Kabiven Central

• Total or Supplemental Parenteral Nutrition (PN):
  • Indicated for patients who cannot meet their nutritional needs orally or enterally, including those with severe gastrointestinal dysfunction, postoperative recovery, trauma, burns, sepsis, or chronic illnesses.
  • Suitable for providing balanced macronutrients—carbohydrates (glucose), amino acids (Vamin 18 Novum), and lipids (Intralipid 20%)—intravenously to support anabolism and maintain metabolic homeostasis.
• Malnutrition and Catabolic States:
  • Used in patients with protein-energy malnutrition or hypercatabolic states where nutritional demands exceed intake.
• Pre- and Postoperative Nutritional Support:
  • Provides metabolic support during perioperative periods when oral feeding is contraindicated or insufficient.
• Other Clinically Accepted Uses:
  • Nutritional support during critical illness or prolonged fasting.
  • Supplementation in intestinal failure or malabsorption syndromes.

• Adults:
  • Dosage individualized according to caloric, protein, fluid, and electrolyte needs based on patient weight, metabolic demands, and clinical status.
  • Glucose concentration is 19%, amino acids provided by Vamin 18 Novum at 18 g/100 mL, and lipids via Intralipid 20%.
  • Total caloric intake typically ranges from 20 to 35 kcal/kg/day, with protein provision of 1.0 to 1.5 g/kg/day.
  • Infusion rates adjusted to avoid hyperglycemia, hyperlipidemia, or fluid overload.
• Pediatrics:
  • Dose calculated carefully based on weight and clinical requirements; start at lower infusion rates and titrate slowly.
  • Close monitoring essential for metabolic tolerance.
• Elderly:
  • Monitor renal and hepatic function; adjust doses to prevent fluid overload and metabolic derangements.
• Renal/Hepatic Impairment:
  • Adjust amino acid and lipid doses cautiously; monitor biochemical parameters regularly.
• Route:
  • Administer via central venous catheter preferred due to hyperosmolarity of glucose 19%. Peripheral administration may be possible with diluted solutions or short durations.
  • Continuous infusion over 12–24 hours as per clinical protocol.
• Duration:
  • Dependent on clinical condition and ability to tolerate oral or enteral nutrition.

This combination solution supplies essential macronutrients intravenously, bypassing the gastrointestinal tract. Glucose 19% provides a rapid source of carbohydrates, metabolized intracellularly via glycolysis and oxidative phosphorylation to produce ATP, the energy currency for cellular functions. Vamin 18 Novum delivers a balanced mixture of essential and non-essential amino acids necessary for protein synthesis, tissue repair, and nitrogen balance. Intralipid 20% supplies long-chain triglycerides as an energy-dense lipid source and essential fatty acids required for membrane integrity, signaling, and anti-inflammatory functions. Together, these nutrients maintain metabolic homeostasis, support anabolic processes, and prevent catabolism in patients unable to receive adequate nutrition orally or enterally.

• Glucose 19%:
  • Rapid systemic availability upon intravenous administration.
  • Metabolized primarily in tissues via glycolysis and the Krebs cycle.
  • Excess glucose converted to glycogen or fat stores.
• Vamin 18 Novum (Amino Acids):
  • Amino acids are quickly distributed and taken up by cells for protein synthesis and metabolic functions.
  • Metabolized mainly in liver and kidneys; nitrogenous wastes excreted as urea.
• Intralipid 20% (Lipid Emulsion):
  • Triglycerides hydrolyzed by lipoprotein lipase into free fatty acids and glycerol.
  • Metabolized in the liver and cleared by the reticuloendothelial system.
• Onset of Action:
  • Immediate upon infusion initiation.
• Elimination:
  • Metabolites processed via normal metabolic and excretory pathways.

• Pregnancy:
  • Considered safe and essential in pregnancy when parenteral nutrition is required due to inability to feed enterally or orally.
  • No known teratogenic effects when used appropriately.
• Lactation:
  • Safe during breastfeeding; supports maternal nutritional status without direct adverse effects on the infant.

• Primary Class: Parenteral nutrition solution
• Subclass: Macronutrient intravenous formulation (carbohydrates + amino acids + lipids)

• Hypersensitivity to glucose, amino acids, or lipid emulsion components.
• Uncontrolled hyperglycemia.
• Severe lipid metabolism disorders (e.g., hyperlipoproteinemia, lipoprotein lipase deficiency).
• Severe hepatic failure or cholestasis (lipid contraindicated).
• Severe renal failure without dialysis.
• Sepsis or systemic infections contraindicating lipid emulsions.

• High-risk groups:
  • Diabetic patients require tight glycemic control during infusion.
  • Monitor triglycerides in lipid administration to avoid hypertriglyceridemia.
  • Use caution and monitor in renal/hepatic impairment.
• Serious risks:
  • Risk of catheter-related infections; strict aseptic technique necessary.
  • Metabolic complications including fluid overload, electrolyte imbalance, acid-base disturbances.
  • Rare fat overload syndrome.
• Monitoring:
  • Regular assessment of blood glucose, lipid profile, electrolytes, liver and renal function.

• Common:
  • Hyperglycemia or hypoglycemia.
  • Electrolyte imbalances.
  • Infusion site reactions (phlebitis, thrombophlebitis).
  • Transient nausea or discomfort during infusion.
• Serious/Rare:
  • Allergic reactions to lipid emulsions.
  • Fat overload syndrome.
  • Central line-associated bloodstream infections.
• Timing & Dose Dependence:
  • Side effects are dose- and infusion rate-dependent; metabolic disturbances often develop with prolonged use.

• Drug-Drug:
  • Insulin and other glucose metabolism drugs influence glycemic response.
  • Drugs affecting liver or kidney function may alter amino acid and lipid metabolism.
  • Anticoagulants require monitoring due to central line use.
• Drug-Food:
  • None (intravenous administration).
• Drug-Alcohol:
  • No direct interactions.
• Enzyme Systems:
  • No significant CYP450 involvement.

• Guidelines:
  • Emphasize early individualized parenteral nutrition for malnourished and critically ill patients.
  • Recommend monitoring to minimize metabolic complications.
  • Highlight safe use of high-concentration glucose solutions like 19% with appropriate vascular access.
• Safety Notices:
  • Reinforcement of aseptic protocols to reduce infections.
  • Updated recommendations on lipid infusion rates and monitoring.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from light, moisture, freezing, and excessive heat.
• Use sterile techniques; discard if contamination or physical changes (cloudiness, precipitates) observed.
• Once opened, use according to institutional protocols.
• Keep out of reach of children.