Crystalline Amino Acids

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

Trade Names

Aminosyn
- Injection, solution 3.5%
- Injection, solution 5%
- Injection, solution 7%
- Injection, solution 8.5%
- Injection, solution 10%

Aminosyn II
- Injection, solution 3.5%
- Injection, solution 5%
- Injection, solution 7%
- Injection, solution 8.5%
- Injection, solution 10%
- Injection, solution 15%

Aminosyn-PF
- Injection, solution 7%
- Injection, solution 10%

Clinisol 15%
- Injection, solution 15%

FreAmine III
- Injection, solution 8.5%
- Injection, solution 10%

Premasol
- Injection, solution 6%
- Injection, solution 10%

Travasol 10%
- Injection, solution 10%

TrophAmine
- Injection, solution 6%
- Injection, solution 10%

Pharmacology

Provides crystalline amino acids to promote protein synthesis and wound healing, and to reduce the rate of endogenous protein catabolism.

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Indications and Usage

IV nutritional therapy to prevent nitrogen loss or treat negative nitrogen balance; protein-sparing therapy.

Contraindications

Anuria; hepatic coma; hypersensitivity to 1 or more amino acids in the solution.

Aminosyn, Aminosyn II

Metabolic disorders involving impaired nitrogen utilization.

Aminosyn PF, Premasol, TrophAmine, FreAmine III 10%

Inborn errors of amino acid metabolism.

Clinisol, Travasol

Severe liver disease; metabolic disorders involving impaired nitrogen utilization ( Clinisol only).

FreAmine III 8.5%

Hepatic encephalopathy; inborn errors of amino acid metabolism.

Dosage and Administration

Individualize dosing. See manufacturers' prescribing information for product-specific recommendations.

Concomitant Therapy

May include dextrose/insulin, fat emulsion, electrolyte supplementation, and 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. Store admixtures under refrigeration and use within 24 h of admixing.

Drug Interactions

Tetracycline

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

Adverse Reactions

GI

Nausea.

Lab Tests

Elevated liver enzymes, increase in BUN.

Local

Erythema, extravasation, infection at the injection site, local inflammatory reactions, phlebitis, venous thrombosis, warm sensation.

Metabolic-Nutritional

Dehydration, edema, electrolyte imbalance, glycosuria, hyperammonemia, hyperglycemia, hyperosmolar nonketotic states, hypervolemia, hypocalcemia, hypophosphatemia, hypo- and hypervitaminosis, metabolic acidosis and alkalosis, osmotic diuresis, osteoporosis, rebound hypoglycemia, water weight gain.

Miscellaneous

Coma, fever, flushing, sepsis.

Precautions

Warnings

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


Monitor

Monitor glucose, acid-base and fluid balance, serum proteins, pH, hematocrit, WBC, kidney and liver function, electrolytes, hemogram, carbon dioxide content, serum osmolarity, blood cultures, and blood ammonia levels (frequently in infants). Monitor urine osmolality and glucose as necessary. Monitor nitrogen intake in patients with renal impairment.


Pregnancy

Category C .

Lactation

Undetermined.

Children

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. For neonates and very small infants, particularly careful monitoring will be required to maintain fluid and electrolyte balance, including monitoring of blood glucose.

Elderly

Use with caution.

Renal Function

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

Hepatic Function

Administration may result in coma, hyperammonemia, metabolic alkalosis, plasma amino acid imbalances, prerenal azotemia, and stupor.

Special Risk Patients

Use with caution in patients with a history of renal or 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 those with 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 those with clinical states in which potassium retention is present. Use acetate-containing solutions with caution in patients with metabolic or respiratory alkalosis and in those with conditions in which there is an increase 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.

Cardiovascular considerations

Avoid circulatory overload, particularly in patients with cardiac insufficiency. In patients with MI, ensure that amino acids are always accompanied by dextrose.

Diabetes

Use special care when giving dextrose 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. Some products do not contain phosphorous; add phosphate (and calcium) as indicated.

Essential fatty acid deficiency

May develop during long-term (more than 5 days) TPN. May be prevented by the use of fat emulsion 4% to 10% of total caloric intake as linoleic acid.

Exogenous calories

Provide exogenous calories concurrently with amino acids in patients receiving long-term TPN 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

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, reduce dosage and titrate against serum ammonia levels.

Metabolic acidosis

May be prevented or controlled by adding the acetate salts of a portion of the electrolytes. Keeping the chloride content to a minimum may prevent or treat hyperchloremic acidosis.

Metabolic complications

These have included alkalosis, electrolyte imbalances, elevated liver enzymes, hyperammonemia in children, hyperglycemia and glycosuria, hyperosmolar nonketotic states, hypo- and hypervitaminosis, hypocalcemia, hypophosphatemia, metabolic acidosis, osmotic diuresis and dehydration, and osteoporosis. Monitor frequently, especially the first few days of therapy. Administration of glucose at a rate exceeding the patients utilization may lead to hyperglycemia, coma, and death.

Protein-sparing therapy

Useful for periods of 10 to 12 days. Place patients requiring nutritional support thereafter on oral or parenteral regimens that include adequate nonprotein calorie components.

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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