Cabivenes Central

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

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Indications Cabivenes Central

Indications for the use of Kabiven Central in a hospital setting are primarily associated with cases where the patient is unable to receive adequate additional (enteral) nutrition due to severe physical conditions (with serious injuries, after surgery, coma, etc.).

The concept of parenteral nutrition was developed by the French professor Solassol and other scientists in the 1970s. It included the development of "all-in-one" medical mixtures. This concept found wide application in Europe and was immediately introduced into medical practice for a number of practical reasons:

• due to its ease of use and high technology;
• parenteral nutrition technology turned out to be less expensive from an economic point of view;
• due to a reduction in the risk of developing infectious complications in the patient;
• Three-in-one mixtures contain a composition of vital nutrients that is optimally balanced for intravenous administration.

Thus, the active substance of Kabiren Central is a unique mixture of amino acids, glucose and other drugs (fat emulsions), which is used in cases of insufficient oral or enteral nutrition in adults and children, or in situations where such nutrition is contraindicated. Thus, the pharmacological action of Kabiren is to replenish the patient's body's deficiency of proteins, fats and carbohydrates.

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Release form

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

The release form of this drug in vials or packages 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 transparent consistency, having a slightly yellowish tint, or absolutely colorless) – 19%;
• Vamine 18 Novum solution – a combination of electrolytes and amino acids (light yellow or completely colorless solution);
• Intralipid solution (white homogeneous fat emulsion) - 20%.

The result of mixing three chambers with active substances in a plastic container is a homogeneous emulsion, colored white. Its unique composition is formed from active components: soybean oil, sodium acetate monohydrate (anhydrous dextrose), glucose oil (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 hospital conditions to replenish the patient's body's deficiency of proteins, fats and carbohydrates. The effective treatment result is due to the unique composition of this drug.

The pharmacodynamics of Kabiven Central is determined by its constituent components - glucose, amino acids, electrolytes and fatty acids. Thus, without glucose, which is a rich source of energy, the process of amino acid metabolism is almost impossible. Intralipid is also an important source of energy and fatty acids. This drug is indicated for severe deficiency of essential fatty acids in the patient, when the body is unable to independently replenish them through oral administration. Intralipid 20% contains soybean oil in combination with purified egg yolk phospholipids. Vamin 18 N is intended for parenteral nutrition of patients with a pronounced need for protein. This combination of beneficial amino acids and electrolytes is used for therapeutic and prophylactic purposes when observing protein deficiency in patients after burns, various injuries, surgery, and is also used in ENT practice, maxillofacial surgery, etc., i.e. in cases where enteral nutrition of the patient is ineffective or impossible.

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Pharmacokinetics

Kabiven Central is a mixture of essential ingredients for intravenous administration to a patient due to the impossibility of oral or enteral nutrition.

Pharmacokinetics of Kabiven central:

• Glucose. As for the pharmacokinetic characteristics of glucose, when it is administered by infusion, the same absorption processes are observed as when it is ingested daily with food.
• Amino acids + electrolytes. When amino acids are administered intravenously with electrolytes, the same pharmacokinetic characteristics are observed as when they are normally administered with food. One difference can be noted: when amino acids are administered directly into a vein, they immediately enter the bloodstream, unlike 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 occurs in the same way as chylomicrons. In this case, hydrolysis of exogenous fat particles occurs in the blood with their subsequent capture in the liver by lipoprotein receptors. As for the rate of elimination of Intralipid, its indicator is determined by both the general condition of the patient and the rate of intravenous administration of the drug, as well as the composition of the fat particles themselves. The maximum clearance rate (i.e., the rate of purification) of Intralipid when taken on an empty stomach is 3.8 + 1.5 grams of triglycerides/kg/day.

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Dosing and administration

Kabiven Central is administered to the patient intravenously in a hospital setting. Four volume options of the drug (packaging in bags of different sizes) are used, respectively, for patients who have a reduced, slightly increased or normal need for proteins, fats, carbohydrates and other nutrients.

The method of administration and dosage of Kabiven 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 general condition of the patient, as well as the need of his body to replenish missing nutrients. Determination of the infusion dosage depends on the ability of the patient's body to remove lipids, as well as to 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 is usually a period of 12 to 24 hours.

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

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

Providing the patient with full parenteral nutrition may require additional administration of essential vitamins, microelements and electrolytes. The dosage of the drug for obese patients is determined based on the ideal body mass index.

Use Cabivenes Central during pregnancy

Kabiven Central is prescribed with caution to pregnant women and nursing mothers, like any other drug, since during the period of bearing a child it is important to take into account all possible risks for the baby and the health of the expectant mother.

The use of Kabiven Central during pregnancy should be carried out only in cases where the expected therapeutic effect greatly exceeds the potential threat to the fetus. This condition is explained by the fact that no medical studies on the safety of using Kabiven Central by pregnant women and nursing mothers have been conducted to date. However, if there are alternative treatment methods, it is better to use them, since during the period of bearing a child it is recommended to refrain from taking drugs whose effect on the developing fetus has not been studied. In any case, the decision on taking Kabiven Central by a 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 draw 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 a patient.

The main contraindications for the use of Kabiven Central:

• hypersensitivity of the patient's body to soy and egg proteins, as well as another auxiliary component of Kabiven central;
• acute liver or kidney failure;
• hyperlipidemia (lipid metabolism disorder);
• severe blood clotting disorders;
• acute phase of shock;
• hemophagocytic syndrome (a life-threatening condition);
• congenital amino acid metabolism disorders;
• pathological increase in the concentration in blood plasma of any of the electrolytes included in Kabiven central.

Contraindications to the use of Kabiven Central also include decompensated heart failure, acute pulmonary edema, myocardial infarction (in the acute stage), hypotonic dehydration, diabetes mellitus, metabolic acidosis, lipid metabolism disorder due to pancreatitis, diabetes mellitus or renal failure. The drug is prescribed with caution to patients with any liver dysfunction, hyperhydration (water-salt balance disorders in the body), hypothyroidism, increased blood osmolarity and various unstable conditions.

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Side effects Cabivenes Central

Like most medications, Kabiven Central may have a number of side effects that should be taken into account when using it. With proper intravenous administration of the drug, the manifestation of significant side effects is unlikely.

Side effects of Kabiven central:

• an allergic reaction of the body to the drug of varying degrees of manifestation: chills, fever or tremors in the body, as well as urticaria, skin rashes, anaphylactic reaction (a state of sharply increased sensitivity of the body to the introduction of an allergen);
• headache of varying intensity;
• tachypnea (breathing disorder);
• hemolysis (the process of destruction of red blood cells);
• arterial hypo- or hypertension;
• increased activity of liver enzymes;
• priapism (prolonged painful erection not accompanied by arousal);
• reticulocytosis (increased content of reticulocytes (“young” red blood cells) in the peripheral blood);
• abdominal pain (stomach pain);
• thrombophlebitis due to injection of the drug into peripheral veins.

In case of any side effects of Kabiven Central, the issue of alternative treatment is considered.

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Overdose

Kabiven central should be administered to the patient strictly in a hospital setting under the supervision of the attending physician and medical staff. Correct administration of this drug does not cause complications in the form of any side effects or overdose. However, if the dosage or infusion rate was set incorrectly, there may be signs of an overdose, which must be eliminated in time to avoid serious complications.

An overdose of Kabiven Central usually manifests itself in the form of the following symptoms:

• fever,
• hyperlipidemia (increased lipid levels),
• anemia,
• leukopenia (decreased white blood cell count),
• hepatosplenomegaly (a syndrome that results in an increase in the size of the spleen and liver),
• coagulopathy (blood clotting disorder),
• thrombocytopenia (decreased platelet count),
• coma.

All these symptoms are caused by the development of the so-called "fat overload" syndrome in the patient's body. Such signs may also occur with the recommended infusion doses against the background of a sharp change in the patient's clinical condition and the development of severe renal or hepatic failure. Treatment of the patient in case of an overdose of Kabiven Central consists of urgently stopping the lipid infusion. Symptomatic therapy (elimination of disease symptoms) is also carried out.

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Interactions with other drugs

Kabiven central may be mixed only with compatible nutrient solutions and medicinal products. Mixing of such solutions must be carried out exclusively under aseptic conditions under the supervision of medical personnel.

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

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

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

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Storage conditions

Kabiven Central, like other medical preparations, is recommended to be stored in a dry place, inaccessible to children and protected from sunlight. The storage of this emulsion mixture must be approached responsibly, observing the required temperature conditions and taking into account the generally accepted rules for storing such drugs.

Storage conditions Kabiven central: this drug is strictly prohibited from freezing. The optimal storage temperature is 25 °C. It should be taken into account that after opening the container locks with the drug, the physicochemical stability of its contents as a result of mixing the components from 3 chambers can only be stored for 24 hours at an optimal temperature of 25 °C.

Microbiological safety of the medicinal mixture is ensured by its use immediately after the introduction of the necessary additives. Such an emulsion mixture, if it is not used immediately, may be stored at a temperature of 2 to 8 °C for up to six days, but only under appropriate aseptic conditions. After the expiration of the specified shelf life, the drug must be used within 24 hours.

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Shelf life

The central kabiven must be stored in the outer packaging bag.

The shelf life of the drug is 2 years. It is strictly forbidden to use this medicine after the expiration date indicated on the package.

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

Kabiven Central, like other drugs, is produced with the appropriate marking: the numbers indicating the year and month of production, as well as the series of the drug, are printed on the packaging with the drug. The following designation may be applied to the packaging, which indicates a strictly limited shelf life of the drug: "Best before..." (the month is indicated by a Roman numeral). It is important to remember that taking an expired drug 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 may not only lose its medicinal properties, but also acquire toxic ones.

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