CLINIMIX E 2.75/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER

Clinical safety rating: caution

Comprehensive clinical and safety monograph for CLINIMIX E 2.75/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 2.75/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER).

How it works

Clinimix E 2.75/25 provides amino acids for protein synthesis and dextrose for caloric support in parenteral nutrition. Amino acids serve as substrates for protein synthesis, while dextrose provides a source of glucose for energy metabolism, preventing catabolism and promoting anabolism.

What the body does with it

Metabolism	Amino acids are metabolized via transamination and deamination in the liver; dextrose undergoes glycolysis and enters the citric acid cycle. Electrolytes are excreted or reabsorbed renally.
Excretion	Amino acids: renal elimination of metabolites and urea. Dextrose: metabolized to CO2 and water, exhaled via lungs. Electrolytes: primarily renal (90-95%), minor fecal (<5%). No significant biliary excretion.
Half-life	Amino acids: not applicable (endogenous turnover). Dextrose: ~1-2 hours (exogenous glucose). Electrolytes: dependent on renal function; not traditionally defined.
Protein binding	Amino acids: negligible (<5% bound). Dextrose: negligible. Electrolytes: variable; calcium ~40% bound to albumin, magnesium ~30% bound to albumin, potassium and sodium minimally bound (<5%).
Volume of Distribution	Amino acids: total body water (~0.5-0.7 L/kg). Dextrose: total body water (~0.2 L/kg initially). Electrolytes: sodium ~0.6 L/kg, potassium ~0.4 L/kg, calcium ~0.2 L/kg, magnesium ~0.3 L/kg.
Bioavailability	Not applicable; administered as intravenous infusion only (bioavailability 100% by IV route). No oral bioavailability.
Onset of Action	Intravenous: immediate (within minutes) for metabolic effects (amino acid incorporation, glucose utilization).
Duration of Action	Intravenous: variable; amino acids metabolized continuously, glucose cleared within hours; electrolytes maintained via infusion rate.

Classification & Brands

Dosing & administration

Intravenous administration: Adult dose based on protein and electrolyte requirements; typical infusion rate not to exceed 4 mg/kg/min of dextrose. Daily dose should not exceed 2.5 g/kg amino acids or 25 g/kg dextrose.

Dosage form	INJECTABLE
Renal impairment	In GFR 30-59 mL/min: reduce amino acid dose by 50% and monitor electrolytes closely. If GFR <30 mL/min: avoid or use only with extreme caution, typically restrict protein to 0.6-0.8 g/kg/day and adjust electrolytes per serum levels.
Liver impairment	Child-Pugh Class A: no adjustment necessary. Child-Pugh B: reduce amino acid dose to 0.8-1.2 g/kg/day. Child-Pugh C: avoid due to risk of encephalopathy; if essential, restrict to 0.5-0.7 g/kg/day with branched-chain amino acid enrichment.
Pediatric use	Neonates and infants: 2-3 g/kg/day amino acids and 10-15 g/kg/day dextrose, titrating gradually. Children: 1-2 g/kg/day amino acids and 5-10 g/kg/day dextrose; rate not to exceed 0.2-0.4 g/kg/h dextrose. Adjust electrolytes per daily requirements.
Geriatric use	Elderly patients: start at lower end of dose range; monitor renal function and serum electrolytes closely. Typical amino acid dose 1.0-1.2 g/kg/day, dextrose dose adjusted to avoid hyperglycemia; infusion rate not to exceed 2 mg/kg/min.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Breastfeeding

Excretion into breast milk: unknown. Components are endogenous, so transfer is likely minimal. No specific M/P ratio available. Considered probably compatible with breastfeeding, but monitor infant for electrolyte disturbances if maternal levels are abnormal.

Teratogenic Risk

CLINIMIX E 2.75/25 (amino acids, dextrose, electrolytes, calcium) is a parenteral nutrition solution. No adequate and well-controlled studies in pregnant women. Animal reproduction studies have not been conducted. However, amino acids and dextrose are endogenous substances; electrolyte imbalances can cause fetal harm. In first trimester: avoid unless maternal benefit outweighs risk; deficiencies in essential nutrients may be teratogenic. Second/third trimester: use only if clearly needed; monitor for hyperglycemia (risk of fetal macrosomia, neonatal hypoglycemia).

Warnings & precautions

■ FDA Black Box Warning

Not for use in patients with severe electrolyte imbalances, severe liver disease, or severe renal impairment. May cause hyperglycemia, electrolyte abnormalities, or volume overload. Must be used under medical supervision.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component","Severe electrolyte imbalance","Severe liver disease (e.g., hepatic coma)","Severe renal impairment (anuria, oliguria)","Galactosemia","Fructose intolerance"]

Clinical Precautions

Precautions

["Monitor serum glucose, electrolytes, fluid status, and renal function","Risk of hyperglycemia in diabetic patients","Risk of electrolyte disturbances including hyperkalemia, hypercalcemia, and hyperphosphatemia","Avoid in patients with galactosemia or fructose intolerance","Use caution in hepatic or renal impairment"]

Clinical Tips & Counseling

Drug interactions

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