Amino Acid, Dextrose & Eloctrolytes

Approved Indications:

• Parenteral Nutrition (TPN):
  Used as a nutritional supplement in patients unable to ingest, digest, or absorb adequate nutrients via the gastrointestinal tract.
• Severe Malnutrition:
  For hospitalized patients with protein-calorie malnutrition needing complete nutritional support intravenously.
• Postoperative Nutrition:
  In patients recovering from major surgery (especially GI or abdominal surgery) who cannot resume oral or enteral feeding.
• Critical Illness or Burns:
  Used in patients with increased metabolic demands due to trauma, burns, sepsis, or major infections.
• Chronic Intestinal Failure:
  Long-term use in patients with short bowel syndrome or other malabsorptive conditions.

Clinically Accepted Off-Label Uses:

• Adjunct in Chemotherapy Support:
  For patients undergoing aggressive chemotherapy and requiring nutritional supplementation.
• Severe Anorexia or Cachexia:
  In patients with advanced cancer, AIDS, or other wasting syndromes.

General Administration:

• Route: Intravenous infusion via central or peripheral vein depending on osmolarity.
• Frequency: Continuous or cyclic infusion over 10–24 hours daily.
• Duration: As per clinical requirement (can range from a few days to long-term TPN).
• Monitoring: Regular labs (electrolytes, renal/liver function, glucose, triglycerides) are mandatory.

Adults:

• Typical Dosage:
• Amino acids: 1.0–2.0 g/kg/day
• Dextrose: 2.0–5.0 g/kg/day
• Electrolytes: Based on individual needs (e.g., Na⁺, K⁺, Ca²⁺, Mg²⁺, PO₄³⁻)

Pediatrics:

• Neonates:
• Amino acids: 2.0–3.0 g/kg/day
• Dextrose: 5.0–12.0 g/kg/day (glucose infusion rate adjusted to tolerance)
• Children:
• Amino acids: 1.5–2.5 g/kg/day
• Dextrose: 3.0–7.0 g/kg/day

Elderly:

• Begin at lower ranges due to reduced metabolic rate and renal function. Frequent monitoring required.

Renal/Hepatic Impairment:

• Renal Failure:
  Protein intake may be reduced; electrolytes (esp. K⁺, Mg²⁺, PO₄³⁻) must be carefully adjusted.
• Hepatic Disease:
  May require specialized formulas with altered amino acid ratios (e.g., decreased aromatic AAs).

This formulation provides essential and non-essential amino acids, dextrose (glucose), and electrolytes intravenously. Amino acids serve as the building blocks for protein synthesis and tissue repair. Dextrose provides a primary source of energy, sparing amino acids from catabolism. Electrolytes maintain cellular homeostasis, acid-base balance, neuromuscular activity, and fluid equilibrium. Together, these components support metabolic needs, prevent catabolism, and sustain vital physiological functions in patients unable to take enteral nutrition.

Absorption:
Directly infused into systemic circulation; bypasses GI absorption.

Distribution:
Distributed throughout extracellular and intracellular fluid compartments. Amino acids are transported into cells for protein synthesis or energy use.

Metabolism:

• Amino acids: Undergo transamination and deamination primarily in the liver.
• Dextrose: Metabolized via glycolysis to ATP.
• Electrolytes: Used in cellular functions or excreted via kidneys.

Elimination:

• Amino acids: Metabolized, nitrogen waste excreted via kidneys (as urea).
• Glucose: Metabolized; excess stored as glycogen or fat.
• Electrolytes: Primarily renal excretion; imbalances corrected via homeostatic mechanisms.

Half-Life:
No defined half-life due to complex metabolic integration.

Pregnancy:

• FDA Category: Not officially categorized; individual components generally considered safe.
• Used when the benefits outweigh potential risks, especially in malnourished or critically ill pregnant women. Caution advised.

Lactation:

• No known risk with appropriate use.
• Amino acids, glucose, and electrolytes are naturally present in breast milk.
• Monitoring advised in nursing mothers requiring TPN.

• Class: Parenteral Nutrition Solution
• Subclass: Total Parenteral Nutrition (TPN) with Amino Acids, Carbohydrates & Electrolytes

• Hypersensitivity to any component of the formulation
• Severe liver or renal failure not managed appropriately
• Hyperkalemia, hyperglycemia, or fluid overload
• Metabolic acidosis or severe electrolyte imbalance
• Uncorrected coagulopathy in certain settings

• Refeeding Syndrome: Initiate slowly in severely malnourished patients. Monitor electrolytes closely.
• Hyperglycemia & Hypoglycemia: Regular blood glucose monitoring required.
• Infection Risk: Central line use increases risk of catheter-related bloodstream infections (CRBSIs).
• Liver Dysfunction: Monitor liver enzymes; long-term use may lead to cholestasis or fatty liver.
• Electrolyte Imbalance: Frequent monitoring essential, especially in renal impairment.
• Fluid Overload & Pulmonary Edema: Careful fluid balance assessment required.

Common:

• Nausea, vomiting
• Mild hepatic enzyme elevation
• Hyperglycemia
• Electrolyte imbalance (e.g., hypokalemia, hypernatremia)

Serious:

• Catheter-related bloodstream infections
• Thrombophlebitis (especially with peripheral infusion)
• Refeeding syndrome
• Hepatic steatosis or cholestasis (long-term use)

Rare:

• Anaphylaxis or severe hypersensitivity
• Metabolic bone disease (long-term use)

• Insulin: May be required to manage hyperglycemia; adjust dose carefully.
• Diuretics or corticosteroids: May alter electrolyte balance (especially potassium).
• Anticonvulsants (e.g., phenytoin): May bind to amino acids or displace from albumin.
• CYP450 enzymes: Not significantly involved.

• ASPEN & ESPEN Guidelines (2024): Reaffirm importance of individualized TPN composition based on caloric and protein needs, fluid status, and disease severity.
• Emphasis on using central lines for high-osmolarity solutions to avoid thrombophlebitis.
• Stricter monitoring protocols now recommended for critically ill patients to prevent refeeding syndrome and liver complications.

• Temperature: Store at 20°C to 25°C.
• Humidity & Light: Protect from light. Avoid excessive humidity.
• Handling: Do not freeze. Inspect for discoloration or particulate matter before use.
• Reconstitution: Some formulations may require mixing amino acids and dextrose just before administration; use within prescribed timeframe after preparation. Refrigerate if required and bring to room temperature before infusion.