Amino acids for parenteral nutrition and other mineral preparations. Solutions of amino acids in parenteral nutrition
Latin name of the substance Diphtheria anatoxin
Anatoxinum diphtericumPharmacological group of the substance Diphtheria anatoxin
Vaccines, serums, phages and toxoidsTypical clinical and pharmacological article 1
Lekforma. suspension for injection -->Characteristic. Sorbed on aluminum hydroxide.
Pharmaceutical action. Forms specific immunity against diphtheria.
Indications. Prevention of diphtheria in children from 6 years of age, adolescents and adults.
Contraindications. Hypersensitivity.
Dosing. IM into the upper outer quadrant of the buttock or the anterior outer part of the thigh or deep subcutaneously (adolescents and adults) into the subscapular region in a single dose of 0.5 ml. Before vaccination, the ampoule must be thoroughly shaken until a homogeneous suspension is obtained.
For planned age-related revaccinations, the drug is administered once to persons who have received a tetanus toxoid vaccination in connection with emergency prophylaxis of tetanus.
Side effect. Rarely (in the first 2 days) - hyperthermia, malaise, local reactions (pain, hyperemia, swelling); in isolated cases - allergic reactions (angioedema, urticaria, polymorphic rash), minor exacerbation of allergic diseases.
Special instructions. Persons who have had acute illnesses are vaccinated 2–4 weeks after recovery. In mild forms of the disease, vaccinations are allowed after the clinical symptoms disappear.
Patients with chronic diseases are vaccinated after achieving complete or partial remission. Persons with neurological changes are vaccinated after progression of the process has been ruled out. For patients with allergic diseases, vaccinations are carried out 2-4 weeks after the end of the exacerbation, while stable manifestations of the disease (localized skin phenomena, hidden bronchospasm, etc.) are not contraindications to vaccination, which can be carried out against the background of appropriate therapy.
Immunodeficiencies, HIV infection, as well as maintenance course therapy (including corticosteroids and neurotropic drugs) are not contraindications to vaccination.
Pregnant women are vaccinated according to epidemiological indications.
In order to identify contraindications, on the day of vaccination, the doctor conducts a survey of parents and examines those vaccinated with mandatory thermometry. When vaccinating adults, preliminary selection of persons to be vaccinated is allowed, with their interview by the medical worker conducting the vaccination on the day of vaccination. Persons temporarily exempt from vaccination must be monitored and registered and vaccinated in a timely manner. If epidemiologically necessary, the drug can be administered against the background of an acute illness.
In case of a strong reaction to the previous dose of this drug, a second dose is administered while using GCS (prednisolone orally 1–1.5 mg/kg/day the day before and immediately after vaccination).
The drug can be administered a month later or simultaneously with the polio vaccine and other drugs in the national vaccination calendar.
Considering the possibility of developing immediate allergic reactions in particularly sensitive individuals, vaccinated individuals must be provided with medical supervision for 30 minutes. Vaccination sites must be provided with anti-shock therapy.
For persons who have suffered severe forms of allergic reactions to the administration of the drug, further scheduled vaccinations of the drug are stopped.
The drug is not suitable for use in ampoules with damaged integrity, lack of labeling, changes in physical properties (change in color, presence of unbreakable flakes), or improper storage.
The opening of ampoules and the vaccination procedure are carried out in strict compliance with the rules of asepsis and antiseptics. The drug cannot be stored in an opened ampoule.
The administration of the drug is registered in the established accounting forms, indicating the batch number, expiration date, manufacturer, and date of administration.
State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; part 2 - 560 s.
Amino acids for parenteral nutrition + Other drugs [Minerals]Latin name
Aminoacids for parental nutrition + Other medicinesPharmacological group
Proteins and amino acids in combinationsCombinations of enteral and parenteral nutrition products
Typical clinical and pharmacological article 1
Pharmaceutical action. Infusion solution for parenteral nutrition.
Indications. Conditions accompanied by protein deficiency. Parenteral nutrition for protein deficiency, incl. in newborns and premature babies; replenishment of blood volume during bleeding, burns, and surgical interventions.
Contraindications. Hypersensitivity, acute renal failure with hyperazotemia, liver failure, metabolic disorders of amino acids, fructose and sorbitol, fructose intolerance, methanol intoxication, hyperhydration, acute head injury.
With caution. CHF, acidosis, hyperkalemia.
Dosing. IV drip. Adults: at the rate of 0.6-1 g of amino acids (up to 25 ml of infesol) per kg/day; in catabolic conditions - at the rate of 1.3-2 g of amino acids (up to 50 ml) per kg/day. Children: at the rate of 1.5-2.5 g of amino acids (up to 60 ml) per kg/day. If the body’s need for fluid and calories is higher, then the drug can be supplemented with electrolyte solution “75”, solutions of dextrose, invert sugar, sorbitol, etc., alternating them or administering them simultaneously.
Side effect. Rarely - nausea, vomiting, chills, phlebitis, allergic reactions, hyperbilirubinemia, increased activity of liver transaminases.
Interaction. The solution cannot be mixed with other drugs.
Special instructions. For chronic renal failure, hyperkalemia, shock, use only after achieving sufficient diuresis. Too high a rate of drug administration can lead to hyperkalemia and ammonia intoxication in infants.
State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; part 2 - 560 s.
Interactions with other active ingredients
| Amikacin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with amikacin. |
| Aminophylline* | Simultaneous administration of arginine as part of a combination of amino acids for parenteral nutrition + other drugs [mineral salts] with aminophylline increases the level of insulin in the blood. The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with aminophylline. |
| Ampicillin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with ampicillin. |
| Vancomycin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with vancomycin. |
| Gentamicin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with gentamicin. |
| Digoxin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with digoxin. |
| Doxycycline* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with doxycycline. |
| Calcium gluconate | The combination of amino acids for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with calcium gluconate. |
| Clindamycin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with clindamycin. |
| Lidocaine* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with lidocaine. |
| Methyldopa* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with methyldopa. |
| Methylprednisolone* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with methylprednisolone. |
| Metoclopramide* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with metoclopramide. |
| Methotrexate* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with methotrexate. |
| Morphine | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with morphine. |
| Netilmicin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with netilmicin. |
| Nizatidine* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with nizatidine. |
| Norepinephrine* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with norepinephrine. |
| Piperacillin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with piperacillin. |
| Propranolol* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with propranolol. |
| Ranitidine* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with ranitidine. |
| Riboflavin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with riboflavin. |
| Spironolactone* | The interaction of arginine in a combination of amino acids for parenteral nutrition + other drugs [mineral salts] with spironolactone may increase severe hyperkalemia. |
| Tetracycline* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with tetracycline. |
| Thiopental sodium* | Arginine as part of a combination of amino acids for parenteral nutrition + other drugs [mineral salts] is not compatible with sodium thiopental. |
| Tobramycin* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with tobramycin. |
| Famotidine* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with famotidine. |
| Folic acid* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with folic acid. |
| Fluorouracil* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with fluorouracil. |
| Furosemide* | |
| Chloramphenicol* | The combination of amino acid for parenteral nutrition + other drugs [mineral salts] is pharmaceutically compatible with chloramphenicol. |
Russian name
Amino acids for parenteral nutrition + Other preparations [Fat emulsions for parenteral nutrition + Dextrose + Minerals]Latin name of substances Amino acids for parenteral nutrition + Other preparations [Fat emulsions for parenteral nutrition + Dextrose + Minerals]
Aminoacids for parenteral nutrition+Other medicines ( genus.)Pharmacological group of substances Amino acids for parenteral nutrition + Other drugs [Fat emulsions for parenteral nutrition + Dextrose + Minerals]
Typical clinical and pharmacological article 1
Pharmaceutical action. The three-component mixture is designed to support protein and energy metabolism. L-amino acids serve as a source of organic nitrogen; dextrose and fatty acids act as an energy source. In addition, the mixture contains electrolytes. Replenishes the deficiency of essential fatty acids in the body. Olive oil contains a significant amount of alpha-tocopherol, which, in combination with a small amount of polyunsaturated fatty acids, increases the level of vitamin E in the body and reduces lipid peroxidation.
Pharmacokinetics. The ingredients of the infusion emulsion (amino acids, electrolytes, dextrose, lipids) are metabolized and excreted from the body in the same way as when administered separately. The pharmacokinetic properties of amino acids administered intravenously generally coincide with the properties of amino acids supplied through natural (enteral) nutrition (however, in this case, amino acids obtained from food proteins pass through the liver before entering the systemic circulation). The rate of elimination of lipid emulsion particles depends on their size. Small lipid particles are excreted more slowly, but they are quickly broken down by lipoprotein lipase. The size of the lipid emulsion particles in the preparation approaches the size of chylomicrons, so they have a similar elimination rate.
Indications. Parenteral nutrition.
Contraindications. Hypersensitivity, severe renal failure in the absence of hemofiltration or dialysis, severe liver failure, congenital disorders of amino acid metabolism, severe blood coagulation disorders, severe hyperlipidemia, hyperglycemia, electrolyte metabolism disorders, increased plasma concentration of one of the electrolytes included in the mixture, lactic acidosis, pulmonary edema, overhydration, decompensated heart failure, hypotonic dehydration, unstable conditions (including severe post-traumatic conditions, decompensated diabetes mellitus, acute phase of hypovolemic shock, acute phase of myocardial infarction, severe metabolic acidosis, severe sepsis, hyperosmolar coma), childhood (up to 2 years).
With caution. Plasma hyperosmolarity, adrenal insufficiency, heart failure, lung diseases, pregnancy, lactation.
Dosing. IV (via the central vein). The dose of the drug and duration of administration are determined by the need for parenteral nutrition in each individual patient, depending on his condition. Adults: average organic nitrogen requirement is 0.16-0.35 g/kg/day (approximately 1-2 g amino acids/kg/day); The energy requirement varies depending on the patient’s condition and the intensity of catabolic processes, on average it is 25-40 kcal/kg/day. The maximum daily dose is 36 ml/kg body weight (equivalent to 1.44 g of amino acids, 5.76 g of dextrose and 1.44 g of lipids per 1 kg of body weight), i.e. 2520 ml of emulsion for a patient weighing 70 kg.
Children over 2 years of age: the average requirement for organic nitrogen is 0.35-0.45 g/kg/day (approximately 2-3 g amino acids/kg/day); energy requirement - 60-110 kcal/kg/day. The dose depends on the amount of fluid entering the body and the daily protein requirement. In this case, the state of water metabolism should be taken into account. The maximum daily dose is 75 ml/kg (equivalent to 3 g of amino acids, 12 g of dextrose and 3 g of lipids per 1 kg of body weight). The dose should not exceed 3 g/kg/day of amino acids and/or 17 g/kg/day of dextrose and/or 3 g/kg/day of lipids (except in special cases).
The infusion rate should not exceed 1.5 ml/kg/h, i.e. no more than 0.06 g of amino acids, 0.24 g of dextrose and 0.06 g of lipids per 1 kg/hour.
Rules for preparing the solution: before mixing, you must ensure the integrity of the container and partitions between sections and heat the preparation to room temperature. Use only if the container is not damaged and the integrity of the partitions between the sections is not broken (i.e. the contents of the three sections have not been mixed), while the solutions of amino acids and dextrose should be transparent and the emulsion homogeneous. Manually rotate the top of the container (from which it is suspended) around its axis. The partitions will disappear from the side of the future inlet. Twist the top until the partitions open for at least half their length. Mix the solutions by turning the container over (at least 3 times).
Side effect. Hyperthermia, sweating, tremor, nausea, headache, respiratory failure; sometimes (especially with long-term use - for several weeks) - a temporary increase in the concentration of biochemical markers of liver function (including alkaline phosphatase, transaminases, bilirubin); in rare cases - hepatomegaly, jaundice, thrombocytopenia in children, severe allergic reaction (contains soybean oil), with a reduced ability to eliminate lipids from the bloodstream or at an administration rate exceeding the recommended one (at the beginning of the infusion) - “fat overload” syndrome (hyperlipidemia, fever, fatty liver, hepatomegaly, anemia, leukopenia, thrombocytopenia, coagulation disorders, coma).
Overdose. Symptoms: hypervolemia, acidosis, nausea, vomiting, tremor, electrolyte imbalance, fat overload syndrome, hyperglycemia, glycosuria and hyperosmolar syndrome.
Treatment: administration is stopped immediately; in severe cases, hemodialysis, hemofiltration or hemodiafiltration may be required.
Interaction. Pharmaceutically incompatible with blood products, compatible with solutions of vitamins, microelements, organic phosphates, electrolytes.
Special instructions. The drug should not be administered through a peripheral vein.
Correction of water and electrolyte imbalances, as well as metabolic disorders, must be carried out before the start of the infusion.
Since the drug does not contain vitamins and microelements, when adding them, the doses of these substances (depending on the need) should be determined before the infusion and the osmolarity of the resulting solution should be calculated.
The drug should be used immediately after opening the container and should not be stored for the next infusion.
During the entire course of treatment, monitoring of water and electrolyte balance, plasma osmolarity, CBS, blood glucose and liver function tests is necessary.
Plasma TG concentrations and the ability to remove lipids from the bloodstream should be assessed regularly. The serum TG concentration during infusion should not exceed 3 mmol/l. Their concentration should be measured no earlier than 3 hours after the start of the infusion. If a disorder of lipid metabolism is suspected, it is recommended to repeat the same tests 5-6 hours after stopping the administration of the emulsion. In adults, lipid elimination should occur less than 6 hours after stopping the lipid emulsion infusion. The next infusion should be carried out only after the plasma TG concentration has normalized.
Regular clinical examination should be carried out for liver failure (due to the risk of onset or worsening of neurological disorders associated with hyperammonemia), renal failure (especially with hyperkalemia - risk of onset or worsening metabolic acidosis, hyperazotemia in the absence of hemofiltration or dialysis), diabetes mellitus (control of glucose concentration, glucosuria, ketonuria and insulin dose correction), blood coagulation disorders, anemia, hyperlipidemia.
With long-term use (several weeks), blood counts and coagulogram should be monitored.
When selecting a dose, you should focus on the child’s age, protein and energy needs, as well as the disease. If necessary, proteins and/or “energy” components (carbohydrates, lipids) should be added enterally. For parenteral nutrition in children over 2 years of age, it is advisable to choose the container volume in accordance with the daily dose. The addition of vitamins and microelements must be carried out in doses used in pediatrics according to age needs.
The infusion emulsion should not be administered in parallel with blood products through the same catheter due to the possibility of pseudoagglutination. If blood sampling was carried out before lipids were eliminated from the plasma (usually 5-6 hours after stopping the administration of the emulsion), then the lipids contained in the emulsion may affect the results of some laboratory tests (including bilirubin, LDH, oxygen saturation , Hb).
Currently, there is no reliable data on the use of the drug in pregnant women and nursing mothers; in such cases, the balance between the benefit to the mother and the potential risk to the fetus should be assessed.
Additional nutrients (including vitamins) can be added to the finished mixture. Vitamins can also be added to the dextrose solution section before the contents of the sections are mixed. The following components can be added to the prepared drug solution: electrolytes (the stability of the emulsion was maintained by adding no more than 150 mmol Na +, 150 mmol K +, 5.6 mmol Mg 2+ and 5 mmol Ca 2+ per 1 liter of the finished mixture), organic phosphates (the stability of the emulsion was maintained when adding up to 15 mmol per 1 packet), microelements and vitamins (the stability of the emulsion was maintained when adding doses not exceeding daily doses).
Russian name
Amino acids for parenteral nutrition + Other drugs [Dextrose + Minerals]Latin name of substances Amino acids for parenteral nutrition + Other drugs [Dextrose + Minerals]
Aminoacids for parenteral nutrition+Other medicines ( genus.)Pharmacological group of substances Amino acids for parenteral nutrition + Other drugs [Dextrose + Minerals]
Typical clinical and pharmacological article 1
Pharmaceutical action. Supplies the body with a substrate for protein synthesis and energy through glucose during parenteral nutrition. Amino acids enter the intravascular and intracellular depots of endogenous free amino acids; ensure the maintenance of homeostasis. Dextrose is involved in various metabolic processes in the body, enhances redox processes in the body, and improves the antitoxic function of the liver. Entering the tissues, it is phosphorylated, turning into glucose-6-phosphate, which is involved in many parts of the body’s metabolism.
Indications. Parenteral nutrition: preoperative preparation, conditions after major surgical interventions, moderate and severe injuries, burns; inflammatory and destructive bowel diseases (including Crohn's disease, intestinal fistulas), malabsorption syndrome, cachexia, cancer, sepsis, peritonitis, acute pancreatitis.
Contraindications. Hypersensitivity, pulmonary edema, amino acid metabolism disorders; hyperkalemia, hyponatremia; metabolic disorder, coma of unknown etiology, hyperglycemia, uncontrolled by doses of insulin up to 6 U/h, acidosis, severe hepatic and/or renal failure without hemodialysis, collapse, shock, severe tissue hypoxia, hypervolemia, water-electrolyte imbalance, CHF in the early stages . decompensation, lactation period, children's age (up to 2 years).
With caution. Pregnancy.
Dosing. IV infusion. Immediately before administration, solutions of amino acids, glucose and electrolytes should be mixed. The maximum daily dose is 40 ml/kg, which corresponds to 1.6 g of amino acids and 3.2 g of glucose.
The maximum infusion rate is 2 ml/kg/h, which corresponds to 0.08 g of amino acids and 0.16 g. The course of treatment is no more than 7 days.
Side effect. Allergic reactions, chills, nausea, vomiting, increased diuresis.
Overdose. Symptoms: hypertensive overhydration, water and electrolyte imbalance, pulmonary edema; loss of amino acids in the urine with the development of amino acid imbalance, vomiting, tremor; hyperglycemia, glycosuria, dehydration, plasma hyperosmolarity, hyperglycemic or hyperosmolar coma.
Treatment: administration of the solution is stopped. Further therapy is selected individually depending on the severity of symptoms. The infusion may be resumed later at a slower rate with frequent monitoring.
Interaction. When adding other solutions or lipid emulsions to the drug, compatibility must be taken into account.
Special instructions. Nutriflex 40/80 is intended for administration into peripheral veins.
If necessary, lipid emulsions can be added to the preparation by introducing them into the prepared solution through a special port located on the top of the bag. If you need to add other ingredients to the finished solution, you must use the addition port located below. All ingredients must be added in compliance with the rules of asepsis and taking into account their compatibility.
When carrying out therapy, it is necessary to take into account the condition of the veins and periodically change the site of injection of the solution.
Before starting the infusion, the water-electrolyte balance and blood CBS should be adjusted. Rapid administration of the drug can lead to volume overload and disruption of water and electrolyte balance.
During the treatment period, it is necessary to monitor the concentration of glucose, water-electrolyte balance and blood CBS, as well as liver function indicators. If hyperglycemia occurs, the injection rate must be reduced or an appropriate dose of insulin must be administered. IV administration of amino acid solutions is accompanied by increased excretion of trace elements in the urine, especially Cu 2+ and Zn 2+. This must be taken into account when selecting doses of microelements, especially during long-term therapy.
Pseudoagglutination is possible, and therefore it is not recommended to use the same infusion systems for administering blood products and multicomponent amino acid solutions.
The drug should be used immediately after mixing solutions of glucose and amino acids.
The drug is supplied in double plastic containers designed for single use. Do not use if the solution is not transparent, the container is damaged or its seal is broken. Unused drug cannot be stored and must be destroyed.
State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; part 2 - 560 s.
Interactions with other active ingredients
Trade names
| Name | The value of the Vyshkowski Index ® |
