What is the recommended dosage and administration of Aminoven (amino acid solution) for patients requiring intravenous nutritional support?

Aminoven (Amino Acid Solution) Dosage and Administration

Recommended Dosage for Adults

For critically ill patients requiring parenteral nutrition, administer amino acids at 1.3-1.5 g/kg ideal body weight per day in conjunction with adequate energy supply. 1

Standard Dosing by Clinical Context

Intensive Care/Critical Illness:

• 1.3-1.5 g/kg/day represents the optimal dose for protein-sparing effects in trauma and sepsis patients 1
• Higher doses up to 2.0-2.5 g/kg/day may be safe and potentially optimal for the most critically ill adults to decrease morbidity and mortality risk 2
• No additional benefit observed when exceeding 1.5 g/kg/day in standard critically ill populations 1

Metabolically Stable Patients:

• Start with 1.5 g/kg/day when initiating total parenteral nutrition 3
• For peripheral vein nutritional maintenance, 1.0-1.5 g/kg/day reduces protein catabolism 3

Severe Liver Disease (Cirrhosis/Alcoholic Hepatitis):

• Standard amino acid solutions should be delivered as in other critically ill patients 1
• Up to 120 grams per day of amino acid solution with hypertonic dextrose has been tolerated in patients with hepatic encephalopathy 4
• Nitrogen balance achieved with 75-80 grams of synthetic amino acids 4

Special Considerations for Amino Acid Composition

Glutamine Supplementation:

• Add 0.2-0.4 g/kg/day of L-glutamine (equivalent to 0.3-0.6 g/kg/day alanyl-glutamine dipeptide) to standard amino acid solutions in ICU patients 1, 5
• Standard dosage is 0.5 g/kg/day of L-alanyl L-glutamine dipeptide when exclusive parenteral nutrition is required 5
• Contraindicated in critically ill patients with acute kidney injury or chronic kidney disease due to increased mortality risk 5, 6

Administration Routes and Concentrations

Peripheral Vein Administration

Concentration and Composition:

• Dilute to final concentration of 3.5-5% amino acids with 5-10% dextrose 3
• Maximum concentration of 12.5% dextrose to avoid peripheral vein complications 1
• Provides approximately 1400-2000 kcal/day when combined with fat emulsion 3

Infusion Management:

• Change peripheral infusion site every 24-48 hours to minimize phlebitis 7
• Consider adding hydrocortisone and heparin to minimize thrombophlebitis 8

Central Vein Administration

Concentration and Composition:

• Each liter typically contains 42.5-50 g amino acids with approximately 250 ± 100 g dextrose 3
• Initial infusion rate: 2 mL/min, increase gradually 3
• Catheter tip must be located in the vena cava 3

Caloric Considerations:

• Each gram of dextrose provides 3.4 kcal 3
• Average depleted surgical patient requires 2500-4000 kcal and 12-24 grams nitrogen per day 3
• Non-hypermetabolic patients require approximately 30 kcal/kg/day 3

Pediatric Dosing

Standard Pediatric Requirements:

• 2.5 grams amino acids/kg/day with dextrose or IV lipid providing 100-130 kcal/kg/day 3
• Administer in 2.5% concentration for most pediatric patients 3

Initiation Protocol:

• Start with half-strength solution at 60-70 mL/kg/day 3
• Within 24-48 hours, increase to full-strength at 125-150 mL/kg/day 3
• Basic pediatric solution contains 25 grams amino acids and 200-250 grams glucose per 1000 mL 3

Essential Additives and Monitoring

Required Supplements

Electrolytes (individualize based on serum levels):

• Major electrolytes: sodium, chloride, potassium, phosphate, magnesium, calcium 3
• Monitor serum electrolytes regularly 3
• In metabolic acidosis, use acetate or lactate salts instead of chloride 3

Vitamins and Trace Elements:

• Vitamins including folic acid and vitamin K are required additives 3
• Trace elements essential for long-term parenteral nutrition 3
• Iron supplementation particularly critical in infants due to increasing red cell mass 3

Lipid Emulsions:

• Administer at 0.7-1.5 g/kg over 12-24 hours to prevent essential fatty acid deficiency 1
• Monitor serum lipids for evidence of deficiency in patients on fat-free TPN 3

Critical Safety Measures

Glucose Management:

• Exogenous insulin may be required to prevent hyperglycemia and glycosuria with hypertonic dextrose 3
• Never abruptly discontinue hypertonic dextrose infusions; transition to 5% dextrose solution to prevent rebound hypoglycemia 3

Refeeding Syndrome Prevention:

• Administer thiamine before commencing PN in high-risk patients (severe alcoholic hepatitis, malnutrition) to prevent Wernicke's encephalopathy 1

Fasting Precautions in Liver Disease:

• Patients with severe alcoholic hepatitis who must abstain from food for >12 hours should receive IV glucose at 2-3 g/kg/day 1
• If fasting exceeds 72 hours, total parenteral nutrition is required 1

Special Population Adjustments

Acute Renal Failure with Dialysis

• Positive nitrogen balance achievable with 0.4 g nitrogen/kg/day (approximately 2.5 g amino acids/kg/day) in patients on continuous renal replacement therapy or hemodialysis 1
• Continuous renal replacement increases glutamine loss by 4-7 g/day, potentially requiring increased supplementation 6

Hypocaloric Feeding

• Nitrogen requirements increase by approximately 25-30% in acutely ill patients receiving hypocaloric feeding 1

Cancer Patients

• Severely malnourished cancer patients may benefit from approximately 2 g amino acids/kg/day (including high doses of branched-chain amino acids) based on metabolic studies 9
• Less malnourished patients receiving longer-term parenteral nutrition: 1.5 g amino acids/kg/day added to oral diet achieved positive results 9

Common Pitfalls to Avoid

• Never attempt to "catch up" if administration falls behind schedule 3
• Do not use flexible containers in series connections 3
• Avoid bicarbonate administration during nutritional solution infusion unless absolutely necessary 3
• Calcium and phosphorus additives are potentially incompatible when added to TPN admixtures; careful pharmaceutical assessment required 3
• Inspect for precipitates before administration as this represents a life-threatening risk 3