Amino acid, sorbitol, xylitol, electrolyte.
5% Amino Acids with Carbohydrates and Electrolytes for Parenteral Nutrition in Cases of Hepatic Insufficiency.
Each 500 mL contains: L-Isoleucine 3.80 g, L-Leucine 4.25 g, L-Lysine Monomalate 3.93 g, L-Methionine 0.25 g, L-Phenylalanine 0.125 g, L-Threonine 0.60 g, L-Tryptophan 0.05 g, L-Valine 3.20 g, L-Arginine 2.45 g, L-Histidine 0.30 g, L-Ornithine-L-Aspartate 4.015 g, L-Alanine 1.05 g, N-Asetyl-L-Cysteine 0.10 g, L-Glutamic Acid 0.50 g, Glycine 0.35 g, L-Proline 0.60 g, L-Serine 1.375 g, Sorbitol 12.5 g, Xylitol 12.5 g, Sodium Glycerophosphate.5H2O 2.296 g, Magnesium Chloride 0.509 g, Potassium Chloride 0.671 g, Water for injection ad 500 mL.
Na+ 30 mEq/L, K+ 18 mEq/L, Mg++ 10 mEq/L, Cl- 28 mEq/L, Malate- 28 mEq/L, P.
Osmolarity 750 mOsm/L, Nitrogen content 3.8 g/500 mL.
Pharmacology: Parenteral nutrient solution with an amino acid (AA) pattern adjusted to the altered AA metabolism of patients with hepatic insufficiency. The high concentration of branched-chain AA (Isoleucine, Leucine, and Valine) and low content of Methionine, Phenylalanine and Tryptophan influence CNS function.
In some cases, this reduce the risk of neurological deterioration which previously present in patients with serious liver disease receiving parenteral nutrition in the form of standard amino acid solution. This solution could increase mental alertness in cases where sensory disorders due to hepatic insufficiency are present.
Another factors which have contribution is the use of reliable substances which back up the detoxication functions of the diseased liver e.g. Ornithine Aspartate, Arginine, Malate (Malic Acid) and electrolyte pattern adjustment into specific needs of liver disease patients, e.g. reduced Na+, average K+ and increased Mg++ content.
Essential parenteral nutrition in patients with severe chronic hepatic insufficiency, e.g. decompensated liver cirrhosis, shunt patients with liver cirrhosis, hepatic insufficiency resulting from other causes (e.g. metastatic liver); possibly also in cases of chronic hepatitis.
Intravenous infusion: Unless otherwise prescribed, 0.7 - 1 g amino acid/kg body weight/day.
In special cases: A reduced dosage ± 0.5 g amino acid/kg body weight/day or with considerably increased requirements up to 1.4 g amino acid/kg body weight/day. This yields 14-20 mL (10-28 mL)/kg body weight/day or approximately 1000-1500 mL (700-2000 mL)/day for patients weighing 70 kg.
Normal infusion rate is 0.1 g amino acid/kg body weight/hour equal with 2 mL/kg body weight/hour or 2.3 mL/minute (45 drops/minute or 500 mL in approximately 3 ¾ hour) for patients weighing 70 kg.
The infusion rate should not exceed 0.15 g amino acid/kg body weight/hour (± 3.5 mL or 70 drops/minute for patients weighing 70 kg).
Non-protein nutritional energy should be given separately at a rate approximately 100-150 kJ (± 25-35 kcal)/kg body weight/day or on special cases where 170 kJ (40 kcal)/kg body weight/day is required preferably via either parenteral or enteral (with feeding tube if necessary), or a combination of the 2 methods.
Vitamin supply should be ensured. If ascites develops, increased diuretic therapy should be considered. Parenteral nutrition should not be applied more than 2 - 3 weeks without control of protein synthesis (i.e., plasma protein assessment, coagulation factors, etc.).
Liver atrophy patient with coma (so-called endogenous hepatic coma, acute liver atrophy) occurring as a result of hepatitis or severe poisoning, e.g. chronic renal disease with serious restriction of renal performance; hyperkalaemia, shock, decompensated cardiac insufficiency, fructose or sorbitol intolerance, fructose-1, 6-diphosphatase deficiency, methanol poisoning, metabolic anomalies in connection with amino acids content in this preparation.
On rare cases, acute poisoning could occur where comatose states are imminent.
Use in Children: There were no definite guidelines according to the use of LIVAMIN in children as their requirement may vary during the growth phase.
Ensure adequate renal function
Adverse reactions may occur because of the solution or technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasations and hypervolemia.
If adverse reactions occurs, discontinue infusion. Initiate appropriate treatment and retain the remainder of fluid for examination, if necessary.
Store below 30°C, away from light.
B05BB01 - electrolytes ; Belongs to the class of solutions affecting the electrolyte balance used in I.V. solutions.
Infusion (glass bottle) 500 mL x 1's.