage and Administration

Adults

IV 1.5 g/kg of amino acids. Severely catabolic states may require higher dosage levels with more frequent laboratory evaluation.

Children

IV 2 to 3 g/kg of amino acids for infants with adequate calories. ( FreAmine HBC only).

Concomitant therapy

May include dextrose/insulin, fat emulsion, electrolyte supplementation, and trace minerals/vitamins.

General Advice

  • The determination of nitrogen balance and accurate daily body weights, corrected for fluid balance, is probably the best means of assessing individual protein requirements.
  • Hypertonic admixtures may be administered by continuous infusion through a central venous catheter with the tip located in the superior vena cava.
  • Solutions administrated to children by peripheral vein should not exceed twice normal serum osmolarity (718 mOsmol/L).
  • Administration time for a single bottle and set should never exceed 24 h.
  • Some additives may be incompatible. When introducing additives, mix thoroughly and do not store.

Storage/Stability

Store between 68° and 77°F. Avoid excessive heat. Protect from freezing. Protect from light until use.

Drug Interactions

Tetracycline

Because of its antianabolic activity, coadministration with tetracycline may reduce the potential anabolic effects of amino acids infused with dextrose as part of a parenteral feeding regimen.

Adverse Reactions

Cardiovascular

Venous thrombosis.

GI

Nausea.

Local

Erythema, extravasation, infection at the injection site, phlebitis extending from the injection site, thrombosis, warm sensation.

Metabolic-Nutritional

Phosphorous deficiency.

Miscellaneous

Fever, flushing, hypervolemia.

Precautions

Warnings

Administration by central venous catheter is only to be used by those familiar with this technique and its complications.


Monitor

Monitor glucose, serum electrolytes, ammonia, acid-base and fluid balance, serum proteins, kidney function tests, LFTs, serum osmolarity, hemogram, carbon dioxide content, and blood cultures. Carefully monitor nitrogen intake in patients with renal impairment.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and effectiveness have not been established. However, the use of amino acid injections in children as an adjunct in the offsetting of nitrogen loss or in the treatment of negative nitrogen balance is well established in the medical literature.

Elderly

Use with caution.

Renal Function

Elevated BUN may be augmented by renal function impairment or GI bleeding. Do not use in patients with azotemia without regard to total nitrogen intake.

Hepatic Function

Administration of amino acid solutions not specifically formulated for patients with hepatic insufficiency may result in plasma amino acid imbalances, hyperammonemia, prerenal azotemia, stupor, and coma.

Special Risk Patients

Use with caution in patients with a history of renal disease, pulmonary disease, or with cardiac insufficiency so as to avoid excessive fluid accumulation.

Sulfite Sensitivity

FreAmine HBC contains a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.

Administration

Administer strongly hypertonic nutrient solutions through an indwelling IV catheter with the tip located in the superior vena cava. Abrupt cessation of hypertonic dextrose infusion may result in rebound hypoglycemia.

Aluminum toxicity

Parenteral products may contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk.

Diabetes

Use special care when giving hypertonic glucose to diabetic or prediabetic patients. Insulin may be required to prevent severe hyperglycemia.

Electrolyte supplementation

May be required in the presence of extraordinary losses such as protracted nasogastric suction, vomiting, diarrhea, or GI fistula drainage. These amino acid injections do not contain phosphorous; add phosphate (and calcium) as indicated. Metabolic acidosis may be prevented or treated by administration of the acetate salts of a portion of the electrolytes. Keeping the chloride content to a minimum may prevent/treat hyperchloremic acidosis.

Exogenous calories

Provide exogenous calories concurrently with amino acids in patients receiving long-term total nutrition or if the patient has inadequate fat stores.

Fluid/Solute overload

May occur and result in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema.

Hyperammonemia

Discontinue if symptoms of hyperammonemia occur.

Metabolic complications

These have included metabolic acidosis, hypophosphatemia, alkalosis, hypocalcemia, osteoporosis, hyperglycemia and glycosuria, osmotic diuresis and dehydration, rebound hypoglycemia, elevated liver enzymes, hypo- and hypervitaminosis, electrolyte imbalances, and elevated plasma amino acid levels and hyperammonemia in children. Monitor frequently, especially the first few days of therapy. Administration of glucose at a rate exceeding the patient's utilization may lead to hyperglycemia, coma, and death.

Myocardial infarction

In patients with MI, accompany amino acid infusion with dextrose.

Sepsis

The constant risk of sepsis is present during central venous nutrition.

Overdosage

Symptoms

None reported.

Patient Information

  • Advise patient that medication will be prepared and administered by a health care provider in a hospital setting.

Copyright © 2009 Wolters Kluwer Health.

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