Crystalline Amino Acids With Dextrose

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

Trade Names

Aminosyn II
- Injection, solution 4.25% in dextrose 20%

Aminosyn II 3.5%
- Injection, solution 3.5% in dextrose 5%

Aminosyn II 4.25%
- Injection, solution 4.25% in dextrose 25%

Clinimix
- Injection, solution 2.75% in dextrose 5%
- Injection, solution 4.25% in dextrose 5%
- Injection, solution 4.25% in dextrose 10%
- Injection, solution 4.25% in dextrose 20%
- Injection, solution 4.25% in dextrose 25%
- Injection, solution 5% in dextrose 15%
- Injection, solution 5% in dextrose 20%
- Injection, solution 5% in dextrose 25%

Pharmacology

Provides carbohydrate calories and crystalline amino acids to stimulate protein synthesis, limit protein catabolism, minimize liver glycogen depletion, and promote wound healing.

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Indications and Usage

IV nutritional therapy to prevent nitrogen loss or treat negative nitrogen balance.

Contraindications

Aminosyn II

Hepatic coma; metabolic disorders involving impaired nitrogen utilization; use in infants younger than 1 year.

Clinimix

Intracranial or intraspinal hemorrhage; severe dehydration; severe liver disease; hepatic coma; hypersensitivity to 1 or more amino acids in the solution; allergy to corn or corn products (solutions containing corn-derived dextrose).

Dosage and Administration

Adults

IV For patients who are not hypermetabolic, in an acceptable weight range, and with restricted physical activity, administer approximately 30 kcal/kg, nitrogen 12 to 18 g (or amino acids 1 to 1.5 g/kg/day), and 2,500 to 3,000 mL of fluids. In depleted and severely traumatized patients, such as burned patients or patients who have received major surgery with complications, the requirements for nutrients and fluids may be significantly higher. In such cases, 4,000 calories and nitrogen 25 g or more may be required daily to achieve nitrogen balance. The fluid losses through drainages and wound surface must be taken into account in calculating the fluid requirements of these patients.

Clinimix

Approximately 3 L of solution may be administered per 24-hour period. When used postoperatively, therapy should begin with 1,000 mL on the first postoperative day. Thereafter, the dose may be increased to 3,000 mL per day.

Aminosyn II 3.5%

For peripheral IV infusion, amino acids 1 to 1.5 g/kg/day will reduce protein catabolism. Infusion or ingestion of carbohydrate or lipid will not reduce the nitrogen-sparing effect of IV amino acid infusions at this dose. Infusion at a rate of 45 mL/kg/day will meet the fluid and amino acid requirements of the stable adult patient.

Children
16 y and older

IV Amino acids 1.5 g/kg/day. Energy requirements are 30 to 60 kcal/kg/day.

13 to 5 y of age

IV Amino acids 1.7 g/kg/day. Energy requirements are 30 to 60 kcal/kg/day.

4 to 12 y of age

IV Amino acids 2 g/kg/day. Energy requirements for children between 4 and 7 y of age are approximately 75 to 90 kcal/kg/day; for children 7 to 12 y of age, 60 to 75 kcal/kg/day; and for children 12 y of age, 30 to 60 kcal/kg/day.

1 to 3 y of age

IV Amino acids 2 to 2.5 g/kg/day. Energy requirements are approximately 75 to 90 kcal/kg/day.

Clinimix

IV Amino acids 2 to 3 g/kg for infants with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance.

Concomitant Therapy

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

General Advice

  • The total daily dose depends of the daily protein and caloric requirements and on 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.
  • 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.
  • Peripheral administration of the Clinimix 4.25% in dextrose 10% product is not recommended unless fat emulsion is delivered simultaneously.
  • The infusion rate for central vein admixture of Aminosyn II 4.25% in dextrose 20% or 25% should be 2 mL/min initially and may be gradually increased.

Storage/Stability

Store at 77°F; however, brief exposure up to 104°F does not adversely affect the product. Avoid excessive heat. Protect from freezing. Protect from light until use. Any storage after mixing should be under refrigeration for as brief a time as possible, preferably less than 24 h.

Drug Interactions

Tetracycline

Tetracycline may reduce the nitrogen-sparing effects of infused amino acids.

Adverse Reactions

GI

Nausea.

Local

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

Metabolic-Nutritional

Hyperglycemia, hyperosmolar syndrome, hypervolemia.

Miscellaneous

Diuresis, fever, flushing, glycosuria.

Precautions

Warnings

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


Monitor

Monitor glucose, BUN, serum electrolytes, ammonia, cholesterol, acid-base and fluid balance, serum proteins, kidney function tests, LFTs, serum osmolarity, hemogram, CBC with differential, and carbon dioxide content. Monitor WBC and blood cultures if indicated. Monitor urine osmolality and glucose as necessary. Monitor nitrogen intake in patients with renal impairment.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Because of their concentration, these solutions are not recommended for use in children younger than 1 y. In very-low-birth-weight infants, excessive or rapid administration of dextrose may result in increased serum osmolality and possible intracerebral hemorrhage. Frequently monitor glucose, particularly in neonates and low-birth-weight infants.

Elderly

Use with caution.

Renal Function

Elevated BUN may be augmented by renal function. Electrolyte retention may occur. Use with caution in patients with anuria or renal failure.

Hepatic Function

Administration may result in plasma amino acid imbalances, metabolic alkalosis, hyperammonemia, prerenal azotemia, stupor, and/or 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. Use sodium-containing solutions with caution, if at all, in patients with CHF or severe renal insufficiency, and in clinical states in which there exists edema with sodium retention. Use potassium-containing solutions with caution, if at all, in patients with hyperkalemia or severe renal failure, and in clinical states in which potassium retention is present. Use acetate-containing solutions with caution in patients with metabolic or respiratory alkalosis and in those conditions in which there is an increased level or an impaired utilization of this ion (eg, severe hepatic insufficiency).

Sulfite Sensitivity

Some products contain 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.

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.

BUN changes

BUN may increase, especially in patients with renal or hepatic impairment. Monitor levels and discontinue infusion or reduce nitrogen content if BUN levels continue to rise inappropriately.

Diabetes

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

Fluid/Solute overload

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

Hyperammonemia

May be associated with mental retardation in infants. Monitor blood ammonia levels frequently. Instances of asymptomatic hyperammonemia have been reported in patients without overt liver dysfunction. If symptoms develop, discontinue therapy and reevalute the patient's clinical status.

Metabolic complications

These have included metabolic acidosis, hypophosphatemia, alkalosis, hypocalcemia, osteoporosis, hyperglycemia and glycosuria, hyperosmolar nonketotic states, osmotic diuresis and dehydration, elevated liver enzymes, hypo- and hypervitaminosis, electrolyte imbalances, 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/or death.

Sepsis

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

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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