This infusion is used as a source of amino acids in various clinical conditions where adequate oral nutrition cannot be maintained or when oral feeding is not appropriate.

Each 100 ml contains:

Essential Amino Acids:

• L-Isoleucine USP: 0.600 g
• L-Leucine USP: 0.730 g
• L-Lysine (as Hydrochloride) USP: 0.580 g
• L-Methionine USP: 0.400 g
• L-Phenylalanine USP: 0.560 g
• L-Threonine USP: 0.420 g
• L-Tryptophan USP: 0.180 g
• L-Valine USP: 0.580 g
• L-Histidine USP: 0.480 g

Non-Essential Amino Acids:

• L-Arginine USP: 1.150 g
• L-Alanine USP: 2.070 g
• L-Tyrosine USP: 0.040 g
• Glycine (Aminoacetic Acid) USP: 1.030 g
• L-Proline USP: 0.680 g
• L-Serine USP: 0.500 g

Electrolytes:

• Sodium (Na⁺): 70.0
• Potassium (K⁺): 60.0
• Acetate (CH₃COO⁻): 150.0
• Magnesium (Mg²⁺): 10.0
• Chloride (Cl⁻): 70.0
• Phosphate (as HPO₄²⁻): 60.0

Carbohydrate:

• Anhydrous Glucose (Dextrose) BP: 20.00 g

This is a sterile, hypertonic, and non-pyrogenic solution containing amino acids, electrolytes, and dextrose. When administered along with an adequate source of calories (such as dextrose, fructose, or sorbitol), it helps improve nitrogen balance. Optimal nitrogen utilization is achieved by ensuring sufficient caloric intake to meet the body’s metabolic demands, typically not less than 168 kJ/kg/day (approximately 40 kcal/kg/day).

The total daily dose of this solution depends on the patient's metabolic requirement and clinical response. The nitrogen content and caloric values of this infusion are-

• Amino Acid Chamber (250 ml): 4.2 g
• Dextrose Chamber (250 ml): 710 Kj (170 Kcal)

Recommended dietary allowances of protein range from approximately 0.8 g/Kg of body weight for adults to 2.2 g/Kg for infants. Daily amino acid doses of approximately 1.0 to 1.5 g/Kg of body weight for adults and 2 to 3 g/Kg of body weight for infants with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance.

In fluid restricted patients (eg. Renal failure), acceptable total daily administration volumes are dependent upon the fluid balance requirements of the patients.

Depending upon the clinical condition of the patient, approximately 3 litres of solution may be administered per 24 hour period. When used post-operatively, the therapy should begin with 1000 ml on the first post-operative day. Thereafter, the dose may be increased to 3000 ml per day.

At recommended doses, amino acid solutions do not exhibit pharmacological activity and are not expected to interact with other medications.

• Acute renal failure
• Severe hepatic disease or hepatic coma
• Hypersensitivity to one or more amino acids
• Inherited disorders of amino acid metabolism

There is always a risk of infection (sepsis) during administration of parenteral nutrition. Contaminated solutions or infusion devices may act as sources of infection; therefore, preparation and catheter insertion must be performed under strict aseptic conditions. If fever occurs, the solution, delivery system, and catheter site should be replaced immediately. Amino acid/dextrose admixtures should be used promptly and stored for short durations, preferably less than 24 hours under refrigeration if necessary. Reported metabolic complications include metabolic acidosis, alkalosis, hypophosphatemia, hyperglycemia, glycosuria, osmotic diuresis, dehydration, rebound hypoglycemia, elevated liver enzymes, vitamin imbalances, electrolyte disturbances, and hyperammonemia.

No adequate animal studies have been conducted with amino acid injections. It is also unknown whether they may cause harm to the fetus or affect reproductive capacity. Therefore, use during pregnancy should be limited to situations where clearly necessary.

• Administration requires proper knowledge of fluid, electrolyte balance, and nutrition management
• Risk of fluid overload or hypo/hyperosmolar states, especially with rapid infusion
• Monitor amino acid levels in hepatic insufficiency; adjust dose if needed
• Use cautiously in renal impairment due to electrolyte retention
• Do not infuse simultaneously with blood through the same line (risk of pseudoagglutination)
• Hyperglycemia, glycosuria, and hyperosmolar syndrome may occur—monitor glucose levels regularly
• Withdraw parenteral nutrition gradually to avoid rebound hypoglycemia
• Use caution in diabetics, prediabetics, or patients with impaired glucose tolerance
• Glucose metabolism may be impaired in liver disease
• Use cautiously in patients receiving corticosteroids or corticotropin

Parenteral nutritional preparations

Store below 30°C. Protect from sunlight. Do not freeze. Keep out of reach of children. Prepared solutions should be used immediately or stored in refrigeration (2–8°C) and used within 24 hours. Do not remove the overwrap until ready to use. The overwrap protects against oxygen and UV light, while the inner bag maintains sterility.