Names and pronunciation
Aminosyn-RF, NephrAmine
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Drug reference
Aminosyn-RF, NephrAmine
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Func. class.: Nutritional supplement/ protein
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ACTION: Needed for anabolism to maintain structure, decrease catabolism, promote healing
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USES: Hepatic encephalopathy, cir- rhosis, hepatitis, nutritional support in cancer; burn or solid organ transplant patients; to prevent nitrogen loss when adequate nutrition by mouth, gastric, or duodenal tube cannot be obtained
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Black Box Warning: Central infusions: administration by central venous catheter should be used only by those familiar with technique and complications
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CONTRAINDICATIONS: Hyper- sensitivity, severe electrolyte imbalances, anuria, severe liver damage, maple syrup urine disease, PKU, azotemia, genetic disease of amino acid metabolism Precautions: Pregnancy, breastfeeding, children, renal disease, diabetes melli- tus, HF, sulfite sensitivity
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SIDE EFFECTS CNS: Dizziness, headache, confusion, loss of concentration, fever CV: Hypertension, HF/pulmonary edema, flushing, thrombosis ENDO: Hyperglycemia, rebound hypogly- cemia, electrolyte imbalances, hyperosmo- lar hyperglycemic nonketotic syndrome, alkalosis, hypophosphatemia, hyperam- monemia, dehydration, hypocalcemia GI: Nausea, abdominal pain, cholestasis GU: Glycosuria osmotic diuresis INTEG: Extravasation necrosis, phlebitis at injection site
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INTERACTIONS Individual Drugs Decrease: Protein-sparing effects— tetracycline Drug/Lab Test Increase: LFTs, ammonia, glucose Decrease: Potassium, phosphate, glucose
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DOSAGE AND ROUTES Nutritional support (cirrhosis, hepatic encephalopathy, hepatitis) • Adult: IV 80-120 g/day amino acids/ 12-18 g nitrogen of hepatic failure for- mula TPN • Adult: IV 1-1.5 g/kg/day Metabolic stress (severe) • Adult: IV 1.5 g/kg; use formula for high metabolic stress Renal failure (nutritional support) • Adult: IV Aminosyn-RF 300-600 mL/70% dextrose/day; NephrAmine 250- 500 mL/70% dextrose/day; the total daily dosage is calculated based on the daily protein requirements, as well as the pa- tient’s metabolic and clinical response. Check product instructions for specific directions • Child: IV 2-3 g/kg/day
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Available forms: Injection: 250, 500, 1000, 2000 mL, containing amino acids in various con- centrations; amino acid infusions, crys- talline: Aminosyn: 3.5%, 5%, 7%, 8.5%, 10%; Aminosyn II: 3.5%, 5%, 7%, 8.5%, 10%, 15%; Aminosyn-PF: 7%, 10%; Clin- isol: 15%; FreAmine III: 8.5%, 10%; Pre- masol: 6%, 10%; Travasol: 10%; TrophAmine: 6%, 10% Amino acid infusion/dextrose: Aminosyn II: 3.5% in 5% dextrose, 4.25% in 20% dextrose, 4.25% in 10% dextrose, 4.25% in 25% dextrose; Clinimix: 2.75% in 5% dextrose, 4.25% in 5% dextrose, 4.25% in 10% dextrose, 4.25% in 20% dex- trose, 4.25% in 25% dextrose, 5% in 10% dextrose, 5% in 15% dextrose, 5% in 20% dextrose, 5% in 25% dextrose infusions/electrolytes: Amino acid Aminosyn: 3.5%, 7%, 8.5%; Aminosyn II: 3.5%, 7%, 8.5%; FreAmine III: 3%, 8.5%; ProcalAmine: 3%; Travasol: 3.5%, 5.5%, 8.5% Amino acid infusions/electrolytes/dex- trose: Aminosyn II: 3.5% with electrolytes in 5% dextrose, 3.5% with electrolytes in 25% dextrose, 4.25% with electrolytes in 10% dextrose, 4.25% with electrolytes in 20% dextrose, 4.25% with electrolytes in 25% dextrose; amino acid infusions (hepatic failure): HepatAmine: 8%; Hepa- tasol: 8% Amino acid infusions (high metabolic stress): Aminosyn-HBC 7%; Freamine HBC: 6.9%; amino acid infusions (renal failure): Aminosyn-RF: 5.2%; NephrA- mine: 5.4%
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Administer: Continuous IV INFUSION route • Up to 40% protein and dextrose (up to 12.5%) via peripheral vein; stronger solution requires central IV administra- tion • TPN only mixed with dextrose to pro- mote protein synthesis • Immediately after mixing under strict aseptic technique, use infusion pump, in-line filter (0.22 µm) unless mixed with fat emulsion and dextrose (3 in 1); use careful monitoring technique; do not speed up infusion; pulmonary edema, glucose overload will result
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Assess: • Electrolytes (potassium, sodium, phos- phate, chloride, magnesium, bicarbonate, blood glucose, ammonia, ketones) • Renal/hepatic studies: BUN, creati- nine, ALT, AST, bilirubin • Weight changes, triglycerides before and after infusion; vitamin A level with renal dis- ease • Injection site for extravasation: red- ness along vein, edema at site, necrosis, pain, hard tender area; site should be changed immediately; discontinue infu- sion, culture tubing and solution • Sepsis: chills, fever, increased tem- perature, if sepsis is suspected • For impending hepatic coma: asterixis, confusion, uremic fetor, lethargy • Hyperammonemia: nausea, vomiting, malaise, tremors, anorexia, seizures • Change of dressing and IV tubing ev- ery 24-48 hr to prevent infection if chills, fever, other signs of infection occur
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Evaluate: • Therapeutic response: weight gain, decrease in jaundice with liver disorders, increased LOC
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Reason for use of TPN • To report chills, sweating at once; risk for infection is higher • About infusion pump, how to care for A tubing/site; and blood glucose HIGH ALERT
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• Adult: IV 80-120 g/day amino acids/ 12-18 g nitrogen of hepatic failure for- mula TPN
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• Adult: IV 1-1.5 g/kg/day Metabolic stress (severe)
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• Adult: IV 1.5 g/kg; use formula for high metabolic stress Renal failure (nutritional support)
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• Adult: IV Aminosyn-RF 300-600 mL/70% dextrose/day; NephrAmine 250- 500 mL/70% dextrose/day; the total daily dosage is calculated based on the daily protein requirements, as well as the pa- tient’s metabolic and clinical response. Check product instructions for specific directions
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