d only bycontinuous infusion through a central venous catheter with the tip located in the vena cava. For optimalnitrogen utilization, 500 mL of 10% FreAmine® III appropriately mixed with concentrated dextrose,electrolytes, and vitamins are typically administered over an 8-hour period. If administration rate shouldfall behind schedule, no attempt to "catch up" to planned intake should be made. In addition to meetingprotein needs, the administration rate is also governed, especially during the first few days of therapyby the patient's glucose tolerance. Daily intake of amino acids and dextrose should be increasedgradually to the maximum required dose as indicated by frequent determination of urine and blood sugar
levels. In many patients, provision of adequate calories in the form of hypertonic dextrose may require
the administration of exogenous insulin to prevent hyperglycemia and glycosuria. To prevent rebound
hypoglycemia, a solution containing 5% dextrose should be administered when hypertonic dextrose
infusions are abruptly discontinued.
Peripheral Parenteral Nutrition
For moderately catabolic, depleted patients requiring parenteral nutrition in whom the central venousroute is not indicated, 10% FreAmine® III can be mixed with 5% dextrose solutions and administered byperipheral vein. In pediatric patients, the final solution should not exceed twice normal serumosmolarity (718 mOsmol/L).
Fat provides approximately 9 kcal per gram and parenteral fat emulsion may be administered along withamino acid-dextrose solutions through a Y-type administration set to supplement caloric intake. Fat,however, should not be the sole caloric intake since some studies have suggested that glucose is more
nitrogen sparing in the stressed patient.
Protein Sparing
For well-nourished, mildly catabolic patients who require short-term parenteral nutritional support,10% FreAmine® III can be administered peripherally with or without parenteral carbohydrate calories.
Such infusates can be prepared by dilution of 10% FreAmine® III with Sterile Water for Injection USP or 5% Dextrose Injection USP solutions to prepare isotonic or slightly hypertonic solutions which maybe administered by peripheral vein.
Pediatric Dosage and Administration
Use of 10% FreAmine® III in pediatric patients is governed by the same considerations that affect theuse of any amino acid solution in pediatrics. The amount administered is dosed on the basis of grams ofamino acids/kg of body weight/day. Two to three g/kg of body weight for infants with adequate calories
are generally sufficient to satisfy protein needs and promote positive nitrogen balance. Solutionsadministered by peripheral vein should not exceed twice normal serum osmolarity (718 mOsmol/L).
Infants (up to 10 kg) on total parenteral nutrition generally receive 2 to 3 grams of protein, 120 to 150calories, and 120 to 150 mL of fluid per kilogram of body weight per day. This can be provided in asolution containing approximately 2-1/8% FreAmine® III (diluted from 10% FreAmine® III (Amino Acid Injection) and 20% dextrose. Less hypertonic mixtures may be administered by peripheral vein. Fat emulsion may be given concurrently by central or peripheral vein through a Y-type administration set to provide essential fatty acids and increase caloric intake. Since physiological changes occur rapidly insmall infants, the daily dose of nutrients |
