Amisol Gold

• Parenteral Nutrition:
• For patients unable to receive adequate nutrition via the gastrointestinal tract, such as in cases of severe malnutrition, critical illness, major surgery, trauma, burns, or chronic malabsorption.
• Fluid and Electrolyte Management:
• Correction and maintenance of electrolyte imbalances including hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and hypophosphatemia.
• Prevention and treatment of dehydration in patients unable to maintain oral intake.
• Energy Provision:
• Glucose serves as a source of calories in patients with increased metabolic demands or fasting states.
• Supportive Care:
• Adjunctive therapy in intensive care units for metabolic support during critical illness or chemotherapy when oral intake is inadequate.

• Adults:
• Amino acids: typically 1 to 2 g/kg/day, adjusted based on nutritional needs and clinical condition.
• Glucose: concentration ranges from 5% to 25%, infusion rate commonly 3–6 mg/kg/min to avoid hyperglycemia.
• Electrolytes: doses individualized according to laboratory values (e.g., potassium 20–40 mEq/day, sodium 1–2 mEq/kg/day).
• Pediatrics:
• Amino acids: 1.5 to 3 g/kg/day, adjusted for age and condition.
• Glucose: lower infusion rates to prevent osmotic diuresis and hyperglycemia.
• Electrolyte needs are weight-based and require close monitoring.
• Elderly:
• Similar dosing as adults with careful monitoring of renal and cardiac function.
• Special Populations:
• Renal impairment: electrolyte and amino acid dosing adjusted to avoid accumulation and toxicity.
• Hepatic impairment: cautious amino acid administration to prevent encephalopathy.
• Route and Frequency:
• Administered intravenously via central or peripheral vein depending on osmolarity.
• Infusions may be continuous or cyclic based on clinical protocols.
• Monitoring:
• Regular assessment of blood glucose, electrolytes, fluid balance, and metabolic status to guide dose adjustments.

Amino acids serve as the fundamental units for protein synthesis and act as substrates in multiple metabolic pathways essential for tissue repair, enzyme function, and nitrogen balance. Glucose provides immediate energy through cellular uptake and metabolism via glycolysis and oxidative phosphorylation, supporting cellular function and organ systems. Electrolytes regulate fluid balance, nerve conduction, muscle contraction, and enzymatic processes by maintaining essential electrochemical gradients across cell membranes. Together, these components restore metabolic homeostasis and support vital physiological functions during periods of nutritional insufficiency or metabolic stress.

• Absorption:
• Administered intravenously, bypassing gastrointestinal absorption for immediate systemic availability.
• Distribution:
• Amino acids and glucose rapidly distribute into extracellular and intracellular fluid compartments.
• Electrolytes distribute according to ionic characteristics; sodium predominantly extracellular, potassium intracellular.
• Metabolism:
• Amino acids metabolized primarily in the liver and peripheral tissues for protein synthesis and energy.
• Glucose metabolized via glycolysis and the citric acid cycle to produce ATP.
• Elimination:
• Metabolic byproducts, such as urea and carbon dioxide, are eliminated via kidneys and lungs.
• Electrolyte levels are regulated primarily by renal excretion and reabsorption.
• Onset and Half-life:
• Immediate onset after infusion; half-life varies depending on metabolic demand and organ function.

• Pregnancy:
• Generally regarded as safe when medically necessary and administered under supervision.
• No known teratogenic effects; essential for maternal and fetal nutrition when oral intake is insufficient.
• Lactation:
• Components do not accumulate in breast milk at harmful levels; considered safe during breastfeeding.
• Caution:
• Limited data on long-term fetal or neonatal outcomes; careful risk-benefit assessment advised.

• Parenteral Nutrition Agents
• Nutritional Supplementation
• Electrolyte Replacement Therapy

• Hypersensitivity to any component of the preparation.
• Severe hyperglycemia uncontrolled by medical therapy.
• Severe electrolyte abnormalities not corrected prior to administration.
• Fluid overload states contraindicating intravenous fluid therapy.
• Inborn errors of amino acid metabolism without appropriate management.

• Monitor blood glucose closely to avoid hypo- or hyperglycemia.
• Risk of fluid overload in patients with cardiac, renal, or hepatic impairment; monitor fluid status.
• Electrolyte imbalances may cause cardiac arrhythmias or neuromuscular symptoms; frequent monitoring required.
• Avoid abrupt discontinuation to prevent hypoglycemia.
• Observe infusion sites for signs of infection or thrombophlebitis.
• Use with caution in hepatic impairment due to altered amino acid metabolism.

• Common:
• Hyperglycemia, hypoglycemia
• Local site reactions such as phlebitis
• Electrolyte imbalance symptoms including muscle cramps and weakness
• Fluid overload manifestations (edema, hypertension)
• Serious/Rare:
• Allergic reactions including anaphylaxis
• Metabolic disturbances such as acidosis or alkalosis
• Hepatic dysfunction or encephalopathy
• Electrolyte-induced cardiac arrhythmias (e.g., hyperkalemia)

• Insulin and hypoglycemic agents require dosage adjustment to prevent hypoglycemia.
• Potassium-sparing diuretics and ACE inhibitors may increase hyperkalemia risk.
• Drugs affecting renal function (NSAIDs, aminoglycosides) may alter electrolyte excretion.
• Corticosteroids and diuretics may influence electrolyte balance.
• Hepatic metabolism of certain drugs may be affected by amino acid levels.

• Early initiation of parenteral nutrition in critically ill patients recommended when enteral feeding is not possible.
• Individualized electrolyte repletion protocols based on frequent laboratory monitoring emphasized to minimize complications.
• Updated guidelines recommend cautious glucose infusion rates to avoid hyperglycemia in ICU patients.
• International nutrition societies endorse combined amino acid, glucose, and electrolyte administration for total parenteral nutrition.

• Store at controlled room temperature between 20°C and 25°C.
• Protect from light to prevent degradation.
• Avoid freezing to prevent solution instability.
• Use aseptic technique for preparation and administration.
• Reconstituted solutions should be used promptly or stored refrigerated (2°C to 8°C) and discarded if unused after 24 hours.