Amino acids for parenteral nutrition Other drugs minerals. Anatoksin diphtheria

Russian name

Amino acids for parenteral nutrition + other drugs [fat emulsions for parenteral nutrition + dextrose + minerals]

Latin names of substances amino acids for parenteral nutrition + other drugs [fat emulsions for parenteral nutrition + dextrose + minerals]

AMINOACIDS FOR PARENTERAL NUTRITION + OTHER MEDICINES ( rod.)

Pharmacological group of substances of amino acids for parenteral nutrition + other preparations [fat emulsions for parenteral nutrition + dextrose + minerals]

Typical clinical and pharmacological article 1

Pharmaceutical. The three-component mixture is designed to maintain protein and energy exchange. L-amino acids are served as a source of organic nitrogen, dextrose and fatty acids are the source of energy. In addition, the mixture contains electrolytes. Fills the deficiency of essential fatty acids in the body. Olive oil contains a significant amount of alpha-tocopherol, which, in combination with a small amount of polyunsaturated fatty acids, increases the content of vitamin E in the body and reduces lipid peroxidation.

Pharmacokinetics. The ingredients of the emulsion for infusion (amino acids, electrolytes, dextrose, lipids) are metabolized and derived from the body in the same way as they are separately intended. The pharmacokinetic properties of amino acids introduced in / B are mainly coincided with the properties of amino acids entering the natural (enteral) nutrition (however, in this case, the amino acids obtained from food proteins pass through the liver before getting into systemic blood flow). The elimination rate of lipid emulsion particles depends on their size. Small lipid particles are outstanding slower, while they are faster split under the action of lipoproteinlipases. The particle size of the lipid emulsion in the drug is approaching the size of chylomikrons, they have a similar rate of elimination.

Indications. Parenteral nutrition.

Contraindications. Hypersensitivity, severe renal failure in the absence of hemoofiltration or dialysis possibility, severe liver failure, congenital metabolic disorders of amino acids, severe blood coagulation disorders, pronounced hyperlipidemia, hyperglycemia, infringement of electrolyte metabolism, increased concentration in plasma of one of the electrolytes included in the mixture, lactoacidosis, Elevation of the lungs, hyperhyrastation, decompensated CH, hypotonic dehydration, unstable states (including heavy post-traumatic states, decomposed diabetes mellitus, the acute phase of the hypovolemic shock, the acute phase of myocardial infarction, severe metabolic acidosis, heavy sepsis, hyperosmolar coma), childhood (up to 2 years).

Carefully. Plasma hyperosmolarness, adrenal insufficiency, CH, lung disease, pregnancy, lactation period.

Dosing. In / in (through the central vein). The dose of the drug and the duration of the destination are determined by the need for parenteral nutrition in each particular patient depending on its condition. Adults: The average need for organic nitrogen - 0.16-0.35 g / kg / day (approximately 1-2 g of amino acids / kg / day); Energy need varies depending on the patient's condition and the intensity of catabolic processes, on average it is 25-40 kcal / kg / day. Maximum daily dose - 36 ml / kg body weight (which is equivalent to 1.44 g of amino acids, 5.76 g of dextrose and 1.44 g of lipids per 1 kg of body weight), i.e. 2520 ml of emulsion to a patient weighing 70 kg.

Children under the age of 2 years: the average need for organic nitrogen is 0.35-0.45 g / kg / day (approximately 2-3 g of amino acids / kg / day); Energy need - 60-110 kcal / kg / day. The dose depends on the amount of fluid entered into the body and the daily needs of the protein. This should take into account the state of water exchange. Maximum daily dose - 75 ml / kg (which is equivalent to 3 g of amino acids, 12 g of dextrose and 3 g of lipids per 1 kg of body weight). Do not exceed a dose of 3 g / kg / day amino acids and / or 17 g / kg / day dextrose and / or 3 g / kg / day of lipids (with the exception of special cases).

The infusion rate should not exceed 1.5 ml / kg / h, i.e. Not more than 0.06 g of amino acids, 0.24 g of dextrose and 0.06 g of lipids per 1 kg / h.

Rules of preparation of a solution: Before mixing, you must make sure that the integrity of the container and partitions between the sections and heat the drug to room temperature. Use only if the container is not damaged and the integrity of partitions between sections (i.e. the contents of the three sections were not mixed), while the solutions of amino acids and dextrose should be transparent, and the emulsion is homogeneous. Manually rotate the top of the container (for which it hangs) around its axis. Partitions will disappear from the future of the inlet. Twist the top up to the moment until the partitions open for at least half of its length. Stir solutions, turning the container (at least 3 times).

Side effect. Hyperthermia, sweating, tremor, nausea, headache, respiratory impairment; Sometimes (especially with long-term use - for several weeks) - a temporary increase in the concentration of biochemical markers of the liver function (incl. SHF, transaminase, bilirubin); In rare cases - hepatomegaly, jaundice, thrombocytopenia in children, a heavy allergic reaction (contains soybean oil), with a reduced ability to eliminate lipids from the bloodstream or at a rate of administration exceeding the recommended (at the beginning of the infusion) - "Fat Overload" syndrome (hyperlipidemia, Fever, fatty infiltration of liver, hepatomegaly, anemia, leukopenia, thrombocytopenia, coagulation disruption, coma).

Overdose. Symptoms: hypervolemia, acidosis, nausea, vomiting, tremor, electrolyte imbalance, fateller syndrome, hyperglycemia, glucosuria and hyperosmolar syndrome.

Treatment: Introduction is immediately terminated, hemodialysis, hemofiltration or hemodialyfiltration may be required in severe cases.

Interaction. Pharmaceutically incompatible with blood preparations, compatible with vitamin solutions, trace elements, organic phosphates, electrolytes.

Special instructions. The drug should not be administered through a peripheral vein.

The correction of violations of water and electrolyte balance, as well as metabolic disorders, must be carried out before the start of infusion.

Since the drug does not contain vitamins and trace elements, then when they are added, it is necessary to determine the doses of these substances before the start of infusion (depending on the need) and calculate the osmolarity of the resulting solution.

The drug should be used immediately after opening the container and should not be maintained for the next infusion.

During the entire course of treatment, water-electrolyte balance, plasma osmolarity, brass, blood glucose and functional hepatic tests are necessary.

The concentration of TG in plasma and the ability to remove lipids from the bloodstream should be regularly. The concentration of serum TG during infusion should not exceed 3 mmol / l. Their concentration should be measured no earlier than 3 hours after the start of the infusion. If you suspect a violation of lipid metabolism, it is recommended to repeat the same tests in 5-6 hours after the termination of the emulsion. In adults, elimination of lipids should occur less than 6 hours after the termination of the lipid emulsion infusion. The following infusion should be carried out only after the concentration of TG in the plasma has normalized.

Regular one should be carried out clinical examination for liver failure (due to the risk of appearance or strengthening neurological disordersassociated with hyperamionmiamia), renal failure (especially with hypercalemia - the risk of or enhancing metabolic acidosis, hyperazotemia in the absence of ability to conduct hemofiltration or dialysis), sugar diabetes (Control of glucose concentration, glucose, ketonuria and insulin dose correction), blood coagulation violation, anemia, hyperlipidemia.

For long use (a few weeks) should control blood and coagulogram indicators.

When selecting a dose, you should guide the age of a child, a protein and energy need, as well as a disease. If necessary, add enteral proteins and / or "energy" components (carbohydrates, lipids). With parenteral nutrition in children over 2 years old, it is advisable to choose the volume of the container in accordance with the daily dose. Adding vitamins and trace elements must be carried out in doses used in pediatrics according to age-related needs.

Emulsion for infusions should not be introduced in parallel with blood preparations through the same catheter due to the possibility of pseudoagglutination. If the blood pressure was made before the lipids were eliminated from plasma (usually, 5-6 hours after termination of the introduction of the emulsion), the lipid contained in the emulsion can affect the results of some laboratory tests (including bilirubin, LDH, oxygen saturation , HB).

Currently, there are no reliable data on the use of the drug in pregnant women and nursing mothers; In such cases, the benefit ratio for mother and potential risk for the fetus should be evaluated.

Additional nutrients can be added to the finished mixture (including vitamins). Vitamins may also be added to a section with declaration solution before the contents of the sections are mixed. In a finished solution, the drug can be added the following components: electrolytes (the stability of the emulsion remained with the addition of no more than 150 mmol Na +, 150 mmol K +, 5.6 mmol Mg 2+ and 5 mmol Ca 2+ per liter of the finished mixture), organic phosphates (The stability of the emulsion remained when adding to 15 mmol per 1 package), microelements and vitamins (the stability of the emulsion remained when adding doses that do not exceed the daily).

Russian name

Amino acids for parenteral nutrition + other drugs [dextrose + minerals]

Latin names of the substances of amino acids for parenteral nutrition + other drugs [dextrose + minerals]

AMINOACIDS FOR PARENTERAL NUTRITION + OTHER MEDICINES ( rod.)

Pharmacological group of substances amino acids for parenteral nutrition + other drugs [dextrose + minerals]

Typical clinical and pharmacological article 1

Pharmaceutical. Supposes the body with a substrate synthesis of proteins and energy due to glucose in parenteral nutrition. Amino acids come to intravascular and intracellular depot of endogenous free amino acids; Provide maintaining homeostasis. Dextrose participates in various metabolic processes in the body, enhances the redox processes in the body, improves antitoxic function of the liver. Entering the tissue, phosphorylated, turning into glucose-6-phosphate, which participates in many links of the body's metabolism.

Indications. Parenteral nutrition: Preoperative preparation, states after extensive operational interventions, Injuries of medium and severe severity, burns; Inflammatory-destructive diseases of the intestine (including Crohn's disease, intestinal fistulas), malabsorption syndrome, cachexia, oncological diseases, sepsis, peritonitis, acute pancreatitis.

Contraindications. Hypersensitivity, pulmonary swelling, impaired amino acid metabolism; hypercalemia, hyponatremia; Violation of metabolism, a coma of unclear etiology, hyperglycemia, uncontrolled insulin doses up to 6 units / h, acidosis, heavy hepatic and / or renal failure without hemodialysis, collapse, shock, pronounced tissue hypoxia, hypervolemia, violation of the water and electrolyte balance, HSN in st . Decompensation, lactation period, children's age (up to 2 years).

C care. Pregnancy.

Dosing. In / in infusion. Immediately before the introduction of amino acid solutions, glucose and electrolytes should be mixed. Maximum daily dose - 40 ml / kg, which corresponds to 1.6 g of amino acids and 3.2 g of glucose.

The maximum infusion rate is 2 ml / kg / h, which corresponds to 0.08 g of amino acids and 0.16 g. The course of treatment is no more than 7 days.

Side effect. Allergic reactions, chills, nausea, vomiting, strengthening diuresis.

Overdose. Symptoms: hypertensive hyperhydration, impaired water and electrolyte balance, pulmonary edema; loss of amino acids with urine with the development of a violation of amino acid equilibrium, vomiting, tremor; hyperglycemia, glucosuria, dehydration, plasma hyperosmolarness, hyperglycemic or hyperosmolar coma.

Treatment: The introduction of the solution is stopped. Further therapy is selected individually depending on the severity of symptoms. Infusion can be resumed later at a lesser speed with frequent control.

Interaction. When adding to the preparation, other solutions or lipid emulsion must be taken into account compatibility.

Special instructions. Nutriflex 40/80 is designed to be introduced into peripheral veins.

If necessary, lipid emulsions can be added to the drug by introducing them to the finished solution through a special port located on a bag from above. If you need to add other ingredients to the finished solution, you must use the extension port located below. All ingredients must be added in compliance with the aseptic rules and the compatibility of their compatibility.

When conducting therapy, it is necessary to take into account the state of the veins and periodically change the place of administration of the solution.

Before starting infusion, you should adjust water-electrolyte balance and KREs. The rapid administration of the drug may result in bulk overload, impaired water and electrolyte balance.

During the period of treatment, it is necessary to control the concentration of glucose, water-electrolyte balance and blood wrestling, as well as the indicators of the liver function. With the manifestation of hyperglycemia, the rate of administration must be reduced or enter the appropriate insulin dose. The introduction of amino acid solutions is accompanied by increased excretion with urine of trace elements, especially Cu 2+ and Zn 2+. This must be taken into account when selecting the doses of trace elements, especially when conducting long therapy.

Pseudoagglutination is possible, and therefore it is not recommended to use the same infusion systems for the introduction of blood preparations and multicomponent solutions of amino acids.

The drug should be used immediately after mixing glucose and amino acid solutions.

The drug is supplied in plastic dual containers designed for one-time application. Do not use if the solution is not transparent, there is damage to the container or its tightness is impaired. The unused drug is not subject to storage and must be destroyed.

State Register medicines. Official publication: at 2 that is - M.: Medical Council, 2009. - T.2, Part 1 - 568 p.; Part 2 - 560 p.

Interactions with other active substances

Trade names

Name	Validation of the Vyshkovsky index ®

Amino acids for parenteral nutrition + other drugs [Minerals]

Latin name

AMINOACIDS FOR PARENTERAL NUTRITION + OTHER MEDICINES

Pharmacological group

Proteins and amino acids in combination
Means for enteral and parenteral nutrition in combination

Typical clinical and pharmacological article 1

Pharmaceutical. Infusion solution for parenteral nutrition.

Indications. States accompanied by protein deficiency. Parenteral nutrition with a protein deficiency, incl. newborn and premature babies; Fill the OCC during bleeding, burns, operational interventions.

Contraindications. Hypersensitivity, acute renal failure with hyperazotemia, hepatic insufficiency, violations of amino acid exchange, fructose and sorbitol, fructose intolerance, methanol intoxication, hypershydration, acute CMT.

Carefully. HSN, acidosis, hypercalemia.

Dosing. In / in drip. Adults: at the rate of 0.6-1 g of amino acids (up to 25 ml of infrared) per kg / day; in catabolic states - 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 in liquid and calories is higher, then the drug can be supplemented with a solution of electrolyte "75", decreases of dextrose, inverted sugar, sorbitol, etc., alternating them or introducing them at the same time.

Side effect. Rarely - nausea, vomiting, chills, phlebitis, allergic reactions, hyperbilirubinemia, increasing the activity of "liver" transaminase.

Interaction. The solution cannot be mixed with other drugs.

Special instructions. With CPN, hyperkalemia, apply shock only after achieving sufficient diuresis. Too high speed of administration of the drug can lead to hypercalemia and ammonia intoxication in infants.

State register of medicines. Official publication: at 2 that is - M.: Medical Council, 2009. - T.2, Part 1 - 568 p.; Part 2 - 560 p.

Interactions with other active substances

Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with a fademide.

Amikacin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with amiccin.
Aminoophyllin *	The simultaneous administration of arginine as part of a combination of amino acids for parenteral nutrition + other drugs [mineral salts] with aminophylline increases the content of insulin in the blood. Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with amino phallin.
Ampicillin *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with ampicillin.
Vancomycin *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with WanoMycin.
Gentamicin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with guntaamycin.
Digoxin*	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with Digoxin.
Doxycycline *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with Dixiccline.
Calcium gluconate	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with calcium gluke.
Clindamycin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with clindamycin.
Lidocaine *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with the lidoka.
Methyldop *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with melli.
Methylprednisolone *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with meylphyc.e.
Metoclopramide *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with METOPRAmid.
Methotrexat *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with a meattrexset.
Morphine	The combination of amino acids for parenteral nutrition + other drugs [mineral salts] are pharmaceutically compatible with Morphin.
Nepylmicin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with nonylmic.
Nizatidin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with low-dine.
Norepinephrine *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with nouropinephrine.
PIPERACILLIN *	Combination of amino acids for parenteral nutrition + other drugs [mineral salts] are pharmaceutically compatible with piperacylline.
Propranolol *	Combination of amino acids for parenteral nutrition + other drugs [mineral salts] are pharmaceutically compatible with prostromol.
Ranitidine *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with Ranitian.
Riboflavin*	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with riboflvin.
Spironolactone *	Arginine interaction as part of a combination of amino acids for parenteral nutrition + other drugs [mineral salts] with spirironolactone can increase heavy hypercalemia.
Tetracycline *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with TTAcycline.
Tiopental sodium *	Arginine as part of a combination of amino acids for parenteral nutrition + other preparations [mineral salts] are not compatible with sodium thiopentle.
Tobramycin *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with ToffeeCine.
Famotidine *	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with Famotidin.
Folic acid*	The combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with a phony acid.
Formuracyl *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with fluorouracil.
Furosemide *
Chloramphenicol *	Combination of amino acids for parenteral nutrition + other preparations [mineral salts] are pharmaceutically compatible with a hlroamfoot.

Russian name

Amino acids for parenteral nutrition + other drugs [Minerals]

Latin names of the substances of amino acids for parenteral nutrition + other drugs [Minerals]

AMINOACIDS FOR PARENTERAL NUTRITION + OTHER MEDICINES ( rod.)

Pharmacological group of substances of amino acids for parenteral nutrition + other preparations [Minerals]

Nonological Classification (ICD-10)

Typical clinical and pharmacological article 1

Pharmaceutical. Infusion solution for parenteral nutrition.

Indications. States accompanied by protein deficiency. Parenteral nutrition with a protein deficiency, incl. newborn and premature babies; Filling of the BCC during bleeding, burns, operational interventions.

Contraindications. Hypersensitivity, acute renal failure with hyperazotemia, hepatic insufficiency, violations of amino acid exchange, fructose and sorbitol, fructose intolerance, methanol intoxication, hypershydration, acute CMT.

Carefully. HSN, acidosis, hypercalemia.

Dosing. In / in drip. Adults: at the rate of 0.6-1 g of amino acids (up to 25 ml of infrared) per kg / day; in catabolic states - 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 in liquid and calories is higher, then the drug can be supplemented with a solution of electrolyte "75", decreases of dextrose, inverted sugar, sorbitol, etc., alternating them or introducing them at the same time.

Side effect. Rarely - nausea, vomiting, chills, phlebitis, allergic reactions, hyperbilirubinemia, increasing the activity of "liver" transaminase.

Interaction. The solution cannot be mixed with other drugs.

Special instructions. With CPN, hyperkalemia, apply shock only after achieving sufficient diuresis. Too high speed of administration of the drug can lead to hypercalemia and ammonia intoxication in infants.

State register of medicines. Official publication: at 2 that is - M.: Medical Council, 2009. - T.2, Part 1 - 568 p.; Part 2 - 560 p.

Interactions with other active substances

Trade names

Name	Validation of the Vyshkovsky index ®
	0.0114
	0.0092
	0.0086

P Owl nutrition is the basis of the vital activity of the human body and is an important factor in ensuring resistance to pathological processes of various genes.

Numerous studies indicate that most of Patients and affected in hospitals have significant violations of food status, manifested in 20% as exhaustion and malnutrition, in 50% of lipid metabolism disorders, have signs of hypo- and avitaminosis, more than 50% detect changes in the immune status.

The initial nutritional disorders greatly reduce efficiency. medical events, especially in injuries, burns, extensive surgical interventions, etc., increase the risk of septic and infectious complications, adversely affect the duration of the patients in the hospital, worsen mortality rates.

The accumulated experience of the development of basic clinical disciplines suggests that in the strategy of therapeutic measures in patients with therapeutic and especially surgical profile, one of the central places occupies a correction of violations of exchange and full-fledged provision of energy and plastic needs.

Stressful situations (injury, burns, surgical intervention) lead to a sharp shift of exchange processes towards increased catabolism. Operating injury causes substantial metabolic disorders in the body of the operated: disorders of protein-amino acid, carbohydrate and fat exchanges, water-electrolyte balance, metabolism of vitamins. This is especially true of protein exchange.

Depending on the severity of the pathological process, the proteins of the body are catabaseed in the amount of 75-150 g / day. The destruction of proteins leads to a certain deficit indispensable amino acids, To a negative nitrogen balance, even if the protein loss is compensated.

Surgical interventions, various pathological conditions, acute infectious diseases may be the cause of direct protein loss due to bloodstures, outrages from the wound, tissue necrosis, etc.

The consequences of protein deficiency are dysfunction of organs and systems, slow motion, weakening reparative processes, reducing the organism resistance to infections, anemia.

Thus, stress, including operations, injuries, burns, severe infectious diseases, sepsis, is accompanied by increased energy consumption and protein. After 24 hours without nutritional support, the stocks of own carbohydrates and the body receives energy from fats and proteins is actually completely exhausted. Not only quantitative, but also qualitative changes in metabolism occur. In patients with S. source violation Nutrition life reserves are particularly reduced. All this requires additional nutritional support in the general treatment program for seriously ill .

Nutritive support (NP) refers to the category of highly efficient methods of intensive therapy and is aimed at preventing in patients who are in severe (or extremely serious) state, loss of body weight and reduction of protein synthesis, immunodeficiency development, electrolyte and microelement imbalance, vitamin deficit, etc. Nutrients. Depending on the clinical situation, it can be used different kinds artificial nutrition : full or partial parenteral nutrition; Enteral nutrition (probe); Mixed nutrition.

Enteral probe power is carried out while maintaining the functions of the gastrointestinal tract, the absence of these functions leaves the only possible parenteral path of artificial nutrition.

Despite the different ways of delivery of nutrients, both types of artificial medicinal nutrition have a number of basic provisions, which should be considered when appointing a particular type of nutritional support:

The timeliness of the beginning of the artificial medicinal nutrition, because warn cachexia is easier than to treat it;

The optimality of the deadline for artificial medicinal nutrition - should be carried out until the moment of stabilization of the main parameters of the nutrient status - metabolic, anthropometric, immunological;

Adequacy of holding - a full provision of patient with all the necessary nutrients (proteins, fats, carbohydrates, vitamins, minerals).

Parenteral nutrition (PP) - method of providing a patient nutrient substances Bypassing the gastrointestinal tract. At the same time, special infusion solutions capable of actively engaged in exchange processes The organism can be administered through a peripheral or central vein.

The main goal that is pursued in the appointment of PP schemes is to provide the necessary amount of calories and the preservation of protein using amino acids, carbohydrates and fats infusion. Amino acids, primarily L-amino acids, are guided mainly on protein synthesis, and carbohydrates and fats - to ensure the body with the necessary amount of energy. PP should include the same nutritional ingredients as natural nutrition (proteins, fats, carbohydrates, vitamins, minerals).

The main reason for the assignment of PP is the impossibility of using a normal oral power supply, i.e. The patient for a long time due to different circumstances does not want, can not or should not eat naturally.

In practice, PP is used:

Full parenteral nutrition (PPP), which implies the introduction of all nutritional ingredients in quantities that fully cover the needs of the body, and is carried out only through the central veins;

Partial parenteral nutrition (CPP) is auxiliary, it is used to solve the problems of short-term nutritional support for the body, includes individual nutritional components.

Additional PP is the introduction of all ingredients of nutrition in quantities that complement enteral nutrition.

Cachexia, long lack of enteral nutrition, diseases and injuries, accompanied by hypermetabolism, the impossibility of natural nutrition under a number of diseases ( inflammatory diseases intestines, pancreatitis, intestinal fistula, shortened syndrome thin gut, condition after surgery on the gastrointestinal tract, sepsis, maxillofacial injury etc.) - all this is an indication for the use of a parenteral method for administering nutrients.

Traditional is the use of parenteral nutrition in intensive therapy of patients undergoing surgical interventions In a planned or emergency order. Parenteral nutrition limits catabolic reactions, normalizes the metabolism, increases the resistance of the body.

The creation of nutrient mixtures of aimed action allows you to successfully apply parenteral nutrition in the treatment of patients with liver and kidney pathology.

The modern standard is the use of only crystalline amino acid solutions as a protein component. Protein hydrolyzates are currently completely excluded from the clinical practice of parenteral nutrition.

The total dose of administered amino acids is up to 2 g / kg body weight per day, the rate of administration 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 allow you to control the organism metabolic processes in various pathological conditions, such as heavy mechanical injury, extensive burns, condition, after operations on the organs digestive tract, with a significant reduction in weight and depletion of patients, in patients with pancreatitis and peritonitis of various genesis, in patients with intestinal fistulas, with severe infectious diseases and etc.

Modern infusion solutions for PPP have a wide range pharmacological action on the system, organ, cellular and subcelet levels. Parenteral nutrition should be carried out strictly according to the indications in compliance with all methodological and technological recommendations, with the mandatory dynamic control of the level of homeostasis and the biochemical composition of blood plasma.

Amino acid solutions used for PPP are divided into standard and special.

The most important component of modern PP is balanced amino acid solutions.

To date, solutions of crystalline amino acids are the main sources of amino nitrogen during PPP. The main requirement presented to this class of infusion environments - mandatory content of all essential amino acids The synthesis of which cannot be implemented in the human body (isoleucine, phenylalanine, leucine, threonine, lysine, tryptophan, methionine, valine).

However, the above amino acids listed above are indispensable only for a healthy and adult organism. It should be borne in mind that 6 amino acids - alanine, glycine, serine, proline, glutamy and asparagic acids - synthesized in the body of carbohydrates. Four amino acids (arginine, histidine, tyrosine and cysteine) are synthesized in insufficient quantities.

Conditionally indispensable amino acids include L -arginine and L-histidine, since in their absence, protein synthesis processes are significantly reduced. The body can synthesize them, but at some pathological conditions And in young children, they can synthesize in insufficient quantities.

The amino acids introduced into the organism intravenously are part of one of two possible metabolic paths: an anabolic path in which amino acids are associated with peptide bonds to the final products - specific proteins; The metabolic path at which the transamination of amino acids occurs.

Amino acid L-Arginine - especially important, because It contributes to the optimal conversion of ammonia into urea. So, L-arginine binds toxic ammonium ions, which are formed when protein catabolism in the liver. L-apple acid is necessary for the regeneration of L-arginine in this process and as an energy source for the synthesis of urea.

The presence in the preparations of replaceable amino acids L-ornithine aspartate, L-Alanine and L-Proline is also important, because They reduce the need of the body in glycine. Since this amino acid is weakly absorbed, when it is replaced, the development of hyperaimiamia becomes impossible. Ornithine stimulates glucose-induced insulin production and carbamoylphosphatetase activity, which contributes to an increase in glucose utilization by peripheral tissues, urea synthesis, in combination with asparagian - decrease in ammonia level. Phosphorus contained in solutions activates glucose phosphate cycle.

Some solutions are amino acids there are components of energy support (sorbitol or xylitol) . Sorbitol is phosphorilated in the liver in fructose-6-phosphate. Insulin does not act on sorbitol or fructose, which makes them insulin-dependent energy sources. When they are used, hyperglycemic acidosis does not occur, which is found in cases where preparations containing glucose are used for parenteral nutrition. In addition, sorbitol is the best than glucose, solvent amino acids, because Does not contain an aldehyde and ketone groups, thereby missing their combination with amino acid amino acids into complexes that reduce the action of amino acids.

A number of standard solutions of amino acids contain Na +, K +, Mg + cations and an anion CL -. Sodium ion - The main cation of the extracelular fluid, which, together with the chloride anion, is an essential element to maintain homeostasis. Ion potassium - The main cation of intracellular fluid. It was also found that the positive nitrogen balance in the body with general parenteral nutrition can be achieved only when potassium ions add to the infusion solution.

Ion Magnesium It is important to maintain the integrity of mitochondria and to excite the pulse in the membranes of nerve cells, myocardium and muscles of the skeleton, as well as for the transfer of high-energy phosphates when synthesis ATF.. In patients with long-term parenteral nutrition, hypomagnesiamia is often accompanied by hypokalemia.

Supplement of standard solutions of amino acids with vitamins of the complex in : Riboflavin, Nicotinamide, Panthenol and Pyridoxin are due to their limited reserves in the body and the need for daily administration, especially with a long PPP.

Nicotinamide It goes into the depot in the form of pyridine nucleotide, which plays an important role in the oxidative processes of the body. Together with Lakoflavin, Nicotinamide participates in the intermediate processes of metabolism and in the form of trifhospyridine nucleotide participates in protein synthesis. A nicotinic acid Reduces the level of serum lipoproteins of very low density and low density and at the same time increases the level of high density lipoproteins, therefore it is used in hyperlipidemia therapy.

D-Panthenol As coenzyme-A is the fundamental basis for metabolism intermediate processes, participates in the metabolism of carbohydrates, glucongenesis, fatty acid catabolism, as well as in the synthesis of sterol, steroid hormones and porphine.

Pyridoxin is an integral part of groups of many enzymes and coenzymes. It plays a significant role in the process of metabolism of carbohydrates and fats. This vitamin is necessary for the formation of Porphine, the synthesis of hemoglobin and myoglobin.

Currently, there are a large number of standard drugs balanced by the content of indispensable and replaceable amino acids - polyamine, aminosteril KE 10%, NADIN, Glak, Infrared 40, aminoplasmal 5%, 10% E, Aminosol - 600, 800 ke, Freamin III 8, 5%, Neonutrin 5, 10, and 15%. So, Aminisol (Hemofarm, Yugoslavia) contains 14 amino acids, incl. 8 essential, as well as electrolytes, vitamins of group B and sorbitol - an energy source with a strong anti-botonon effect. Aminosol quickly restores a negative nitrogen balance, significantly increases the body's resistance and promotes rapid recovery in severe injuries, operations, infections and diseases of the gastrointestinal tract.

With different pathological conditions, there are features in the manifestation of exchange disorders characteristic of this pathology. Accordingly, the quantitative and qualitative need for amino acids is changed, up to the occurrence of selective failure of individual amino acids. In this regard, for pathogenetically directed metabolic treatment and parenteral nutrition, special solutions of amino acids (amino acid mixtures of aimed) were developed and widely used in clinical practice.

A distinctive feature of amino acid solutions for patients with hepatic insufficiency (Aminosteril N-Heps 5% and 8%, AMINOGLASSMAL HEPA 10%, hepatamin) is a decrease in the content of aromatic (phenylalanine, tyrosine) amino acids and methionine with a simultaneous increase in arginine content (6-10 g / L) and branched indispensable amino acids (valine, leucine, isoleucine) - 43.2 g / l. The number of arginine increases to ensure the function of the urea cycle (cycle of Krebs) and thereby activating ammonia detoxification in the liver and the prevention of hyperamimemia. An exception aromatic amino acids The mixtures caused by the fact that during the hepatic insufficiency in the plasma, the concentration of aromatic amino acids and methionine increases. At the same time, the concentration of branched amino acids is reduced. The increase in the transport of aromatic amino acids in the brain enhances the synthesis of pathological mediators causing symptoms of hepatic encephalopathy. Introduction of drugs S. increased content Branched irreplaceable amino acids reduces these manifestations. Since these amino acid solutions contain all indispensable and wide spectrum Replaceable 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, nephrometry, nephormin with a certain ratio of amino acids. The ratio of essential amino acids and replacements is 60:40. In addition, the preparations of this group contain eight essential amino acids and histidine (5 g / l), which makes it possible to reduce azotemia when introduced. Due to the interaction of a specially selected spectrum of amino acids with nitrogen slags of the body, new replaceable amino acids and protein synthesis are developed. As a result, uremia decreases. The concentration of amino acids in the range of 5-7%. There are no carbohydrates and electrolytes or the amount of electrolytes in the solution minimally.

For proper use side effects No missing. In violation of the rules for the administration of solutions of amino acids, nausea, sweating, tachycardia, an increase in body temperature are possible. Care of lactacidosis is needed if the drug includes sorbitol.