Generic name: amino acid
Dosage form: Injection Pharmacy Bulk Package
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Fat emulsion coadministration should be considered when prolonged (more than 5 days) parenteral nutrition is required in order to prevent essential fatty acid deficiency (EFAD). Serum lipids should be monitored for evidence of EFAD in patients maintained on fat free TPN.
The total daily dose of RenAmin® (Amino Acid) Injection depends on the patient's metabolic requirement 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 nitrogen requirements.
Nutritional management of renal decompensation includes providing sufficient amino acid and caloric support for protein synthesis while not exceeding renal capacity for excretion of metabolic wastes. A dosage of 2.5 to 5.0 grams of nitrogen per day with adequate calories will maintain nitrogen equilibrium in most patients with uremia. If more nitrogen and calories are required, higher dosages may be administered, provided great care is taken to avoid exceeding limits of fluid intake or glucose tolerance.
Dosage should be guided by fluid, glucose and nitrogen tolerances, as well as metabolic and clinical responses. The rate of increase in blood urea nitrogen concentration generally diminishes when infusion of amino acids is accompanied by adequate calories. However, excessive intake of protein or increased protein catabolism may alter this response.
Patients receiving RenAmin® (Amino Acid) Injection should be monitored carefully and their electrolyte requirements individualized. Electrolyte supplementation may be required. This injection contains approximately 60 mEq acetate and 31 mEq chloride.
Electrolyte (phosphorous, potassium and magnesium) concentrations usually fall during administration of RenAmin® (Amino Acid) Injection. Particular care should be taken in the presence of cardiac arrhythmias or digitalis toxicity to assure that these electrolytes are supplemented when necessary.
Pediatric requirements vary depending upon growth, nutritional state and degree of renal insufficiency. A dosage of 0.5 to 1.0 gram of amino acids per kilogram body weight per day will meet the requirements of the majority of pediatric patients. Initial daily dosage should be low and increased slowly. More than one gram of essential amino acids per kilogram of body weight per day is not recommended. The total volume of nutritional solution, and the rate at which it is administered, will vary with the child’s age, nutritional and growth state, as well as the degree of renal failure. See Special Precautions in Pediatric Patients for additional information.
Central Vein Administration:
Hypertonic mixtures of amino acids and dextrose may be administered safely by continuous infusion through a central vein catheter with the tip located in the vena cava. In addition to meeting nitrogen needs, the administration rate is governed, especially during the first few days of therapy, by the patient's tolerance to dextrose. Daily intake of amino acids and dextrose should be increased gradually to the maximum required dose as indicated by frequent determinations of urine and blood sugar levels.
Uremic patients frequently are glucose intolerant. Provision of adequate calories in the form of hypertonic dextrose may require the administration of exogenous insulin to prevent hyperglycemia and glycosuria.
Parenteral nutrition may be started at lower administration rates and with infusates containing lower concentrations of dextrose; dextrose content and rate may be gradually increased to estimated caloric needs as the patient’s glucose tolerance increases. The patient’s fluid, nitrogen and glucose tolerance should be the determining factor of the rate of administration.
Peripheral Vein Administration:
For patients requiring parenteral nutrition in whom the central vein route is not indicated, this injection can be mixed with low concentration dextrose solutions and administered by peripheral vein with fat emulsions.
Intravenous fat emulsions provide approximately 1.1 kcal/mL (10%) or 2.0 kcal/mL (20%) and may be administered along with amino acid-dextrose solutions through a short Y-connector near the infusion site to supplement caloric intake. Fat, however, should not be the sole caloric intake since studies have indicated that glucose is more nitrogen sparing in the stressed patient.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Use of a final filter is recommended during administration of all parenteral solutions where possible.
RenAmin® (Amino Acid) Injection in the Pharmacy Bulk Package is intended for use in the preparation of sterile, intravenous admixtures. Additives may be incompatible with the fluid withdrawn from this container. Complete information is not available. Those additives known to be incompatible should not be used. Consult with pharmacist, if available. When compounding admixtures, use aseptic technique. Mix thoroughly. Do not store any unused portion of RenAmin® (Amino Acid) Injection.