Indications
This is a sterile intravenous (IV) nutrition product that combines amino acids (the building blocks of protein), glucose (sugar for energy) and electrolytes (salts such as sodium, potassium, magnesium, calcium and phosphate). Some versions also contain a fat emulsion in a separate chamber. It is used as parenteral nutrition, that is feeding through a vein, for patients who cannot eat or absorb enough food through the gut, for example after major surgery, in severe illness, bowel failure or serious burns.
How It Works
The solution delivers nutrients straight into the bloodstream. Amino acids are used to build and repair body proteins such as muscle and to support healing and immunity. Glucose provides energy so that the body does not break down its own protein for fuel. Electrolytes keep the body’s salt and fluid balance and support nerve, muscle and heart function.
Dosage and Administration
Given only in hospital by doctors and nurses. The amount and infusion rate are calculated for each patient according to body weight, medical condition, fluid needs and blood test results, and are given as prescribed. Multi-chamber bags must be mixed by breaking the seals before use. Depending on the concentration, it is infused into a large central vein or a peripheral vein, usually slowly over 12 to 24 hours. Vitamins and trace elements are usually added separately.
Interactions
Only compatible additives should be mixed into the bag, under pharmacy guidance, as some medicines can cause precipitation or break the emulsion. Insulin may be needed if blood sugar rises. Care is needed with medicines that affect potassium, such as potassium-sparing diuretics, ACE inhibitors and Ciclosporin. Ceftriaxone must not be given in the same line with calcium-containing solutions.
Contraindications
Not used in people with inborn errors of amino acid metabolism, severe uncontrolled high blood sugar, severe liver failure or coma, severe kidney failure without dialysis, shock or unstable circulation, fluid overload, high levels of electrolytes in the blood that the solution contains, or known allergy to any component (for example egg, soy or fish protein if a fat emulsion is included).
Side Effects
Possible effects include high or low blood sugar, electrolyte and fluid imbalance, nausea, fever, irritation or inflammation of the vein at the infusion site, and, with long-term use, liver changes. Infection of the IV line is a serious risk. Refeeding syndrome (dangerous shifts in phosphate, potassium and magnesium) can occur when feeding is started in severely malnourished patients.
Staff should be told straight away about fever or chills, pain, redness or swelling at the drip site, shortness of breath, chest pain, rash, confusion or swelling of the legs, as these need urgent medical attention.
Pregnancy and Lactation
It may be used in pregnancy and breastfeeding when the doctor decides that IV nutrition is needed, with careful monitoring.
Precautions and Warnings
- Blood sugar, electrolytes, fluid balance, kidney and liver function, and triglycerides are checked regularly.
- Start slowly in malnourished patients to avoid refeeding syndrome.
- Strict sterile technique is needed for the IV line.
- Use with care in heart failure, kidney or liver disease and diabetes.
- Use the bag only if the solution is clear (or evenly milky if fat is included) and the bag is undamaged.
Overdose
Infusing too much or too fast may cause fluid overload, high blood sugar, electrolyte disturbance, nausea, vomiting, chills and acidosis. The infusion is stopped or slowed and the patient is treated according to symptoms.
Therapeutic Class
Parenteral nutrition solution (amino acids with glucose and electrolytes)
Storage
Store as directed on the pack, usually below 25°C, do not freeze, and keep in the overpouch to protect from light. Once mixed and with additives, use promptly as directed. Hospital use only; keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.