Kabiven peripheral

Kapiven's peripheral product includes solutions of amino acids and glucose, as well as fat emulsion. This tool is designed to save the lives of patients who, due to circumstances, are unable to receive enteral nutrition. Thus, a complex of vital drugs "three in one" performs the most important functions: replenishes the body's deficiency of carbohydrates, fats and proteins.

Indications Kabiven peripheral

Indications for use Kabiven peripheral - providing qualitative parenteral nutrition of patients with various pathologies. The effective effect of this drug is due to the pharmacological activity of its constituent components. Thus, Vamin 18 Novum replenishes the protein deficiency in the body with the impossibility of enteral feeding of the patient. Intralipid acts as a supplier of essential fatty acids. Glucose provides a normal metabolism of amino acids. Infusion of a glucose solution together with a lipid emulsion helps reduce the risk of thrombophlebitis, which is often found with intravenous administration of various hypertonic solutions.

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Release form

Kabiven peripheral is presented in the form of an emulsion and is intended for infusions with protein-energy deficiency of mild to moderate degree.

The form of the preparation is a three-chamber bag (plastic container) containing solutions of amino acids and glucose, as well as fat emulsion and having three versions of volumes - 2400 ml, 1920 ml and 1440 ml. The volume of the container determines the number of solutions. The three main components of Kabiven's peripheral are presented in a balanced ratio.

As a result of mixing the components of the 3 chambers, a homogeneous emulsion is formed, which is colored white.

• Vamin (amino acids + electrolytes) is a solution of amino acids that have the highest biological value.
• Intralipid - is widely used in the US and Europe so-called. "Gold standard" fat emulsion.
• Glucose has many advantages, among which it is necessary to distinguish an optimally balanced composition, simplicity and convenience in use, the ability to reduce the risk of developing infectious complications. In addition, by means of a special port, glucose can be introduced into the central and peripheral veins together with vitamins and various trace elements.

It should be noted that for the best technology and design, the Kabiven peripheral drug was awarded the Medical Design Excellence Awards in 2001 (New York).

Pharmacodynamics

Kabiven peripheral is effective due to its special composition, which determines the pharmacological properties of this drug.

Pharmacodynamics Kabiven peripheral consists in the action of its active components - a solution of amino acids and glucose, as well as an intralipid (fat emulsion).

Vamin 18 H (amino acid solution) is optimal for patients who need to compensate for protein deficiency as a result of surgical interventions, burns and various injuries; It is widely used in ENT and surgery (including maxillofacial), in cases when enteral nutrition of the patient is impossible, or it does not give the desired effect.

Fat emulsion Intralipid is an effective source of energy, which is indicated to patients with a pronounced deficiency of essential fatty acids. It is necessary for patients who have an acute need to normalize the balance of essential fatty acids.

Glucose is an indispensable source of so-called. "Fast-releasing" energy and plays an important role in the metabolism of amino acids.

In a complex these three main components of Kabivena peripheral provide a positive result in therapy and help to quickly fill the deficit of fats, proteins and carbohydrates in the patient's body.

[2], [3],

Pharmacokinetics

Kabiven peripheral is a medicinal preparation in the form of a three-component mixture, which is used in medical practice to maintain optimal protein-energy metabolism. The recommended duration of infusion of peripheral Kabivena usually ranges from 12 to 24 hours.

Pharmacokinetics Kabiven peripheral is caused by the excretion of three of its constituent components from the body. Thus, the removal of Intralipid from the bloodstream occurs in a similar manner to that of chylomicrons (particles of neutral fat). In general, the hydrolysis of exogenous fat particles occurs in the blood. With regard to the rate of excretion, it depends directly on the speed of infusion, the composition of fat particles, as well as the general condition of the patient.

The intravenous solution of amino acids and electrolytes (Wamin 18 H) has almost the same pharmacokinetic characteristics as when the amino acids enter the body together with food. The only difference is that the ingestion of amino acids of food proteins in the bloodstream occurs through the hepatic portal vein, and entered into the vein - immediately into the systemic bloodstream. As for the pharmacokinetic characteristics of glucose administered by infusion, they are no different from those observed when it enters the body with food.

[4], [5]

Dosing and administration

Kabiven peripheral is administered intravenously. Infusions can be carried out in the patient's central or peripheral veins. The choice of the dosage of the drug and the speed of its intravenous administration depend on the individual ability of the human body to excrete lipids, as well as metabolize glucose.

The method of administration and dose of this medication is selected individually, depending on the disease pattern. The choice of the volume of the container with active substances Kabivena peripheral depends on the general condition of the patient, its weight, as well as the level of the body's need for nutrients. The implementation of parenteral nutrition in full may require additional addition of individual vitamins, electrolytes and trace elements.

The maximum daily dose is usually 40 ml / kg / day, which equates to one three-chamber Kabivena peripheral bag, which has the largest size - a volume of 2400 ml. This dosage is optimal for adults with an average body mass index of 64 kg. It should be taken into account that the choice of the maximum daily dose may vary, since this indicator depends entirely on the clinical picture of the disease and the patient's well-being. For people who are obese, the dosage of the drug is set taking into account the ideal body weight.

Kabiven peripheral can be prescribed to children from two years old. At the same time, it is administered starting from the lowest dosages (from 14 to 28 ml / kg / day), after which the dose gradually increases to a maximum of 40 ml / kg / day. Children older than 10 years of age, Kabiven's peripheral dosage is set in the same amounts as for adults.

[13], [14], [15], [16]

Use Kabiven peripheral during pregnancy

Kabiven peripheral belongs to the group of combined medicines used in modern medicine for parenteral nutrition of patients in those cases when oral or enteral nutrition is contraindicated, is carried out in insufficient or almost impossible.

In the instructions to the drug it is said that it can be used both for adults and children over 2 years old. The use of Kabiven peripheral during pregnancy remains questionable, as the annotation to the medication states that to date no special studies have been carried out regarding the safety of Kabiven peripheral during childbearing and the lactation period. Also, the instruction emphasizes that, in principle, the administration of this drug to pregnant women and nursing mothers is possible, but only in cases where the expected therapeutic effect exceeds the possible risks to the fetus.

Thus, the decision on the appointment of Kabiven as a peripheral as a therapeutic agent during pregnancy should only be taken by a doctor who will weigh the pros and cons and only in case of emergency use this medication for treatment. In this case, you need to take into account the condition of the pregnant woman, the results of her examination and medical tests.

Contraindications

Kabiven peripheral is assigned to patients with caution because of a number of contraindications that can cause complications during therapeutic treatment.

Contraindications for use Kabiven peripheral concern the following pathological conditions:

• hypersensitivity to one of the auxiliary components of the drug, in particular, soy and egg proteins;
• hyperglycemia;
• hyperlipidemia;
• hepatic / renal failure (acute form of the disease);
• serious bleeding disorders;
• Contraindications to infusions (the state of hyperhydration (excessive accumulation of fluid in the body), dehydration (significant loss of water), heart failure or acute pulmonary edema, etc.);
• congenital metabolic disorder of amino acids;
• a pathological increase in the concentration in the blood plasma of any of the peripheral electrolyte that is part of the Kabivena;
• acute phase of shock;
• various unstable conditions (severe form of sepsis, the patient's diabetes, all kinds of post-traumatic conditions, heart attack, etc.).

Kabiven peripheral with great care is prescribed when observing the patient's metabolic disorders of lipids after the development of diabetes mellitus, as well as in renal failure or liver failure, pancreatitis, metabolic acidosis (changes in acid status), sepsis, a tendency to delay electrolytes, a pronounced need for plasma-substituting therapy, increased osmolarity of blood, etc.

[6], [7], [8],

Side effects Kabiven peripheral

Kabiven peripheral can have side effects only in rare cases. If the infusion is done correctly, there are usually no side effects from taking this medication.

Side effects Kabiven peripheral cover a number of the following symptoms:

• allergic reactions (skin rash, tremor, fever, urticaria, chills, anaphylactic reaction);
• arterial hypo- or hypertension;
• tachypnea (breathing disorder);
• abdominal pain (neurotic abdominal pain);
• headache;
• reticulocytosis (an increase in the number of reticulocytes in the peripheral blood);
• increased activity of hepatic enzymes;
• hemolysis (the process of erythrocyte destruction);
• priapism (pathologically arising (painful) erection of the penis).

Of the possible local reactions can be noted the emergence of thrombophlebitis with the introduction of the drug in the peripheral veins of the patient.

If any adverse reactions occur as a result of taking peripheral Kabivena, the dosage of the medicine changes or alternative therapy is selected. Everything depends on the specific situation and the correctness of the drug administration. In any case, infusions of Kabiven peripheral are carried out in a medical facility under the strict supervision of medical staff.

[9], [10], [11], [12],

Overdose

The peripheral kabiven must be administered to the patient taking into account the general picture of the disease and the condition of the patient, since various complications are possible due to an overdose.

Overdose can cause so-called. "Fatty overload syndrome," which consists in a violation of the body's ability to excrete fats. Such a syndrome can be either the result of an overdose by the drug or the result of a violation of the infusion rate in cases where the patient has a sudden change in the clinical state, which leads to acute hepatic or renal failure. Treatment of such conditions consists in stopping the introduction of lipids.

The main signs of fat overload syndrome:

• fever;
• coagulopathy (bleeding disorder of the blood);
• anemia (reduction of hemoglobin);
• hyperlipidemia (impaired lipid metabolism);
• hepatosplenomegaly (simultaneous enlargement of the liver and spleen);
• leukopenia (a decrease in the number of leukocytes in the blood);
• thrombocytopenia (low platelet count in the blood);
• coma (deep loss of consciousness as a result of the development of the critical state of orgasm due to pathology).

To avoid drug overdose, it is important to conduct Kabiven peripheral infusion strictly in a hospital, under the supervision of medical staff and taking into account the appointment of a doctor.

Interactions with other drugs

Kabiven peripheral can interact with other drugs, adversely affecting certain processes in the body. This should be taken into account when combining this drug.

Interactions Kabiven peripheral with other drugs have their own characteristics. In particular, the drug can be combined only with those drugs and nutrient solutions that are compatible with it at the chemical level, i.e. Do not cause any negative consequences and complications. These drugs include: Vitalipid H (for adults and for children), Dipeptiven, Addamel N, Soluvit N. Mixing solutions should be done exclusively in aseptic conditions.

Heparin in clinically applied doses causes a transient release into the bloodstream of lipoprotein lipase, which can lead first to an increase in lipolysis in the blood plasma, and then to a transient weakening of the clearance of triglycerides.

Insulin can also affect the activity of lipase, but there is no evidence of an adverse effect of this factor on the therapeutic value of the drug.

Vitamin K1, contained in soybean oil, is an antagonist of coumarin derivatives, therefore it is recommended to carefully monitor blood coagulability in patients receiving these drugs.

Kabiven peripheral can be mixed only with those medicines and for which compatibility with it is confirmed, for example: adult and Vitalipid N children;

[17], [18], [19],

Storage conditions

At a temperature of no higher than 25 ° C. Do not freeze. Keep out of the reach of children.

After opening the latches, the chemical and physical stability of the mixed contents of the 3 chambers is maintained for 24 hours at a temperature of 25 ° C. To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then, provided that aseptic conditions are met when adding additives, the emulsion mixture can be stored for up to 6 days at a temperature of 2-8 ° C, after which it must be used for 24 hours.

Shelf life

Shelf life of the drug in the outer bag is 2 years.

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