Комбинированный препарат для парентерального питания, которы... Инструкция
Показания к применению
Парентеральное питание частичное или полное (с добавлением жировых эмульсий), а также профилактика и терапия потери белков и жидкости, когда невозможно энтеральное питание. Тяжелые случаи гастроинтестинальных заболеваний (обструкция, мальабсорбция, воспалительные заболевания кишечника, панкреатит, кишечные свищи), гиперметаболические состояния (травмы, ...
Метаболический ацидоз, тяжелая почечная и печеночная недостаточность, шок, декомпенсированная сердечная недостаточность, гипергидратация, гиперкалиемия, беременность и период лактации, детский возраст до 18 лет (эффективность и безопасность не установлены).
Раствор для инфузий Аминосол-Нео Е - прозрачный раствор от бесцветного до светло-желтого цвета. Комбинированный препарат для парентерального питания, который содержит незаменимые и заменимые аминокислоты. Все аминокислоты находятся в L-форме, что обеспечивает возможность их прямого участия в биосинтезе белков.
Фармакологические свойства
Комбинированный препарат для парентерального питания, который содержит незаменимые и заменимые аминокислоты в сбалансированном соотношении (аминокислот всего 100,00 г/1000 мл, азота всего 16,40 г/1000 мл). Все аминокислоты находятся в L-форме, что обеспечивает возможность их прямого участия в биосинтезе белков. Содержит восемь незаменимых аминокислот (не синтезируемых в организме человека): L-изолейцин, L-лейцин, L-лизин, L-метионин, L-фенилаланин, L-треонин, L-триптофан и L-валин. Условно заменимыми - считаются L-аргинин и L-гистидин. Условно заменимые аминокислоты синтезируются в организме, однако при некоторых патологических состояниях (например, при почечной и печеночной недостаточности) или в силу возрастных физиологических особенностей (например, у детей раннего возраста) концентрация их не достигает целевого значения. L-аргинин участвует в цикле превращения аммиака в мочевину, связывая токсичные ионы аммония, которые образуются при катаболизме протеинов в печени. L-изолейцин, L-лейцин и L-валин - незаменимые аминокислоты с разветвленными боковыми цепями - удовлетворяют энергетические потребности организма, что особенно важно в раннем послеоперационном периоде. Аминокислоты, содержащие ароматические кольца, являются необходимыми для синтеза полноценных белков и представлены L-фенилаланином и L-триптофаном. L-яблочная кислота служит энергетическим источником для синтеза мочевины. Катионы и анионы обеспечивают гиперосмолярность раствора (1137 мОсмол/л), являясь элементами для поддержания гомеостаза.
Показания к применению
Парентеральное питание частичное или полное (с добавлением жировых эмульсий), а также профилактика и терапия потери белков и жидкости, когда невозможно энтеральное питание. Тяжелые случаи гастроинтестинальных заболеваний (обструкция, мальабсорбция, воспалительные заболевания кишечника, панкреатит, кишечные свищи), гиперметаболические состояния (травмы, ожоги, сепсис) и другие случаи, требующие парентерального питания (при злокачественных заболеваниях, при подготовке к операции и после оперативного вмешательства).
Противопоказания
Метаболический ацидоз, тяжелая почечная и печеночная недостаточность, шок, декомпенсированная сердечная недостаточность, гипергидратация, гиперкалиемия, беременность и период лактации, детский возраст до 18 лет (эффективность и безопасность не установлены).
Применение при беременности и в период грудного вскармливания
Эффективность и безопасность препарата при беременности и в период лактации не установлены.
Способ применения и дозы
Раствор применяется в виде внутривенной инфузии через одну из центральных вен. Доза подбирается индивидуально, согласно тяжести метаболического нарушения и потребности организма в аминокислотах и электролитах. Максимальная допустимая скорость введения 1 мл/кг/ч, а максимальная суточная доза составляет 20 мл/кг. Для человека массой 70 кг максимальная суточная доза препарата 1400 мл, рекомендуемая скорость введения 20-35 капель/мин. Дозирование при печеночной недостаточности: пациенты с печеночной недостаточностью не переносят повышенное количество аминокислот, и поэтому их потребности в белках составляют 0,8-1,1 г/кг/сутки, что в пересчете на раствор Аминосола-Нео Е составляет 8-11 мл/кг/сутки.
Побочное действие
Повышение активности ферментов печени, тошнота, рвота, боль в животе, чувство усталости, крапивница, повышение АД, повышенное потоотделение, нарушение дыхания, тахикардия, повышение температуры тела, цианоз, изменение состава крови, повышение содержания аммиака в крови, раздражение кожи в месте введения препарата, тромбофлебит. Ускоренное введение препарата может вызвать гипергидратацию и нарушение электролитного состава плазмы (гиперкалиемия).
Передозировка
Симптомы: тошнота, рвота, дрожь, "приливы", повышенное потоотделение, лихорадка, тахикардия. При большой скорости введения возможны гиперволемия и нарушение электролитного состава плазмы. У пациентов высокого риска возможно развитие отека легких и левожелудочковой недостаточности, гипераммониемии и печеночной энцефалопатии (особенно у пациентов с печёночной и почечной недостаточностью). Лечение: инфузию следует немедленно прекратить, обеспечить мониторинг биохимических показателей, функции дыхательной и сердечно-сосудистой систем. Специфического антидота нет. Лечение симптоматическое. При гиперкалиемии - инфузия 200-500 мл 10% раствора глюкозы с инсулином в дозе 1-3 ЕД на каждые 3-5 г глюкозы. В случае неудовлетворительного результата показано назначение ионно-обменных смол и гемодиализ. После полного исчезновения симптомов передозировки инфузию можно возобновить, уменьшив скорость вливания или дозу.
Особые указания
Аргинин, входящий в состав препарата, может привести к уменьшению концентрации фосфатов и увеличения концентрации калия в плазме. Эти изменения особенно выражены у больных сахарным диабетом. Необходим постоянный контроль кислотно-щелочного и электролитного статуса, баланса жидкости в организме и состояния функции почек. При наличии гипонатриемии при назначении данного раствора необходимо контролировать концентрацию натрия в плазме. Раствор может вызвать гиперкалиемию, особенно у больных сахарным диабетом и у больных в состоянии стресса. При установленной гиперкалиемии проводится фармакологическая коррекция. При прибавлении стандартного питания обратить внимание на совместимость. Применять только прозрачный раствор из неповрежденного флакона!
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