Solutions of amino acids in parenteral nutrition. Solutions of amino acids in parenteral nutrition Pharmacological group of the substance Diphtheria anatoxin
Russian name
Amino acids for parenteral nutrition + Other drugs [Minerals]Latin name of substances Amino acids for parenteral nutrition + Other drugs [Minerals]
Aminoacids for parenteral nutrition + Other medicines ( genus.)Pharmacological group of substances Amino acids for parenteral nutrition + Other drugs [Minerals]
Nosological classification (ICD-10)
Typical clinical and pharmacological article 1
Pharmaceutical action. Infusion solution for parenteral nutrition.
Indications. Conditions accompanied by protein deficiency. Parenteral nutrition for protein deficiency, incl. in newborns and premature babies; replenishment of blood volume during bleeding, burns, and surgical interventions.
Contraindications. Hypersensitivity, acute renal failure with hyperazotemia, liver failure, metabolic disorders of amino acids, fructose and sorbitol, fructose intolerance, methanol intoxication, hyperhydration, acute head injury.
Carefully. CHF, acidosis, hyperkalemia.
Dosing. IV drip. Adults: at the rate of 0.6-1 g of amino acids (up to 25 ml of infesol) per kg/day; in catabolic conditions - at the rate of 1.3-2 g of amino acids (up to 50 ml) per kg/day. Children: at the rate of 1.5-2.5 g of amino acids (up to 60 ml) per kg/day. If the body’s need for fluid and calories is higher, then the drug can be supplemented with electrolyte solution “75”, solutions of dextrose, invert sugar, sorbitol, etc., alternating them or administering them simultaneously.
Side effect. Rarely - nausea, vomiting, chills, phlebitis, allergic reactions, hyperbilirubinemia, increased activity of liver transaminases.
Interaction. The solution cannot be mixed with other drugs.
Special instructions. For chronic renal failure, hyperkalemia, shock, use only after achieving sufficient diuresis. Too high a rate of drug administration can lead to hyperkalemia and ammonia intoxication in infants.
State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; Part 2 - 560 s.
Interactions with other active ingredients
Trade names
| Name | The value of the Vyshkowski Index ® |
| 0.0114 | |
| 0.0092 | |
| 0.0086 | |
Latin name of the substance Diphtheria anatoxin
Anatoxinum diphtericumPharmacological group of the substance Diphtheria anatoxin
Vaccines, serums, phages and toxoidsTypical clinical and pharmacological article 1
Lekforma. suspension for injection -->Characteristic. Sorbed on aluminum hydroxide.
Pharmaceutical action. Forms specific immunity against diphtheria.
Indications. Prevention of diphtheria in children from 6 years of age, adolescents and adults.
Contraindications. Hypersensitivity.
Dosing. IM into the upper outer quadrant of the buttock or the anterior outer part of the thigh or deep subcutaneously (adolescents and adults) into the subscapular region in a single dose of 0.5 ml. Before vaccination, the ampoule must be thoroughly shaken until a homogeneous suspension is obtained.
For planned age-related revaccinations, the drug is administered once to persons who have received a tetanus toxoid vaccination in connection with emergency prophylaxis of tetanus.
Side effect. Rarely (in the first 2 days) - hyperthermia, malaise, local reactions (pain, hyperemia, swelling); in isolated cases - allergic reactions (angioedema, urticaria, polymorphic rash), minor exacerbation of allergic diseases.
Special instructions. Persons who have had acute illnesses are vaccinated 2–4 weeks after recovery. In mild forms of the disease, vaccinations are allowed after the clinical symptoms disappear.
Patients with chronic diseases are vaccinated after achieving complete or partial remission. Persons with neurological changes are vaccinated after progression of the process has been ruled out. For patients with allergic diseases, vaccinations are carried out 2-4 weeks after the end of the exacerbation, while stable manifestations of the disease (localized skin phenomena, hidden bronchospasm, etc.) are not contraindications to vaccination, which can be carried out against the background of appropriate therapy.
Immunodeficiencies, HIV infection, as well as maintenance course therapy (including corticosteroids and neurotropic drugs) are not contraindications to vaccination.
Pregnant women are vaccinated according to epidemiological indications.
In order to identify contraindications, on the day of vaccination, the doctor conducts a survey of parents and examines those vaccinated with mandatory thermometry. When vaccinating adults, preliminary selection of persons to be vaccinated is allowed, with their interview by the medical worker conducting the vaccination on the day of vaccination. Persons temporarily exempt from vaccination must be monitored and registered and vaccinated in a timely manner. If epidemiologically necessary, the drug can be administered against the background of an acute illness.
In case of a strong reaction to the previous dose of this drug, a second dose is administered while using GCS (prednisolone orally 1–1.5 mg/kg/day the day before and immediately after vaccination).
The drug can be administered a month later or simultaneously with the polio vaccine and other drugs in the national vaccination calendar.
Considering the possibility of developing immediate allergic reactions in particularly sensitive individuals, vaccinated individuals must be provided with medical supervision for 30 minutes. Vaccination sites must be provided with anti-shock therapy.
For persons who have suffered severe forms of allergic reactions to the administration of the drug, further scheduled vaccinations of the drug are stopped.
The drug is not suitable for use in ampoules with damaged integrity, lack of labeling, changes in physical properties (change in color, presence of unbreakable flakes), or improper storage.
The opening of ampoules and the vaccination procedure are carried out in strict compliance with the rules of asepsis and antiseptics. The drug cannot be stored in an opened ampoule.
The administration of the drug is registered in the established accounting forms, indicating the batch number, expiration date, manufacturer, and date of administration.
State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; Part 2 - 560 s.
P nutritious nutrition forms the basis of the human body’s vital functions and is an important factor in ensuring resistance to pathological processes of various origins.
Numerous studies indicate that the majority of patients and victims admitted to hospitals have significant disturbances in nutritional status, manifested in 20% as exhaustion and malnutrition, in 50% as lipid metabolism disorders, up to 90% have signs of hypo- and vitamin deficiency, more than 50% detect changes in immune status.
Initial nutritional disorders significantly reduce the effectiveness of treatment measures, especially for injuries, burns, extensive surgical interventions, etc., increase the risk of developing septic and infectious complications, negatively affect the length of stay of patients in the hospital, and worsen mortality rates.
The accumulated experience in the development of basic clinical disciplines indicates that in the strategy of treatment measures for therapeutic and especially surgical patients, one of the central places is occupied by the correction of metabolic disorders and the full provision of energy and plastic needs.
Stressful situations (trauma, burns, surgery) lead to a sharp shift in metabolic processes towards increased catabolism. Surgical trauma causes significant metabolic disorders in the body of the person being operated on: disturbances in protein-amino acid, carbohydrate and fat metabolism, water-electrolyte balance, and vitamin metabolism. This is especially true for protein metabolism.
Depending on the severity of the pathological process, body proteins are catabolized in an amount of 75-150 g/day. The destruction of proteins leads to a certain deficiency of essential amino acids, to a negative nitrogen balance, even if protein losses are compensated.
Surgical interventions, various pathological conditions, acute infectious diseases can cause direct protein loss due to blood loss, wound discharge, tissue necrosis, etc.
The consequences of protein deficiency are dysfunction of organs and systems, delayed recovery, weakening of reparative processes, decreased body resistance to infections, and anemia.
Thus, stress, including operations, injuries, burns, severe infectious diseases, sepsis, is accompanied by increased energy and protein consumption. Within 24 hours, without nutritional support, the reserves of its own carbohydrates are virtually completely exhausted and the body receives energy from fats and proteins. Not only quantitative, but also qualitative changes in metabolism occur. In patients with initial malnutrition, vital reserves are especially reduced. All this requires additional nutritional support in the general treatment program for seriously ill patients .
Nutritional support (NS) belongs to the category of highly effective intensive care methods and is aimed at preventing, in patients in severe (or extremely serious) condition, weight loss and decreased protein synthesis, the development of immunodeficiency, electrolyte and microelement imbalances, vitamin deficiency, etc. nutrients. Depending on the clinical situation, they can be used various types of artificial nutrition : full or partial parenteral nutrition; enteral nutrition (tube); mixed nutrition.
Enteral tube feeding is carried out while the functions of the gastrointestinal tract are preserved, while the absence of these functions leaves the only possible parenteral route of artificial nutrition.
Despite the different routes of delivery of nutritional components, both types of artificial therapeutic nutrition have a number of basic provisions that should be taken into account when prescribing one or another type of nutritional support:
The timeliness of starting artificial therapeutic nutrition, because preventing cachexia is easier than treating it;
The optimal timing of artificial therapeutic nutrition - it should be carried out until the main parameters of the nutritional status - metabolic, anthropometric, immunological - are stabilized;
Adequacy of implementation - complete provision of the patient with all necessary nutrients (proteins, fats, carbohydrates, vitamins, minerals).
Parenteral nutrition (PN) - a way to provide a patient with nutrients bypassing the gastrointestinal tract. In this case, special infusion solutions that can be actively involved in the body’s metabolic processes can be administered through a peripheral or central vein.
The main goal pursued when prescribing PN regimens is to provide the required amount of calories and preserve protein through the infusion of amino acids, carbohydrates and fats. Amino acids, primarily L-amino acids, are used primarily for protein synthesis, while carbohydrates and fats are used to provide the body with the necessary amount of energy. PN should include the same nutritional ingredients as natural nutrition (proteins, fats, carbohydrates, vitamins, minerals).
The main reason for prescribing PN is the inability to use the normal oral route of nutrition, i.e. the patient for a long time, due to various circumstances, does not want, cannot or should not take food naturally.
In practice, PP is used:
Total parenteral nutrition (TPN), which involves the introduction of all nutritional ingredients in quantities that fully cover the body's needs, and is carried out only through the central veins;
Partial parenteral nutrition (PPN) is auxiliary in nature, used to solve problems of short-term nutritional support of the body, and includes individual nutritional components.
Additional PN - the introduction of all nutritional ingredients in quantities that complement enteral nutrition.
Cachexia, prolonged lack of enteral nutrition, diseases and injuries accompanied by hypermetabolism, inability to natural nutrition in a number of diseases (inflammatory bowel diseases, pancreatitis, intestinal fistulas, short small bowel syndrome, condition after surgery on the gastrointestinal tract, sepsis, maxillofacial trauma etc.) - all this is an indication for the use of the parenteral route of administration of nutrients.
It is traditional to use parenteral nutrition in intensive care of patients undergoing planned or emergency surgical interventions. Parenteral nutrition limits catabolic reactions, normalizes metabolism, and increases the body's resistance.
The creation of targeted nutritional mixtures makes it possible to successfully use parenteral nutrition in the treatment of patients with liver and kidney pathologies.
The modern standard is to use only solutions of crystalline amino acids as the protein component. Protein hydrolysates are currently completely excluded from clinical parenteral nutrition practice.
The total dose of administered amino acids is up to 2 g/kg body weight per day, the rate of administration is up to 0.1 g/kg body weight per hour.
Artificially created solutions of balanced crystalline amino acids with solutions of fat emulsions and concentrated solutions of carbohydrates make it possible to control the metabolic processes of the body in various pathological conditions, such as severe mechanical trauma, extensive burns, conditions after operations on the digestive tract, with significant weight loss and exhaustion of patients , in patients with pancreatitis and peritonitis of various origins, in patients with intestinal fistulas, with severe infectious diseases, etc.
Modern infusion solutions for TPN have a wide range of pharmacological effects at the systemic, organ, cellular and subcellular levels. Parenteral nutrition should be carried out strictly according to indications in compliance with all methodological and technological recommendations, with mandatory dynamic monitoring of homeostasis indicators and the biochemical composition of blood plasma.
Amino acid solutions used for TPN are divided into standard and special.
The most important component of modern PP is balanced amino acid solutions.
Today, the main sources of amine nitrogen during TPN are solutions of crystalline amino acids. Main requirement requirements for this class of infusion media - mandatory content of all essential amino acids , the synthesis of which cannot be carried out in the human body (isoleucine, phenylalanine, leucine, threonine, lysine, tryptophan, methionine, valine).
However, the amino acids listed above are essential only for a healthy and adult body. It should be taken into account that 6 amino acids - alanine, glycine, serine, proline, glutamic and aspartic acids - are synthesized in the body from carbohydrates. Four amino acids (arginine, histidine, tyrosine and cysteine) are synthesized in insufficient quantities.
Conditionally essential amino acids include L-arginine and L-histidine, since in their absence the processes of protein synthesis are significantly reduced. The body can synthesize them, but in some pathological conditions and in young children they may be synthesized in insufficient quantities.
Amino acids introduced into the body intravenously enter one of two possible metabolic pathways: the anabolic pathway, in which amino acids are linked by peptide bonds into final products - specific proteins; metabolic pathway in which transamination of amino acids occurs.
The amino acid L-arginine is especially important because... it promotes optimal conversion of ammonia to urea. Thus, L-arginine binds toxic ammonium ions, which are formed during the catabolism of proteins in the liver. L-malic acid is necessary for the regeneration of L-arginine in this process and as an energy source for the synthesis of urea.
The presence of non-essential amino acids L-ornithine aspartate, L-alanine and L-proline in the preparations is also important, because they reduce the body's need for glycine. Since this amino acid is poorly absorbed, when replacing it, the development of hyperammonemia becomes impossible. Ornithine stimulates glucose-induced insulin production and the activity of carbamoyl phosphate synthetase, which increases the utilization of glucose by peripheral tissues, the synthesis of urea, and in combination with asparagine, reduces ammonia levels. The phosphorus contained in solutions activates the glucose-phosphate cycle.
Some amino acid solutions contain energy components (sorbitol or xylitol) . Sorbitol is phosphorylated in the liver to fructose-6-phosphate. Insulin has no effect on either sorbitol or fructose, making them insulin-independent energy sources. When they are used, hyperglycemic acidosis does not occur, which occurs in cases where drugs containing glucose are used for parenteral nutrition. In addition, sorbitol is a better solvent for amino acids than glucose, because does not contain aldehyde and ketone groups, thereby preventing their combination with amino groups of amino acids into complexes that reduce the effect of amino acids.
A number of standard solutions of amino acids contain Na +, K +, Mg + cations and the Cl - anion. Sodium ion - the main cation of extracellular fluid, which, together with the chloride anion, is the most important element for maintaining homeostasis. Potassium ion - the main cation of intracellular fluid. It was also found that a positive nitrogen balance in the body with total parenteral nutrition can only be achieved by adding potassium ions to the infusion solution.
Magnesium ion important for maintaining the integrity of mitochondria and for excitation of impulses in the membranes of nerve cells, myocardium and skeletal muscles, as well as for the transfer of high-energy phosphates during ATP synthesis. In patients on long-term parenteral nutrition, hypomagnesemia is often accompanied by hypokalemia.
Supplementation of standard amino acid solutions with B complex vitamins : riboflavin, nicotinamide, panthenol and pyridoxine, due to their limited reserves in the body and the need for daily administration, especially with long-term TPN.
Nicotinamide goes into storage in the form of pyridine nucleotide, which plays an important role in the oxidative processes of the body. Together with lactoflavin, nicotinamide participates in intermediate metabolic processes and, in the form of triphosphopyridine nucleotide, participates in protein synthesis. Nicotinic acid reduces the level of serum very low-density lipoproteins and low-density lipoproteins and at the same time increases the level of high-density lipoproteins, therefore it is used in the treatment of hyperlipidemia.
D-panthenol , as coenzyme-A, is the fundamental basis of intermediate metabolic processes, participates in carbohydrate metabolism, gluconeogenesis, fatty acid catabolism, as well as in the synthesis of sterol, steroid hormones and porphin.
Pyridoxine is an integral part of groups of many enzymes and coenzymes. It plays a significant role in the metabolism of carbohydrates and fats. This vitamin is necessary for the formation of porphin, the synthesis of hemoglobin and myoglobin.
Currently, there are a large number of standard preparations balanced in the content of essential and non-essential amino acids - Polyamine, Aminosteril KE 10%, Vamin, Glamin, Infezol 40, Aminoplasmal 5%, 10% E, Aminosol - 600, 800 KE, Freamin III 8, 5%, neonutrin 5, 10, and 15%. So, Aminosol (Hemofarm, Yugoslavia) contains 14 amino acids, incl. 8 essential, as well as electrolytes, B vitamins and sorbitol - a source of energy with a strong anti-ketone effect. Aminosol quickly restores the negative nitrogen balance, significantly increases the body's resistance and promotes rapid recovery from severe injuries, operations, infections and diseases of the gastrointestinal tract.
In various pathological conditions, there are features in the manifestation of metabolic disorders that are characteristic of this pathology. Accordingly, the quantitative and qualitative need for amino acids changes, up to the occurrence of selective deficiency of individual amino acids. In this regard, for pathogenetically targeted metabolic treatment and parenteral nutrition, special solutions of amino acids (amino acid mixtures of targeted action) have been developed and are widely used in clinical practice.
A distinctive feature of amino acid solutions for patients with liver failure (aminosteril N-hepa 5% and 8%, aminoplasmal Hepa 10%, hepatamine) is a decrease in the content of aromatic (phenylalanine, tyrosine) amino acids and methionine with a simultaneous increase in the content of arginine (6-10 g/ l) and branched essential amino acids (valine, leucine, isoleucine) - 43.2 g/l. The amount of arginine is increased to ensure the function of the urea cycle (Krebs cycle) and thereby activate ammonia detoxification in the liver and prevent hyperammonemia. The exclusion of aromatic amino acids from mixtures is due to the fact that in case of liver failure, the concentration of aromatic amino acids and methionine in the plasma increases. At the same time, the concentration of branched amino acids decreases. An increase in the transport of aromatic amino acids into the brain enhances the synthesis of pathological mediators that cause symptoms of hepatic encephalopathy. The introduction of drugs with a high content of branched-chain essential amino acids reduces these manifestations. Since these amino acid solutions contain all essential and a wide range of non-essential amino acids, they have a corrective effect on metabolic processes and are used for parenteral nutrition.
For parenteral nutrition and treatment of patients with acute and chronic renal failure, special solutions of amino acids are used: aminosteril KE - nephro, nephrosteril, neframin with a certain ratio of amino acids. The ratio of essential and non-essential amino acids is 60:40. In addition, drugs in this group contain eight essential amino acids and histidine (5 g/l), which makes it possible to reduce azotemia when administered. Due to the interaction of a specially selected spectrum of amino acids with nitrogenous wastes of the body, the production of new non-essential amino acids and protein synthesis occur. As a result, uremia decreases. The concentration of amino acids is within 5-7%. There are no carbohydrates and electrolytes or the amount of electrolytes in the solution is minimal.
When used correctly, there are no side effects. If the rules for administering amino acid solutions are violated, nausea, sweating, tachycardia, and increased body temperature are possible. Caution is necessary for lactic acidosis if the drug contains sorbitol.
