Kabiven Central

Kabiven central is a kind of therapeutic mixture consisting of vital nutrients, which is used for the purpose of mixed or complete parenteral (intravenous) nutrition of the patient. What does parenteral nutrition include ? First of all, it includes an optimal combination of glucose solution, essential amino acids and fatty emulsions.

[1], [2], [3]

Indications Kabiven Central

Indications for use Kabiven central in a stationary mode is primarily associated with cases when the patient is unable to obtain adequate additional (enteral) nutrition due to severe physical conditions (in case of serious injuries, after surgery, coma, etc.) .

The concept of parenteral nutrition was developed by the French professor Solassolo together with other scientists in the 70's. The last century. It included the development of medical mixtures "all in one." This concept has found wide application in Europe and was immediately introduced into medical practice for a number of practical reasons:

• thanks to the convenience in use, high adaptability;
• technology of parenteral nutrition was less costly from an economic point of view;
• because of the reduced risk of developing infectious complications in the patient;
• Three-in-one mixtures have a vital nutrient composition that is optimally balanced for intravenous administration.

So, the active substance of Kabiren central is a unique mixture of amino acids, glucose and other preparations (fat emulsions), which is used in cases of insufficiency of oral or enteral nutrition in adults and children, or in situations when such nutrition is contraindicated. Thus, the pharmacological action of Kabiren is the replenishment in the patient's body of a deficiency of proteins, fats and carbohydrates.

[4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]

Release form

Kabiven central is produced in a three-chamber plastic container (with two ports) in the form of an emulsion, intended for infusion - intravenous administration of the drug.

The form of this drug in vials or packs is presented in four volumes: 2566, 2053, 1540 and 1026 milliliters. Each package contains 2 or 4 bags. The chambers contain the following medicinal solutions:

• Glucose solution (a solution of a transparent consistency, slightly yellowish, or completely colorless) - 19%;
• solution of Vamin 18 Novum - a combination of electrolytes and amino acids (a solution of light yellow color or completely colorless);
• Intralipid solution (fatty homogeneous emulsion of white color) - 20%.

The result of mixing in the plastic container three chambers with active substances becomes a homogeneous emulsion, painted in white. Its unique composition is formed from active components: soybean oil, sodium acetate monohydrate (anhydrous dextrose), glucose (dextrose), calcium chloride, L-histidine, L-aspartic acid, lysine, L-arginine, glycine, magnesium sulfate, etc. The following components act as auxiliary substances: water for injection, glycerol (anhydrous), egg yolk phospholipids, glacial acetic acid, sodium hydroxide.            

Pharmacodynamics

Kabiven central is used exclusively in stationary conditions in order to replenish the body's lack of proteins, fats and carbohydrates. The effective result of treatment is determined by the unique composition of this drug.

Pharmacodynamics Kabiven central is determined by its constituent components - glucose, amino acids, electrolytes and fatty acids. So, without glucose, which is a rich source of energy, the process of metabolism of amino acids is practically impossible. The most important source of energy and fatty acids is Intralipid. This drug is indicated with a severe deficit in the patient of essential fatty acids, when there is an inability of the body to independently replenish them through oral intake. Intralipid composition of 20% includes soybean oil in combination with purified egg yolk phospholipids. Vamin 18 H is intended for parenteral nutrition of patients who have a marked need for protein. Such a combination of useful amino acids and electrolytes is used for therapeutic and preventive purposes when observing protein deficiency in patients after getting burns, various injuries, performing surgical operations, and also used in ENT, maxillofacial surgery, etc. - e. In those cases when there is inefficiency or impossibility of enteral feeding of the patient.

[16], [17], [18], [19], [20], [21], [22], [23], [24]

Pharmacokinetics

Kabiven central is a mixture of the most important ingredients for intravenous administration to the patient due to the inability of oral or enteral nutrition.

Pharmacokinetics Kabiven central:

• Glucose. As for the pharmacokinetic characteristics of glucose, when administered by infusion, the same absorption processes are observed as with daily intake into the human body together with food.
• Amino acids + electrolytes. With an intravenous method of introducing amino acids with electrolytes, the same pharmacokinetic characteristics are observed as when they are normally introduced into the body together with food. One can only note the difference: when directly introducing amino acids into a vein, they immediately enter the bloodstream system, in contrast to the amino acids of food proteins, which first pass through the portal vein of the liver and only then end up in the systemic bloodstream.
• Intralipid. The elimination of this fat emulsion by the bloodstream system occurs in the same way as chylomicrons. In the blood, the exogenous fat particles are hydrolyzed, followed by their capture in the liver by the lipoprotein receptors. With regard to the rate of excretion of Intralipid, its value is determined by the general condition of the patient, the speed of intravenous administration of the drug, and also directly by the composition of the fat particles. The maximum clearance (i.e., cleansing rate) of Intralipid when taken on an empty stomach is 3.8 + 1.5 grams of triglycerides / kg / day.

[25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36]

Dosing and administration

Kabiven central is administered to a patient intravenously in a hospital setting. Four variants of the volume of the preparation (packages in the form of bags of different sizes) are used, respectively, for patients who have a decreased, slightly increased or normal body requirement for proteins, fats, carbohydrates and other nutrients.

The way of administration and doses of the Kabivena Central are selected strictly on an individual basis. Usually, the choice of the volume of the drug package for intravenous administration depends on the body weight and the general condition of the patient, as well as the needs of his body for replenishing the missing nutrients. The determination of the dosage of the infusion depends on the ability of the patient's body to excrete lipids, as well as metabolize dextrose. In general, the infusion rate should not exceed 2.6 ml / kg / h. The duration of the infusion depends on the general condition of the patient and usually ranges from 12 to 24 hours.

Infusions are carried out by intravenous drip into the central veins. Before using the drug, the septa (latch) of the container are separated, and the contents of the 3 chambers are mixed.

The maximum daily dose of Kabiven is central for adults of 40 ml per 1 kg of body weight. Determination of dosage for children depends on the child's ability to metabolize individual nutrients. Thus, for children from 2 to 10 years of age, the drug should be started at the lowest dose, 14-28 ml / kg / day, gradually increasing the dosage from 10-15 to 40 ml / kg / day. Children 10 years of age or older are usually prescribed the same dosage as adults.

The implementation of parenteral nutrition of the patient in full may require additional introduction of the necessary vitamins, trace elements and electrolytes. Dosage of the drug for patients suffering from obesity, is set taking into account the ideal body mass index.

Use Kabiven Central during pregnancy

Kabiven central with caution is given to pregnant women and nursing mothers, like any other drug, because during the period of bearing the child it is important to take into account all possible risks for the baby and the health of the future mother.

Use Kabiven central during pregnancy should only be carried out if the expected therapeutic effect in many ways exceeds the potential threat to the fetus. This condition is due to the fact that no medical research has been carried out regarding the safety of Kabiven's use by central pregnant women and nursing mothers until now. Nevertheless, if there are alternative methods of treatment, it is better to take advantage of them, since during the period of gestation the child is recommended to refrain from taking medications, the effect of which on the fetus being formed is not investigated. In any case, the decision to take Kabiven as the central pregnant woman should be made exclusively by a qualified doctor who, based on the clinical condition of the expectant mother, the results of all necessary tests and the general course of pregnancy, will assess the situation and make the right conclusions.

Contraindications

Kabiven central has a number of contraindications for use. This factor must be taken into account when prescribing the drug to the patient.

The main contraindications for use Kabiven central:

• hypersensitivity of the patient's body to soy and egg proteins, as well as to another auxiliary component of Kabivena central;
• acute course of hepatic or renal insufficiency;
• hyperlipidemia (impaired lipid metabolism);
• serious bleeding disorders;
• acute phase of shock;
• hemophagocytic syndrome (a dangerous state with a threat to life);
• disorders of the metabolism of amino acids of an innate nature;
• a pathological increase in the concentration in the blood plasma of any of the electrolytes that make up the central Kabivena.

Among the contraindications to the use of Kabiven central drug, decompensated heart failure, acute pulmonary edema, myocardial infarction (in acute stage), hypotonic dehydration, diabetes mellitus, metabolic acidosis, lipid metabolism disorders due to pancreatitis, diabetes mellitus, or kidney failure can also be noted. . With caution the drug is prescribed for patients with any violations of the liver, hyperhydration (violations of water-salt balance in the body), hypothyroidism, increased blood osmolarity and various unstable conditions.

[37], [38], [39], [40]

Side effects Kabiven Central

Like most drugs, Kabiven central may have a number of side effects that should be considered when it is used. With the correct intravenous administration of the drug manifestation of pronounced side effects is unlikely.

Side effects Kabiven central:

• an allergic reaction of the body to a drug of varying degrees of manifestation: chills, febrile condition or trembling in the body, as well as urticaria, skin rashes, anaphylactic reaction (a state of sharply increased sensitivity of the organism to the introduction of an allergen);
• headache of varying degrees of intensity;
• tachypnea (violation of the breathing process);
• hemolysis (the process of erythrocyte destruction);
• arterial hypo- or hypertension;
• increased activity of hepatic enzymes;
• priapism (prolonged painful erection, not accompanied by excitement);
• reticulocytosis (increased content of reticulocytes ("young" erythrocytes) in peripheral blood);
• abdominal pain (abdominal pain);
• thrombophlebitis due to the introduction of the drug into the peripheral veins.

With any side effects of Kabiven central, the issue of alternative treatment is being considered.

[41], [42], [43], [44], [45], [46]

Overdose

Kabiven central should be administered to the patient strictly in a hospital environment under the supervision of the attending physician and medical personnel. The correct administration of this medication does not cause complications in the form of any side effects or overdose. However, if the dosage or speed of the infusion has not been established correctly, there may be signs of an overdose that must be rectified in time to avoid serious complications.

Overdose of Kabiven central drug usually manifests itself in the form of the following symptoms:

• fever,
• hyperlipidemia (increased lipid levels),
• anemia,
• leukopenia (decrease in the level of leukocytes),
• hepatosplenomegaly (a syndrome, the development of which is an increase in the size of the spleen and liver),
• coagulopathy (bleeding disorders),
• thrombocytopenia (decrease in the number of platelets),
• coma.

All these symptoms are caused by the development of the so-called syndrome. "Fatty overload" of the patient's body. Also such signs can arise at recommended doses of infusion against the background of a sharp change in the clinical state of the patient and the development of severe renal or hepatic insufficiency. Treatment of the patient in case of an overdose of Kabinen central is the urgent cessation of lipid infusion. Symptomatic therapy (elimination of symptoms of the disease) is also carried out.

[47], [48], [49], [50], [51], [52], [53]

Interactions with other drugs

Kabiven central is allowed to mix only with compatible nutrient solutions and medications. At the same time, mixing of such solutions should be carried out exclusively in aseptic conditions under the supervision of medical personnel.

Interactions Kabiven central with other drugs depend on their compatibility. This drug is compatible with the following medicines (solutions, powders and additives):

• Dipeptiven (concentrated solution of amino acids);
• Soluvit (sterile powder, which contains water-soluble vitamins);
• Vitalipid (vitamin supplement for adults and children, which is used in solutions for parenteral nutrition);
• Addamel (an additive that provides the daily requirement of an adult organism in microelements).

It is recommended to strictly control blood clotting in patients simultaneously receiving Kabiven central and preparations Heparin, Insulin and Vitamin K1 (contained in soybean oil). The use of these drugs on the background of Kabiven's central treatment should be carried out only in a hospital under the supervision of the attending physician, who will take into account all possible risks to the patient's health.

[54], [55], [56], [57], [58], [59], [60]

Storage conditions

Kabiven central, like other medications, is recommended to store in a dry place, inaccessible to children and protected from sunlight. The storage of this emulsion mixture must be treated responsibly, with observance of the necessary temperature regime and taking into account the generally accepted rules for storage of such medicinal products.

Storage conditions Kabiven central: this preparation is strictly not allowed to be frozen. The optimum storage temperature is 25 ° C. It should be taken into account that after opening the catches of the container with the preparation, the physical and chemical stability of its contents as a result of mixing components from 3 chambers can be stored only for 24 hours at an optimum temperature of 25 ° C.

Microbiological safety of the medicinal mixture is ensured by its use immediately after the introduction of the necessary additives. Such emulsion mixture, if not used immediately, can be stored at a temperature of 2 to 8 ° C for up to six days, but only if the appropriate aseptic conditions are met. After the indicated period of storage, the drug should be used within a day.

[61], [62]

Shelf life

Kabiven central must be stored in an outer packaging bag.

Shelf life of the drug is 2 years. It is strictly prohibited to use this medication after the expiry of the period indicated on the package.

After opening the package and mixing the solutions of the three chambers, the content of the preparation is 24 hours. It is important to observe the correct temperature storage regime, which is 25 ° C. If the emulsion mixture is not used immediately, care must be taken to ensure reliable storage conditions. The recommended period is 24 hours, the temperature regime is 2-8 ° С.

Kabiven central, like other drugs, is issued with the appropriate marking: on the package with the medicine, the figures designating the year and month of release, as well as the series of the preparation, are printed. It is possible to apply the following designation on the packaging, which indicates a strictly limited period of the drug's validity: "Good to ..." (the Roman numeral indicates the month). It must be remembered that taking an expired medication is usually not dangerous, but the active substances in it are simply inactivated. If the storage conditions of the drug are not properly observed, it can not only lose its medicinal properties, but also acquire poisonous ones.

[63], [64]