Oliklinomel

Oliklinomel is a combined agent used to feed the patient parenterally.

[1]

Indications of the oliklyonomel

It is used as a parenteral method of feeding to children from 2 years of age and adults in situations when it is not possible to carry out natural nutrition (either this method is contraindicated or is not effective enough).

[2], [3]

Release form

The release is carried out in the form of an infusion emulsion (it is formed as a result of mixing the contents of all 3 chambers of the container).

Oliklinomel n4-550e

Oliklinomel n4-550e is available in 3-chamber containers with a volume of 1 liter (6 pieces), 1.5 liters (4 pieces) or 2 liters (4 pieces).

Oliklinomel n7-1000e

Oliklinomel n7-1000e is produced in 3-chamber containers with a volume of 1 liter (in a quantity of 6 pieces), 1.5 or 2 liters (in the number of 4 pieces), or 2.5 liters (2 pieces each).

Pharmacodynamics

Consisting of 3 elements, the mixture is used as a source supporting the energy, and in addition protein metabolism. The presence of organic nitrogen provides L-AMK, and the energy saturation is due to the presence of fatty acids along with dextrose. Along with this, the mixture contains also electrolytes.

Moderate indices of the components of EFA within the mixture increase the level of higher derivatives of EFA within the body, filling the lack of these substances.

Large amounts of α-tocopherol are found inside olive oil. This element in combination with a small number of PUFAs increases the indices of tocopherol within the body, and also reduces lipid peroxidation.

[4]

Pharmacokinetics

Components of the infusion emulsion (they are electrolytes together with amino acids, as well as lipids along with dextrose) are metabolized and excreted from the body similarly to these processes in case of separate use of elements.

The pharmacokinetics of amino acids that are administered intravenously, mostly coincides with the characteristics of amino acids that come in the process of natural nutrition (but in such a situation, the amino acids contained within the food proteins undergo hepatic passage before penetrating the circulatory system).

The rate of excretion of the components of the lipid emulsion is determined by the size of these particles. Small lipid elements are eliminated more slowly, but at the same time, they are more quickly decomposed under the influence of the substance lipoprotein lipase.

The size of the components of the lipid emulsion inside the mixture approximately corresponds to the size of the chylomicrons, which is why they have a similar rate of excretion.

Dosing and administration

The drug is administered to patients intravenously - by means of a peripheral or central vein. The size of the portion, as well as the duration of administration, depend on the patient's need for this type of nutrition and are determined by its condition.

Adults need an average of 0.16-0.35 g / kg of organic nitrogen component per day (the AMC index is about 1-2 g / kg / day). The fluctuation of energy needs is determined by the patient's condition, as well as by the intensity of the catabolic processes that occur. Their average values are in the range of 25-40 kcal / kg / day.

The maximum daily dose is 40 ml / kg (this corresponds to 3.2 g of dextrose, and at the same time 0.88 g of AMK, as well as 0.8 grams of lipids per kilogram), which is 2,800 ml of an infusion emulsion that will be sufficient for administration to a person weighing 70 kg.

Children older than 2 years of age on average require 0.35-0.45 g / kg of element organic nitrogen per day (accordingly, in AMC this leaves about 2-3 g / kg / day). The average energy needs of such patients are 60-110 kcal / kg / day.

The size of the dose is determined by the amount of liquid that has got inside the body, and also by the daily need of the person in the protein. In addition, it is necessary to take into account the state of water metabolism.

Per day, you can enter a maximum of 100 ml / kg of medication (which corresponds to 8 grams of dextrose and in addition 2.2 g of AMC, as well as 2 grams of lipids per kilogram). It is generally forbidden to exceed a portion of 17 g / kg / day of dextrose or 3 g / kg / day of amino acids or lipids (except for special situations only).

The highest possible rate of infusion is 3 ml / kg / hour, which is a maximum of 0.24 g of dextrose, 0.06 g of amino acids, and 0.06 g of lipids per kg / h.

Oliklinomelya When stored at low temperature, before applying the infusion medications required to heat the mixture 25 to a mark ^of C.

The introduction of the mixture can begin only after the destruction of the partitions between the 3 chambers of the container, as a result of which all the elements of the drug are mixed.

[6]

Use of the oliklyonomel during pregnancy

At the moment there is no reliable information about the use of Oliklinomel during lactation or pregnancy. Therefore, when there is a need for its use in this period, before making a decision, the doctor should evaluate the ratio of care to a woman and the risk to the fetus.

Contraindications

The main contraindications:

• severe form of kidney failure in the absence of the possibility of dialysis or hemofiltration;
• severe liver failure;
• congenital form of the disorder of amino acid metabolism;
• severe stages of disorders of blood uptake processes;
• pronounced degree of hyperlipidemia;
• the presence of hyperglycemia;
• problems with the metabolism of electrolytes, increased plasma values of any of the electrolytes that are a constituent element of the mixture;
• development of lactic acidosis;
• Hyperhydria, pulmonary edema, decompensated stage of heart failure, and dehydration with a lack of salts;
• instability in the state of health (such as decompensated stage of diabetes mellitus, severe form of posttraumatic disorder, acute stage of myocardial infarction or hemorrhagic shock, and in addition a severe form of sepsis or metabolic acidosis and a non-ketonemic coma);
• children under 2 years of age;
• the presence of intolerance with respect to the elements of the drug.

Caution is prescribed to individuals with increased plasma osmolarity, adrenal insufficiency or heart failure, and with lung disease.

[5]

Side effects of the oliklyonomel

Among the possible side effects: the development of hyperhidrosis, hyperthermia, and in addition nausea, tremor and headaches, as well as respiratory function disorder.

In addition, there is sometimes a transient increase in the level of biochemical markers of hepatic activity (among them transaminase, alkaline phosphatase and bilirubin), especially in the case of prolonged use of this method of nutrition (over a period of several weeks).

Occasionally there is the appearance of jaundice or hepatomegaly.

Due to the weakening of the ability to eliminate lipids from the inside of the bloodstream, one should expect the development of a syndrome associated with overloading with fats. This disorder can be triggered by an overdose or appear at the beginning of the infusion. As a result, a sudden and dramatic deterioration in the patient's condition is observed. This syndrome manifests itself in the form of fever, hyperlipidemia, hepatomegaly, and in addition fatty liver infiltration, leukemia and thrombocytopenia, as well as anemia, coma and coagulation disorders. These symptoms can be cured by stopping the infusion of lipid emulsion.

At the same time, there is information that thrombocytopenia occasionally developed after the use of emulsion infusion in children.

A component of drugs is soybean oil. This ingredient can occasionally cause severe allergic symptoms.

It is required to stop the infusion immediately if the patient develops allergies (among them, a tremor, a respiratory disorder, a fever and rashes on the skin).

Overdose

Signs of poisoning: the development of acidosis, hypervolemia, tremors, as well as vomiting with nausea and destruction of the electrolyte balance. They arise because of an overdose or as a result of exceeding the required infusion rate. After the introduction of excessive portions of drugs, the appearance of glucosuria, hyperglycemia or hyperosmolar syndrome.

To eliminate the violation, you must immediately stop the infusion immediately. With a rapid cessation of infusion, the resulting disorders and their symptoms can be quickly eliminated and cured.

In case of severe intoxication, hemofiltration, hemodialysis or hemodiafiltration procedures may be necessary.

[7]

Interactions with other drugs

Infusion emulsion can not be administered in combination with blood medications using the same catheter, because it can cause pseudoagglutination.

When performing blood sampling before eliminating lipids from the plasma (often after 5-6 hours after completion of the infusion) they are able to influence the values of individual laboratory studies. For example, lipids can change the level of hemoglobin with bilirubin, as well as oxygen saturation and lactate dehydrogenase.

[8], [9]

Storage conditions

Oliklinomel should be kept out of reach for young children, without freezing, with temperatures in the range of 2-25 ° C. The mixed emulsion should be stored at 2-8 ° C (7 days) or 25 ° C (maximum 48 hours).

[10]

Shelf life

Oliklinomel is allowed to be used for 2 years from the date of manufacture of the medicament.