CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% IN PLASTIC CONTAINER (CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% IN PLASTIC CONTAINER).
CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% is a parenteral nutrition solution providing amino acids (essential and non-essential) for protein synthesis and dextrose as a caloric source. The amino acids serve as substrates for protein synthesis, supporting tissue repair and maintenance. Dextrose provides energy to prevent catabolism and promote anabolism.
| Metabolism | Amino acids are metabolized via transamination, deamination, and urea cycle; dextrose is metabolized via glycolysis and oxidative phosphorylation. Metabolism primarily hepatic and renal. |
| Excretion | Amino acids: renal elimination of nitrogen (urea), with ~90% of infused nitrogen recovered in urine; dextrose: primarily metabolized to CO2 and water, with <5% excreted renally unchanged under normal conditions. |
| Half-life | Amino acid components: distribution t1/2 ~10–30 min, elimination t1/2 ~3–6 h (hepatic metabolism and renal clearance); dextrose: not applicable as it is rapidly used under insulin control. |
| Protein binding | Amino acids: minimal protein binding (<20%, mainly to albumin for specific amino acids); dextrose: not bound. |
| Volume of Distribution | Amino acids: Vd ~0.3–0.5 L/kg (confined to extracellular space and rapidly equilibrating tissues); dextrose: Vd ~0.2 L/kg (total body water distribution). |
| Bioavailability | IV only; 100% by intravenous route. |
| Onset of Action | Amino acids: immediate upon IV infusion; dextrose: immediate upon IV infusion. |
| Duration of Action | Amino acids: 4–6 h (depends on protein synthesis and catabolism); dextrose: 1–2 h (varies with insulin and metabolic demand). |
Intravenous infusion. Typical adult dose: 500-2000 mL/day at a rate not exceeding 100 mL/hour based on caloric and nitrogen requirements. Maximum infusion rate: 100 mL/hour. Administered via central or peripheral line.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in patients with oliguria, anuria, or acute kidney injury. In chronic kidney disease (CKD), use with caution; GFR < 30 mL/min: reduce volume by 50% and monitor electrolytes. Not recommended in dialysis patients due to fluid and electrolyte imbalance risk. |
| Liver impairment | Child-Pugh Class A: No adjustment. Class B: Reduce dose by 25% and monitor ammonia. Class C: Avoid use due to risk of hyperammonemia and hepatic encephalopathy. |
| Pediatric use | Weight-based dosing: Initiate at 0.5-1 g amino acids/kg/day and increase by 0.5 g/kg/day to target 2-3 g/kg/day. Dextrose: start at 5-10% concentration, titrate to maintain blood glucose. Infusion rate: 0.5-1 mL/kg/hour, adjust per tolerance. Monitor liver function and ammonia. |
| Geriatric use | Start at lower end of adult dosing (500 mL/day) and titrate slowly due to decreased renal function and fluid reserve. Monitor for fluid overload, hyperglycemia, and electrolyte disturbances. Maximum infusion rate: 50-100 mL/hour with close monitoring. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% IN PLASTIC CONTAINER (CLINIMIX 2.75/25 SULFITE FREE IN DEXTROSE 25% IN PLASTIC CONTAINER).
| Breastfeeding | Safety in breastfeeding is established; amino acids, dextrose, and electrolytes are normal constituents of human milk. Parenteral nutrition supplementation does not pose risk. M/P ratio not applicable as components are endogenous substances. |
| Teratogenic Risk | Parenteral nutrition components including amino acids, dextrose, and electrolytes are generally considered safe in pregnancy when clinically indicated; no specific teratogenic effects reported. First trimester: No increased risk of major malformations. Second/third trimesters: Risks from maternal malnutrition may outweigh theoretical concerns. Use only if clearly needed. |
■ FDA Black Box Warning
Not for use in patients with untreated anuria, inborn errors of amino acid metabolism, or severe electrolyte disturbances. Risk of hyperglycemia, hyperosmolar syndrome, and metabolic acidosis. Do not administer simultaneously with blood products through the same infusion line due to risk of agglutination.
| Serious Effects |
["Untreated anuria","Inborn errors of amino acid metabolism","Severe electrolyte disturbances","Hypersensitivity to any component","Severe hyperglycemia not controlled"]
| Precautions | Monitor for fluid and electrolyte imbalances, hyperglycemia, hypertriglyceridemia, and metabolic acidosis. Use with caution in patients with renal impairment, hepatic insufficiency, or cardiac failure. Risk of infection from intravenous catheter. Do not add to the container; use only with dedicated infusion lines. |
| Food/Dietary | No oral food intake typically allowed during parenteral nutrition therapy. If transition to oral feeding is initiated, monitor for refeeding syndrome. Avoid concurrent administration of enteral feeds unless specifically ordered. |
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| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, fluid balance, renal and hepatic function. In pregnancy, monitor fetal growth and amniotic fluid volume via ultrasound if prolonged therapy. Assess for maternal metabolic complications including hyperglycemia, electrolyte imbalances, and volume overload. |
| Fertility Effects | No known adverse effects on fertility. Proper maternal nutrition may support normal reproductive function. |
| Clinical Pearls | CLINIMIX 2.75/25 is a parenteral nutrition solution containing 2.75% amino acids and 25% dextrose, indicated for central venous administration only due to high osmolarity (~1700 mOsm/L). Must not be used for peripheral infusion. Monitor serum electrolytes, glucose, and liver function tests closely. Contains no sulfites; suitable for sulfite-allergic patients. Do not add other medications directly to the container; use dedicated Y-site or separate line. Inspect for particulate matter before use; discard if cloudy or if seal is broken. |
| Patient Advice | This medication is given through a central vein (large vein near the heart) and must be administered by a healthcare professional. · Report any signs of infection at the catheter site (redness, swelling, pain) or systemic symptoms (fever, chills) immediately. · Blood sugar levels will be checked regularly; inform your care team if you experience excessive thirst, frequent urination, or nausea. · Do not eat or drink anything unless directed by your doctor, as this solution provides complete nutrition. · Notify your nurse if you feel burning, pain, or swelling at the infusion site. |