Kabiven Perifer

• Parenteral Nutrition:
  • Indicated for providing total or supplemental parenteral nutrition (PN) in patients unable to meet nutritional requirements orally or enterally.
  • Used in patients with malnutrition, severe gastrointestinal disorders, post-operative nutritional support, or critical illness.
  • Appropriate for adults and pediatric patients requiring balanced macronutrient (carbohydrates, amino acids, and lipids) supply intravenously.
• Catabolic States:
  • Recommended for patients in hypercatabolic states such as trauma, burns, sepsis, or chronic illnesses where enhanced nutritional demands exist.
• Other Clinically Accepted Uses:
  • Short-term nutritional support during pre- and post-operative periods.
  • Supplementation during intestinal failure or absorption disorders.

• Adults:
  • Dosage individualized based on patient’s nutritional needs, clinical status, and laboratory parameters.
  • Typical glucose concentration provided is 11%, amino acids (Vamin 18 Novum) at 18 g/100 mL, and Intralipid 20% as the lipid emulsion.
  • Volume and infusion rates adjusted to supply daily caloric and protein requirements, usually 20–30 kcal/kg/day and 1.0–1.5 g protein/kg/day.
• Pediatrics:
  • Dosing carefully calculated based on weight and metabolic demands.
  • Initiate at lower rates and gradually increase to avoid metabolic complications.
• Elderly:
  • Monitor closely for fluid overload, renal function, and metabolic tolerance; adjust doses accordingly.
• Renal/Hepatic Impairment:
  • Dose modifications required; monitor nitrogen balance, electrolytes, and liver enzymes.
  • Lipid infusion caution advised in severe hepatic dysfunction.
• Administration Route:
  • Administered via central venous catheter (preferred) or peripheral line depending on osmolarity and duration of therapy.
  • Infused continuously over 12–24 hours as per clinical protocol.
• Duration:
  • Based on clinical nutritional needs; short-term or long-term as determined by healthcare provider.

This combination preparation provides a balanced source of macronutrients intravenously: glucose 11% supplies immediate energy through rapidly metabolizable carbohydrates; Vamin 18 Novum delivers essential and non-essential amino acids required for protein synthesis and tissue repair; Intralipid 20% provides long-chain triglycerides as a concentrated energy source and essential fatty acids necessary for cellular membrane integrity and metabolic functions. Together, they bypass gastrointestinal absorption, directly supplying nutrients into the bloodstream, supporting anabolism, preserving lean body mass, and maintaining metabolic homeostasis in patients unable to consume adequate nutrition orally or enterally.

• Glucose 11%:
  • Rapidly available in systemic circulation; metabolized by cells via glycolysis and oxidative phosphorylation.
  • Excess glucose stored as glycogen or converted to fat.
• Vamin 18 Novum (Amino Acids):
  • Amino acids rapidly distributed and taken up by tissues for protein synthesis, gluconeogenesis, and other metabolic pathways.
  • Metabolized mainly in liver and kidneys; nitrogen eliminated as urea.
• Intralipid 20% (Lipid Emulsion):
  • Lipids emulsified as triglycerides hydrolyzed by lipoprotein lipase into free fatty acids and glycerol.
  • Fatty acids utilized by tissues for energy or stored.
  • Metabolism occurs in the liver; clearance via reticuloendothelial system.
• Onset of Action:
  • Immediate systemic availability upon infusion.
• Elimination:
  • Metabolites excreted via normal metabolic pathways; nitrogen primarily as urea via kidneys.

• Pregnancy:
  • Parenteral nutrition is generally considered safe and necessary during pregnancy when oral or enteral feeding is not feasible.
  • No specific teratogenic risks associated with glucose, amino acids, or lipid emulsions when used appropriately.
• Lactation:
  • Safe during breastfeeding; provides maternal nutritional support.
  • No direct adverse effects on breastfed infants expected.

• Primary Class: Parenteral nutrition solution
• Subclass: Macronutrient intravenous formulation (carbohydrate + amino acid + lipid emulsion)

• Known hypersensitivity to any component (glucose, amino acids, or lipid emulsions).
• Severe hyperglycemia or disorders of glucose metabolism uncontrolled by insulin.
• Severe lipid metabolism disorders (e.g., hyperlipidemia, lipoprotein lipase deficiency).
• Severe hepatic failure or cholestasis (for lipid component).
• Severe renal failure without adequate dialysis.
• Presence of sepsis or systemic infections where lipid administration is contraindicated.

• High-risk groups:
  • Patients with diabetes mellitus require close glucose monitoring.
  • Monitor triglyceride levels in patients receiving lipid emulsions to avoid hypertriglyceridemia.
  • Caution in hepatic or renal impairment; adjust dose accordingly.
  • Risk of fluid overload and electrolyte imbalances; monitor regularly.
• Serious risks:
  • Potential for catheter-related bloodstream infections; aseptic technique essential.
  • Metabolic complications including hyperglycemia, electrolyte disturbances, acid-base imbalances.
  • Fat overload syndrome (rare, lipid infusion-related).
• Monitoring:
  • Blood glucose, electrolytes, liver and renal function tests, triglycerides, and nitrogen balance during therapy.

• Common:
  • Hyperglycemia or hypoglycemia.
  • Electrolyte disturbances (e.g., hypo/hypernatremia, hypo/hyperkalemia).
  • Infusion site reactions (phlebitis, thrombosis).
  • Gastrointestinal disturbances (if PN discontinued abruptly).
• Serious/Rare:
  • Allergic reactions or anaphylaxis to lipid emulsions.
  • Fat overload syndrome presenting with fever, hepatosplenomegaly, coagulopathy.
  • Infection related to central line use.
• Onset & Dose Dependence:
  • Adverse effects often related to dose and infusion rate; metabolic side effects may develop over prolonged therapy.

• Major Interactions:
  • Insulin and glucose metabolism modulators affect glucose utilization.
  • Drugs influencing liver or kidney function may alter metabolism of amino acids and lipids.
  • Concomitant use of anticoagulants requires monitoring due to risk of thrombosis with central lines.
• Food Interactions:
  • None applicable due to intravenous administration.
• Alcohol:
  • No direct interactions; alcohol metabolism unrelated.

• Clinical Guidelines:
  • Updated nutrition support guidelines recommend early initiation of parenteral nutrition in malnourished or critically ill patients unable to receive enteral feeding.
  • Emphasis on individualized nutrient composition based on metabolic demands and monitoring for complications.
  • Recent studies support the safety and efficacy of balanced glucose, amino acid, and lipid combinations for improved clinical outcomes.
• Regulatory Notes:
  • Approved formulations widely available with strict sterility and quality controls.
  • Guidelines stress prevention of catheter-related infections and metabolic monitoring.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from excessive heat, light, and freezing.
• Use aseptic technique to prevent contamination.
• Do not use if solution is discolored, cloudy, or contains particulate matter.
• Once opened, discard unused portions per institutional protocols.
• Keep out of reach of children.