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Rx19% • Emulsion for infusion
Indications & Uses
This parenteral nutrition is for adults and for children above 2 years of age, when feeding by mouth or by tube into the gut is not possible, is not enough, or must not be used.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
The dose is set for each patient, and the bag size is chosen according to the patient's clinical condition, body weight and nutritional needs. For total parenteral nutrition, trace elements and vitamins must be given in addition.
Adult patients: The nitrogen needed to maintain body protein mass depends on the patient's condition (for example nutritional state and degree of catabolic stress). The requirement is 0.10-0.15 g nitrogen/kg/day in a normal nutritional state or when metabolic stress is mild. In patients with moderate to high metabolic stress, with or without malnutrition, it is in the range of 0.15-0.30 g nitrogen/kg/day (1.0-2.0 g amino acid/kg/day). The commonly accepted requirements that go with this are 2.0-6.0 g for glucose and 1.0-2.0 g for fat. A dose range of 0.10-0.20 g nitrogen/kg/day (0.7-1.3 g amino acid/kg/day) covers the need of most patients. This corresponds to 19 ml-38 ml/kg/day, so for a 70-kg patient it equals 1330 ml-2660 ml of this solution per day.
The total energy requirement depends on the patient's clinical condition and is most often between 25-35 kcal/kg/day. In obese patients, base the dose on the estimated ideal weight. The solution comes in four sizes, meant for patients with high, moderately increased, basal or low nutritional requirements. Again, trace elements and vitamins should be given additionally to provide total parenteral nutrition.
Children: The child's ability to handle each nutrient must decide the dose. In general, for small children (2-10 years) the infusion should start low, at 12.5-25 ml/kg (corresponding to 0.49-0.98 g fat/kg/day, 0.41-0.83 g amino acids/kg/day and 1.2-2.4 g glucose/kg/day). It is then increased by 10-15 ml/kg/day up to a maximum of 40 ml/kg/day. For children over 10 years of age, the adult dose can be used. This parenteral nutrition is not recommended in children under 2 years of age, because the amino acid cysteine may be considered conditionally essential in them.
Side Effects
Intralipid may cause a rise in body temperature (incidence <3%). Less often, people get shivering, chills and nausea or vomiting (incidence <1%). Short-lived increases in liver enzymes have also been reported during intravenous nutrition. As with all hypertonic solutions for infusion, thrombophlebitis may occur if peripheral veins are used. Other unwanted effects with Intralipid infusions are extremely rare, less than one adverse event per million infusions. These include hypersensitivity reactions (anaphylactic reaction, skin rash, urticaria), respiratory symptoms (e.g. tachypnoea) and hyper/hypotension. Haemolysis, reticulocytosis, abdominal pain, headache, tiredness and priapism have also been reported. Then there is fat overload syndrome. If the body can't clear Intralipid (the fat component in this parenteral nutrition) properly, this syndrome may follow. It can happen because of over-dosage, but also at the recommended rates of infusion when the patient's clinical condition changes suddenly, for example with renal function impairment or infection. The syndrome is characterised by hyperlipidaemia, fever, fat infiltration, hepatomegaly, splenomegaly, anaemia, leucopenia, thrombocytopenia, blood coagulation disorders and coma. All of these symptoms are usually reversible once the infusion is stopped.
Cautions & Contraindications
Warnings & Precautions
The body's ability to clear fat should be monitored. The usual way is to measure serum triglycerides after a fat-free period of 5 to 6 hours, and the level should not go above 3 mmol/l during the infusion. Choose the bag size with care, especially the volume and the quantitative composition. For children, adjust these volumes to suit their hydration and nutritional status. One reconstituted bag is for single use only. Correct any disturbance of electrolyte and fluid balance (for example, abnormally high or low serum levels of the electrolytes) before starting the infusion. Special clinical monitoring is needed at the start of any intravenous infusion, and if any abnormal sign appears, the infusion must be stopped. Using any central vein raises the risk of infection. So strict aseptic precautions should be taken to avoid contamination during catheter insertion and handling. Give this solution with caution in conditions where lipid metabolism is impaired, such as renal insufficiency, uncompensated diabetes mellitus, pancreatitis, impaired liver function, and hypothyroidism (with hypertriglyceridemia or sepsis). If it is given to patients with these conditions, close monitoring of serum triglyceride concentrations is mandatory.
Contraindications
This preparation must not be given to anyone with hypersensitivity to egg, soya or peanut protein, or to any of the active substances or excipients. It is also contraindicated in severe hyperlipaemia, severe liver insufficiency, severe blood coagulation disorders and inborn errors of amino acid metabolism. Severe renal insufficiency without access to haemofiltration or dialysis rules it out too, as do acute shock and hyperglycemia that requires more than 6 units insulin/h. Pathologically elevated serum levels of any of the included electrolytes are another contraindication. The general contra-indications to infusion therapy also apply: acute pulmonary oedema, hyper hydration, decompensated cardiac insufficiency and hypotonic dehydration. Haemophagocytotic syndrome is a further contraindication. So are unstable conditions (for example severe post-traumatic conditions, uncompensated diabetes, acute myocardial infarction, metabolic acidosis, severe sepsis and hyperosmolar coma). It must not be given to infants under 2 years of age.
Overdose
Nausea, vomiting and sweating have been seen when amino acids were infused faster than the recommended maximum rate. If any symptoms of overdose appear, slow the infusion down or stop it. An overdose can also cause fluid overload, electrolyte imbalances, hyperglycemia and hyperosmolality. In some rare serious cases, haemodialysis, haemofiltration or haemo diafiltration may be needed.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Store at 25°C and do not freeze it. Storing it this way is recommended.
Common questions about Kabiven Central 19%
What is Kabiven Central 19% Emulsion for infusion?
Kabiven Central 19% Emulsion for infusion is a medicine that contains Glucose 19% + Vamin 18 Novum + Intralipid 20%. It is made by Radiant Pharmaceuticals Ltd. It belongs to the Parenteral nutritional preparations group of medicines.
What is Kabiven Central used for?
This parenteral nutrition is for adults and for children above 2 years of age, when feeding by mouth or by tube into the gut is not possible, is not enough, or must not be used.
What are the side effects of Kabiven Central?
Intralipid may cause a rise in body temperature (incidence <3%). Less often, people get shivering, chills and nausea or vomiting (incidence <1%).
What happens if I take too much Kabiven Central?
Nausea, vomiting and sweating have been seen when amino acids were infused faster than the recommended maximum rate. If any symptoms of overdose appear, slow the infusion down or stop it. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store Kabiven Central?
Store at 25°C and do not freeze it. Storing it this way is recommended.
Do I need a prescription for Kabiven Central?
Kabiven Central is a prescription (Rx) medicine. Take it as your doctor advises.