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Amino Acid Formulations for High Metabolic Stress
Pronunciation: a-MEE-noe AS-id
Class: Amino acid combinations
- Injection, solution 7%
FreAmine HBC 6.9%
- Injection, solution 6.9%
Promotes protein synthesis.
Indications and Usage
IV nutritional therapy to prevent nitrogen loss or treat negative nitrogen balance in catabolic or depleted patients.
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 AdministrationAdults
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.
- 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.
Store between 68° and 77°F. Avoid excessive heat. Protect from freezing. Protect from light until use.
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.
Erythema, extravasation, infection at the injection site, phlebitis extending from the injection site, thrombosis, warm sensation.
Fever, flushing, hypervolemia.
Administration by central venous catheter is only to be used by those familiar with this technique and its complications.
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.
Category C .
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.
Use with caution.
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.
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.
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.
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.
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.
Use special care when giving hypertonic glucose to diabetic or prediabetic patients. Insulin may be required to prevent severe hyperglycemia.
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.
Provide exogenous calories concurrently with amino acids in patients receiving long-term total nutrition or if the patient has inadequate fat stores.
May occur and result in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema.
Discontinue if symptoms of hyperammonemia occur.
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.
In patients with MI, accompany amino acid infusion with dextrose.
The constant risk of sepsis is present during central venous nutrition.
- Advise patient that medication will be prepared and administered by a health care provider in a hospital setting.
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