Indications for: KABIVEN
To provide a source of calories, protein, electrolytes, and essential fatty acids in adults requiring parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. May be used to prevent essential fatty acid deficiency or treat negative nitrogen balance.
Individualize. Dose based on patient’s clinical condition, body wt, nutritional/fluid requirements, and additional energy given orally/enterally. Administer by IV infusion via a central vein only. Usual dose: 19–38mL/kg/day; max: 40mL/kg/day. Max infusion rate: 2.6mL/kg/hr. Usual infusion duration: 12–24 hours; may continue treatment based on patient’s clinical condition. If serum triglycerides (>400mg/dL): interrupt infusion and monitor serum triglycerides; restart at a lower rate once triglycerides are <400mg/dL; increase in smaller increments and check levels before each adjustment. Renal impairment: may adjust dose based on protein requirements; see full labeling.
<2yrs: not recommended.
Concomitant treatment with ceftriaxone in neonates ≤28 days of age. Egg, soybean or peanut allergy. Severe disorders of lipid metabolism characterized by hypertriglyceridemia (serum triglyceride >1000mg/dL). Inborn errors of amino acid metabolism. Cardiopulmonary instability (including pulmonary edema, cardiac insufficiency, MI, acidosis, hemodynamic instability requiring significant vasopressor support). Hemophagocytic syndrome.
Clinical decompensation with rapid IV infusion in neonates/infants. Risk of parenteral nutrition-associated liver disease (eg, cholestasis or hepatic steatosis), other hepatobiliary disorders (eg, cholecystitis and cholelithiasis); monitor liver function and consider discontinuation or dose reduction if abnormalities occur. Correct severe fluid, electrolyte and acid-base disorders prior to initiating. Measure serum triglycerides at baseline, with each dose increase, and regularly during therapy. Discontinue and treat if hypersensitivity reactions occur. Monitor for signs/symptoms of infection. Severely undernourished: monitor closely and slowly increase nutrient intake. Diabetes or hyperglycemia. Risk of pulmonary embolism and respiratory distress due to pulmonary vascular precipitates; discontinue and evaluate if occurs. Monitor essential fatty acids, fluids, electrolytes, serum osmolarity, blood glucose, liver and kidney function, CBCs, coagulation parameters, and overall energy intake periodically during treatment. Pulmonary edema or heart failure: monitor fluid status closely. Renal or hepatic impairment. Elderly. Pregnancy. Nursing mothers.
Macronutrients + electrolytes.
See Contraindications. Do not administer simultaneously with ceftriaxone via a Y-site: precipitation can occur; may administer sequentially if infusion lines are thoroughly flushed. Vitamin K content may antagonize anticoagulants (eg, coumarin, warfarin); monitor. High lipid levels in plasma may interfere with blood tests (eg, hemoglobin, triglycerides, bilirubin, LDH, oxygen saturation).
Nausea, pyrexia, hypertension, vomiting, decreased hemoglobin and total protein, hypokalemia, increased gamma glutamyltransferase; hyperglycemia, hyperosmolar syndrome, refeeding syndrome, thrombophlebitis, hepatobiliary disorders, hypertriglyceridemia, aluminum toxicity (esp. preterm infants, renal impairment); rare: fat overload syndrome.
Generic Drug Availability:
Emulsion (2566mL, 2053mL, 1540mL, 1026mL)—1