FreAmine HBC Dosage
Generic name: ISOLEUCINE 0.76g in 100mL, LEUCINE 1.37g in 100mL, LYSINE ACETATE 0.41g in 100mL, METHIONINE 0.25g in 100mL, PHENYLALANINE 0.32g in 100mL, THREONINE 0.2g in 100mL, TRYPTOPHAN 0.09g in 100mL, VALINE 0.88g in 100mL, ALANINE 0.4g in 100mL, ARGININE 0.58g in 100mL, HISTIDINE 0.16g in 100mL, PROLINE 0.63g in 100mL, SERINE 0.33g in 100mL, GLYCINE 0.33g in 100mL, CYSTEINE HYDROCHLORIDE 0.014g in 100mL
Dosage form: injection, solution
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The total daily dose of 6.9% FreAmine HBC® (Amino Acid Injection) depends on daily protein requirements and on the patient's metabolic and clinical response. The determination of nitrogen balance and accurate daily body weights, corrected for fluid balance, are probably the best means of assessing individual protein requirements.
While Recommended Dietary Allowances of protein are approximately 0.8 g/kg of body weight for a healthy adult, it must be recognized that protein as well as caloric requirements in traumatized or malnourished patients may be substantially increased. Daily amino acid doses of approximately 1.5 g/kg of body weight for adults with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance. Higher doses may be required in severely catabolic states. Such higher doses must be accompanied by frequent laboratory evaluation. Fat emulsion may be supplied to help meet energy requirements.
Fat emulsion coadministration should be considered when prolonged (more than 5 days) 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 TPN.
The provision of sufficient intracellular electrolytes, principally potassium, magnesium, and phosphate, is also required for optimum utilization of amino acids. Approximately 60 – 180 mEq of potassium, 10 – 30 mEq of magnesium, and 20 – 80 mEq of phosphate per 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 precursor. The electrolyte content of 6.9% FreAmine HBC® 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, vitamins, especially the water soluble vitamins, and trace elements should also be provided.
Central Venous Nutrition
For severely catabolic, depleted patients or those requiring long-term total parenteral nutrition, central venous nutrition should be considered. Total parenteral nutrition may be started with infusates containing lower concentrations of dextrose; dextrose content may be gradually increased to estimated caloric needs as the patient's glucose tolerance increases.
In adults, strongly hypertonic mixtures of amino acids and dextrose may be safely administered only by continuous infusion through a central venous catheter with the tip located in the vena cava. A mixture of 750 mL 6.9% FreAmine HBC® (Amino Acid Injection) solution, and 250 mL 70% Dextrose, supplemented with electrolytes, and vitamins may be administered over an 8-hour period. If administration rate should fall behind schedule, no attempt to "catch up" to planned intake should be made. In addition to meeting protein needs, the administration rate is also governed, especially during the first few days of therapy by the patient's glucose tolerance. Daily intake of amino acids and dextrose should be increased gradually to the maximum required dose as indicated by frequent determination of urine and blood sugar levels. In many patients, provision of adequate calories in the form of hypertonic dextrose may require the administration of exogenous insulin to prevent hyperglycemia and glycosuria. To prevent rebound hypoglycemia, a solution containing 5% Dextrose should be administered when hypertonic dextrose infusions are abruptly discontinued.
Peripheral Parenteral Nutrition
For moderately catabolic, depleted patients requiring parenteral nutrition in whom the central venous route is not indicated, diluted 6.9% FreAmine HBC® with minimal caloric supplementation may be infused by peripheral vein, supplemented, if desired, with fat emulsion. In pediatric patients, the final solution should not exceed twice normal serum osmolarity (718 mOsmol/L).
Fat provides approximately 9 kcal per gram and parenteral fat emulsion may be administered along with amino acid-dextrose solutions through a Y-type administration set to supplement caloric intake. Fat, however, should not provide more than 60% of the total caloric intake.
Use of 6.9% FreAmine HBC® in pediatric patients is governed by the same considerations that affect the use of any amino acid solution in pediatrics. The amount administered is dosed on the basis of grams of amino acids/kg of body weight/day. Two to three g/kg of body weight for infants with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance. Solutions administered by peripheral vein should not exceed twice normal serum osmolarity (718 mOsmol/L). See WARNINGS and PRECAUTIONS, Pediatric Use.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
6.9% FreAmine HBC® may be admixed with solutions which contain phosphate or which have been supplemented with phosphate. The presence of calcium and magnesium ions in an additive solution should be considered when phosphate is also present, in order to avoid precipitation.
Care must be taken to avoid incompatible admixtures. Consult with pharmacist.