Amino Acid Formulations for Renal Failure
Pronunciation: a-MEE-noe AS-id
Class: Amino acid combinations
- Injection, solution 5.2%
- Injection, solution 5.4%
Administration of essential amino acids to uremic patients results in the utilization of retained urea in protein synthesis. As a result, BUN levels may decrease and many symptoms of azotemia may resolve.
Indications and Usage
IV nutritional support for patients with uremia or those with potentially reversible acute renal failure.
Severe, uncorrected electrolyte and acid-base imbalance; hyperammonemia; decreased circulating blood volume; inborn errors of amino acid metabolism ( NephrAmine only); hypersensitivity to 1 or more amino acids in the solution ( NephrAmine only).
Dosage and AdministrationAdults Aminosyn-RF
IV 300 to 600 mL/day. Higher dosages may be administered cautiously if more nitrogen and calories are required in severely stressed patients in acute renal failure who cannot eat.NephrAmine
IV 250 to 500 mL/day.Children
IV 0.5 to 1 g of essential amino acids/kg per day will meet the requirements of the majority of children. Initial daily dosage should be low and increased slowly. Frequent laboratory and clinical monitoring is strongly recommended, especially in very young patients, to avoid clinically significant elevations of serum ammonia and plasma amino acid levels. Max dosage is 1 g/kg/day.Concomitant Therapy
May include dextrose/insulin, fat emulsion, electrolyte supplementation, and vitamins.
- Guide dosage by fluid, glucose, and nitrogen tolerances, as well as the patient's metabolic and clinical response.
- Hypertonic admixtures may be administered by continuous infusion through a central venous catheter with the tip located in the superior vena cava. Solutions administrated 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.
- Incompatibilities: Potentially incompatible ions (calcium, phosphate) may be added to alternative infusion bottles to avoid precipitation.
- Initial infusion rates for central venous administration should be slow, generally 20 to 30 mL/h for the first 6 to 8 h. Increments of 10 mL/h for each hour are suggested to a max rate of 60 to 100 mL/h.
Store between 68° and 77°F. Avoid excessive heat. Protect from freezing. Protect from light until use.
None well documented.
Infection at the injection site.
Hyperammonemia; hypermethionemia; hypervolemia; metabolic, fluid, electrolyte, and acid-base imbalances; phosphorous deficiency.
Administration by central venous catheter is only to be used by those familiar with this technique and its complications.
Monitor glucose, urea nitrogen, serum electrolytes, ammonia, cholesterol, acid-base balance, serum proteins, kidney and liver function, serum osmolarity, and hemogram.
Category C .
Use with caution, especially in low-birth-weight infants. Frequently monitor glucose because of the risk of hyperglycemia. Elevated plasma amino acid levels (eg, hypermethionemia) and hyperammonemia may occur; consider amino acid formulations developed specifically for infants and children.
Use with caution; more prone to fluid overload and electrolyte imbalance.
Amino acid injection does not replace dialysis and conventional supportive therapy in patients with renal failure. Monitor fluid balance to avoid circulatory overload, particularly in association with cardiac insufficiency.
May result in plasma amino acid imbalances, hyperammonemia, or CNS deterioration. Use with caution.
Special Risk Patients
Use solutions containing acetate ion with great care in patients with metabolic or respiratory alkalosis.
NephrAmine 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.
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.
Use special care when giving hypertonic glucose to diabetic or prediabetic and uremic patients. Insulin may be required to prevent severe hyperglycemia.
Hypokalemia, hypophosphatemia, or hypomagnesemia may occur. Electrolyte replacement therapy may be necessary.
Essential fatty acid deficiency
Essential fatty acid deficiency (EFAD) may occur in patients on long-term TPN. The use of fat emulsion to provide 4% to 10% of total caloric intake as linoleic acid may prevent EFAD.
Provide exogenous calories concurrently with amino acids in patients receiving long-term total nutrition or if the patient has inadequate fat stores. Administration of amino acids without carbohydrates may result in the accumulation of ketone bodies in the blood.
May occur and result in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema.
May be associated with mental retardation in infants. Monitor blood ammonia levels frequently.
These have included metabolic acidosis, hypophosphatemia, alkalosis, 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 infants and 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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