Nutriflex 70/240 solution for infusion 1500ml container, 5pcs

Composition

Solution for infusions (1 chamber-r-r of dextrose).

Solution for infusions (210-r-r amino acids with electrolytes).

Excipients: d/i water.

Pharmacological action

Intravenous amino acids enter the intravascular and intracellular depots of endogenous free amino acids.

The introduction of all the amino acids necessary for protein synthesis (including essential, conditionally substituted and substitutable amino acids) contained in the preparation ensures high nutritional efficiency and reduces the load on the body that occurs during protein synthesis.

Thus, the main therapeutic effect of Nutriflex 70/240 is to provide the body with a substrate for protein synthesis and energy due to glucose during parenteral nutrition.

Individual concentrations of amino acids are selected in such a way that when this solution is administered intravenously, the increase in the concentration of each amino acid in plasma does not go beyond the normal range, which ensures the maintenance of homeostasis of amino acids in plasma.

Glucose is the most adapted energy carrier for the body and in the specified dose itself or together with an additionally administered lipid emulsion covers the patient’s needs for non-protein calories, protecting amino acids from misuse.

Indications

It is used for parenteral nutrition in inpatient and outpatient settings to cover the daily needs of patients for energy, amino acids, electrolytes and fluids during parenteral nutrition in patients with a moderate to severe degree of catabolism in cases where enteral nutrition is impossible, insufficient or contraindicated, as well as in combination with it. The composition is designed for the category of patients who have a limited volume of injected fluid, for example:

• heart failure;
• parenteral nutrition in acute and chronic renal failure in patients receiving hemodialysis;
• parenteral nutrition in patients with hypercatabolism (burns, neurotrauma, sepsis, etc. ).

Recommendations for use

Nutriflex 70/240 is intended for use only in the central veins.

Method of preparing Nutriflex 70/240 for use:

Nutriflex 70/240 is a two-chamber bag, the compartments of which are separated by a special seam. One chamber is filled with a solution of amino acids and electrolytes, and the other with a solution of glucose and electrolytes.

Immediately before starting parenteral use, solutions of amino acids, glucose and electrolytes should be mixed. To do this, you need to:

• remove the two-chamber bag from the protective packaging,
• unfold and spread it on a flat surface (on a table),
• tear the separation seam by pressing two hands on one of the bag chambers,
• pick up and mix the contents of both chambers, moving the right and left parts of the bag up and down.

After that, the solution is ready for use.

At the end of the infusion, the bag is discarded.

If necessary, lipid emulsions can be added to Nutriflex 70/240 by injecting them into the finished solution through a special port located on the top of the bag. If you need to add other ingredients to the finished solution, use the additional port located at the bottom. All ingredients must be added in compliance with the rules of asepsis and taking into account their compatibility with each other.

Doses:

They are selected according to individual needs.

The maximum daily dose is 25 ml / kg mt / day, which corresponds to 1.75 g of amino acids/kg mt/day and 6 g of glucose /kg mt/day.

Introduction rate:

The maximum infusion rate is 1.4 ml / kg mt / h, which corresponds to 0.098 g of amino acids/kg mt/h and 0.336 g of glucose/kg mt/h.

Duration of application:

There are no restrictions on the duration of use of the drug.

Precautions when using the drug:

For patients with cardiac, hepatic and renal insufficiency, the dosage and mode of use of the drug are set individually.

Contraindications

Common for parenteral nutrition:

• severe circulatory disorders (collapse and shock);
• severe tissue hypoxia;
• hyperhydration;
• impaired water and electrolyte balance;
• pulmonary edema;
• decompensated heart failure.

With caution:  in patients with increased plasma osmolarity, heart failure, hepatic and / or renal insufficiency.

Side effects

Side effects are very rare. When therapy is discontinued, they are quickly reversible. use of the drug may lead to allergic reactions, chills, nausea, vomiting. Due to the high osmolarity of the solution, signs of increased diuresis may appear in some cases. In such cases, the drug should be discontinued and resumed later at a slower infusion rate. In case of side effects that are not described in the instructions, patients should inform their doctor about them.

Overdose

If the drug is prescribed correctly, an overdose of the drug is not observed

Symptoms of volume overload or electrolyte overdose:

Hypertonic hyperhydration, water-electrolyte balance disorders, pulmonary edema.

Symptoms of an amino acid overdose:

Loss of amino acids in the urine with the development of impaired amino acid balance, vomiting, tremor.

Symptoms of glucose overdose:

Hyperglycemia, glucosuria, dehydration, serum hyperosmolarity, hyperglycemic or hyperosmolar coma.

Therapy:

In cases of symptoms of drug overdose, the solution should be discontinued. Further therapy is selected individually, depending on the severity of symptoms. The infusion may be resumed later at a slower rate with frequent monitoring.

Special instructions

With full parenteral nutrition, Nutriflex 70/240 should be used in combination with lipid emulsions. The concentration of glucose in it is close to the upper limit of its safe level in relation to the body’s ability to absorb it effectively. Therefore, an increase in the caloric content of the mixture is recommended exclusively by introducing a lipid emulsion into its composition through a special bag port.

Before starting the Nutriflex 70/240 infusion, the water-electrolyte balance and the acid-base state of the blood should be corrected. Too rapid use of the drug can lead to volume overload, violation of the water-electrolyte balance.

It is necessary to monitor the concentration of sugar in the blood.If hyperglycemia occurs, the rate of use of Nutriflex 70/240 should be reduced or the appropriate dose of insulin should be administered.

Intravenous use of amino acid solutions is accompanied by increased urinary excretion of trace elements, especially copper and zinc. This should be taken into account when selecting doses of trace elements, especially during long-term therapy.

Due to the risk of pseudoagglutination, it is not recommended to use the same infusion systems for the use of blood products and multicomponent solutions of amino acids.

When the drug is administered, regular monitoring of the water-electrolyte balance and acid-base state of the blood, monitoring of blood sugar concentration, and blood serum ionograms should be carried out. During long-term therapy, monitoring of blood parameters (coagulogram, liver function indicators) is necessary.

If necessary, it is possible to add LDL emulsions, essential fatty acids, electrolytes, vitamins and trace elements. As with all intravenous solutions, strict adherence to the rules of asepsis is required.

Nutriflex 70/240 is a multicomponent solution. When adding other solutions or a lipid emulsion to it, it is necessary to take into account the compatibility of all ingredients.

The drug is delivered in double plastic containers designed for a single use. Any unused volumes of the drug should not be stored and should be discarded. After mixing glucose and amino acid solutions, it is possible to store the drug for up to 7 days at room temperature and up to 14 days when it is stored in the refrigerator (including the time of drug use).

Do not use the product if the solution is not transparent, there are obvious signs of damage on the bag or its tightness is broken.

Storage conditions

Keep out of the reach of children and protected from light at a temperature not exceeding 25°C.

Active ingredient

Amino acids for parenteral nutrition, Other preparations Minerals

Conditions of release from pharmacies

By prescription

Dosage form

emulsion for infusions

Purpose

Children by doctor’s prescription, Adults by doctor’s prescription