Drug reference
Supplement in intravenous nutrition ▶BY INTRAVENOUS INFUSION, OR BY SLOW INTRAVENOUS INJECTION ▶Adult: (consult product literature) DIPEPTIVEN 20G/100ML CONCENTRATE FOR SOLUTION FOR INFUSION BOTTLES Amino acid supplement for hypercatabolic or hypermetabolic states ▶BY INTRAVENOUS INFUSION ▶Adult: 300–400 mg/kg daily, dose not to exceed 20% of total amino acid intake
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Total parenteral nutrition exceeding one month Measure serum manganese concentration and check liver function before commencing treatment and regularly during treatment— discontinue if manganese concentration raised or if cholestasis develops.
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ADDITRACE SOLUTION FOR INFUSION 10ML AMPOULES For patients over 40 kg. Additrace ® solution contains traces of Fe3+, Zn2+, Mn2+, Cu2+, Cr3+, Se4+, Mo6+, F-, I-. DIPEPTIVEN 20G/100ML CONCENTRATE FOR SOLUTION FOR INFUSION BOTTLES Dipeptiven ® solution contains N(2)-L- alanyl-L-glutamine 200 mg/mL (providing L-alanine 82 mg, L-glutamine 134.6 mg). ADDIPHOS ® VIALS Addiphos ® sterile solution contains phosphate 40 mmol, K+ 30 mmol, Na+ 30 mmol/20 mL. DECAN CONCENTRATE FOR SOLUTION FOR INFUSION 40ML BOTTLES For patients over 40 kg. Decan ® solution contains trace elements Fe2+, Zn2+, Cu2+, Mn2+, F-, Co2+, I-, Se4+, Mo6+, Cr3+. TRACUTIL ® AMPOULES Tracutil ® solution contains trace elements Fe2+, Zn2+, Mn2+, Cu2+, Cr3+, Se4+, Mo6+, I-, F-. SOLIVITO N POWDER FOR SOLUTION FOR INFUSION VIALS Solivito N ® powder for reconstitution contains biotin 60 micrograms, cyanocobalamin 5 micrograms, folic acid 400 micrograms, glycine 300 mg, nicotinamide 40 mg, pyridoxine hydrochloride 4.9 mg, riboflavin sodium phosphate 4.9 mg, sodium ascorbate 113 mg, sodium Blood and nutrition pantothenate 16.5 mg, thiamine mononitrate 3.1 mg. VITLIPID N ADULT EMULSION FOR INJECTION 10ML AMPOULES Vitlipid N ® adult emulsion contains vitamin A 330 units, ergocalciferol 20 units, dl-alpha tocopherol 1 unit, phytomenadione 15 micrograms/mL. For adults and children over 11 years. CERNEVIT ® POWDER FOR SOLUTION FOR INJECTION VIALS Cernevit ® powder for reconstitution contains dl- alpha tocopherol 10.2 mg, ascorbic acid 125 mg, biotin 69 micrograms, colecalciferol 220 units, cyanocobalamin 6 micrograms, folic acid 414 micrograms, nicotinamide 46 mg, pantothenic acid (as dexpanthenol) 17.25 mg, pyridoxine hydrochloride 5.5 mg, retinol (as palmitate) 3500 units, riboflavin (as dihydrated sodium phosphate) 4.14 mg, thiamine (as cocarboxylase tetrahydrate) 3.51 mg. For adults and children over 11 years.
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Because of the complex requirements relating to parenteral nutrition, full details relating to administration have been omitted. In all cases specialist pharmacy advice, product literature, and other specialist literature should be consulted. Compatibility with the infusion solution must be ascertained before adding supplementary preparations. Additives should not be mixed with fat emulsions unless compatibility is known. ADDITRACE SOLUTION FOR INFUSION 10ML AMPOULES For adddition to Vamin ® solutions and glucose intravenous infusions. DIPEPTIVEN 20G/100ML CONCENTRATE FOR SOLUTION FOR INFUSION BOTTLES For addition to infusion solutions containing amino acids. ADDIPHOS ® VIALS For addition to Vamin ® solutions and glucose intravenous infusions. DECAN CONCENTRATE FOR SOLUTION FOR INFUSION 40ML BOTTLES For addition to infusion solutions. TRACUTIL ® AMPOULES For addition to infusion solutions. SOLIVITO N POWDER FOR SOLUTION FOR INFUSION VIALS Dissolve in water for injections or glucose intravenous infusion for adding to glucose intravenous infusion or Intralipid ®; dissolve in Vitlipid N ® or Intralipid ® for adding to Intralipid ® only. VITLIPID N ADULT EMULSION FOR INJECTION 10ML AMPOULES For addition to Intralipid ®. CERNEVIT ® POWDER FOR SOLUTION FOR INJECTION VIALS Dissolve in 5 mL water for injections or Glucose 5% or Sodium Chloride 0.9% for adding to infusion solutions.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for infusion Solution for infusion ▶Parenteral nutrition supplements (Non-proprietary) Sodium glycerophosphate 216 mg per 1 ml Sodium glycerophosphate 4.32g/20ml concentrate for solution for infusion vials | 1 vial P £5.60 ▶Additrace (Fresenius Kabi Ltd) Sodium molybdate 4.85 microgram per 1 ml, Chromic chloride 5.33 microgram per 1 ml, Sodium selenite 10.5 microgram per 1 ml, Potassium iodide 16.6 microgram per 1 ml, Manganese chloride 99 microgram per 1 ml, Sodium fluoride 210 microgram per 1 ml, Copper chloride 340 microgram per 1 ml, Ferric chloride 544 microgram per 1 ml, Zinc chloride 1.36 mg per 1 ml Additrace concentrate for solution for infusion 10ml ampoules | 1 ampoule P £1.96 ▶Dipeptiven (Fresenius Kabi Ltd) N(2)-L-alanyl-L-glutamine 200 mg per 1 ml Dipeptiven 20g/100ml concentrate for solution for infusion bottles | 1 bottle P £25.93 Dipeptiven 10g/50ml concentrate for solution for infusion bottles | 1 bottle P £13.94 ▶Tracutil (B.Braun Melsungen AG) Sodium molybdate dihydrate 2.42 microgram per 1 ml, Chromic chloride 5.3 microgram per 1 ml, Sodium selenite pentahydrate 7.89 microgram per 1 ml, Potassium iodide 16.6 microgram per 1 ml, Sodium fluoride 126 microgram per 1 ml, Manganese chloride 197.9 microgram per 1 ml, Copper chloride 204.6 microgram per 1 ml, Zinc chloride 681.5 microgram per 1 ml, Ferrous chloride 695.8 microgram per 1 ml Tracutil concentrate for solution for infusion 10ml ampoules | 5 ampoule P £7.96 Powder for solution for infusion ▶Solivito N (Fresenius Kabi Ltd) Cyanocobalamin 5 microgram, Biotin 60 microgram, Folic acid 400 microgram,Thiamine nitrate 3.1 mg, Pyridoxine hydrochloride 4.9 mg, Riboflavin sodium phosphate 4.9 mg, Sodium pantothenate 16.5 mg, Nicotinamide 40 mg, Sodium ascorbate 113 mg Solivito N powder for solution for infusion vials | 1 vial P £1.97 Emulsion for injection ▶Vitlipid N Adult (Fresenius Kabi Ltd) Ergocalciferol 500 nanogram per 1 ml, Phytomenadione 15 microgram per 1 ml, Retinol palmitate 99 microgram per 1 ml, Alpha tocopherol 910 microgram per 1 ml Vitlipid N Adult emulsion for infusion 10ml ampoules | 1 ampoule P £1.97 Powder for solution for injection EXCIPIENTS: May contain Glycocholic acid ▶Cernevit (Baxter Healthcare Ltd) Cyanocobalamin 6 microgram, Biotin 69 microgram, Folic acid 414 microgram,Thiamine 3.51 mg, Riboflavin (as Riboflavin sodium phosphate) 4.14 mg, Pyridoxine (as Pyridoxine hydrochloride) 4.53 mg, Pantothenic acid (as Dexpanthenol) 17.25 mg, Nicotinamide 46 mg, Ascorbic acid 125 mg, Alpha tocopherol 11.2 unit, Colecalciferol 220 unit, Retinol 3500 unit Cernevit powder for solution for injection vials | 10 vial P s Blood and nutrition Nutrition (oral) Enteral nutrition Overview The body’s reserves of protein rapidly become exhausted in severely ill patients, especially during chronic illness or in those with severe burns, extensive trauma, pancreatitis, or intestinal fistula. Much can be achieved by frequent meals and by persuading the patient to take supplementary snacks of ordinary food between the meals. However, extra calories, protein, other nutrients, and vitamins are often best given by supplementing ordinary meals with enteral sip or tube feeds. When patients cannot feed normally, for example, patients with severe facial injury, oesophageal obstruction, or coma, a nutritionally complete diet of enteral feeds must be given. The advice of a dietitian should be sought to determine the protein and total energy requirement of the patient and the form and relative contribution of carbohydrate and fat to the energy requirements. Most enteral feeds contain protein derived from cows’ milk or soya. Elemental feeds containing protein hydrolysates or free amino acids can be used for patients who have diminished ability to break down protein, for example in inflammatory bowel disease or pancreatic insufficiency. Even when nutritionally complete feeds are given, water and electrolyte balance should be monitored. Haematological and biochemical parameters should also be monitored, particularly in clinically unstable patients. Extra minerals (e.g. magnesium and zinc) may be needed in patients where gastro-intestinal secretions are being lost. Additional vitamins may also be needed. Enteral nutrition in children Children have special requirements and in most situations liquid feeds prepared for adults are totally unsuitable—the advice of a paediatric dietitian should be sought. 5.1 Special diets Nutrition in special diets Overview These are preparations that have been modified to eliminate a particular constituent from a food or that are nutrient mixtures formulated as food substitutes for patients who either cannot tolerate or cannot metabolise certain common constituents of food. In certain clinical conditions, some food preparations are regarded as drugs and can be prescribed within the NHS if they have been approved by the Advisory Committee on Borderline Substances (ACBS). Coeliac disease Coeliac disease is caused by an abnormal immune response to gluten. For management and further information, see Coeliac disease p. 40. Phenylketonuria Phenylketonuria (hyperphenylalaninaemia, PKU), which results from the inability to metabolise phenylalanine, is managed by restricting dietary intake of phenylalanine to a small amount sufficient for tissue building and repair. Sapropterin dihydrochloride below, a synthetic form of tetrahydrobiopterin, is licensed as an adjunct to dietary restriction of phenylalanine in the management of patients with phenylketonuria and tetrahydrobiopterin deficiency. Aspartame (used as a sweetener in some foods and medicines) contributes to the phenylalanine intake and may affect control of phenylketonuria. Where the presence of aspartame is specified in the product literature this is indicated in the BNF against the preparation; the patient should be informed of this. 5.1a Phenylketonuria DRUGS FOR METABOLIC DISORDERS › TETRAHYDROBIOPTERIN AND DERIVATIVES
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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300–400 mg/kg daily, dose not to exceed 20% of
First-line fragment. Read the complete Indications and Dose section above.
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