CLINIMIX E 2.75/5 SULFITE FREE W/ ELECT IN DEXTROSE 5% W/ CALCIUM IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for CLINIMIX E 2.75/5 SULFITE FREE W/ ELECT IN DEXTROSE 5% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 2.75/5 SULFITE FREE W/ ELECT IN DEXTROSE 5% W/ CALCIUM IN PLASTIC CONTAINER).
CLINIMIX E 2.75/5 is a combination of amino acids, electrolytes, and dextrose used for parenteral nutrition. The amino acids provide substrates for protein synthesis, dextrose supplies caloric energy, and electrolytes maintain acid-base and fluid balance. Calcium is included for bone health and neuromuscular function.
| Metabolism | Amino acids are metabolized in the liver and peripheral tissues via transamination, deamination, and urea cycle. Dextrose is metabolized via glycolysis and the Krebs cycle. Electrolytes are distributed and excreted primarily by the kidneys. Calcium metabolism is regulated by the kidneys, bones, and gastrointestinal tract. |
| Excretion | CLINIMIX E 2.75/5 is a parenteral nutrition solution; components are eliminated via normal metabolic pathways. Amino acids undergo deamination and oxidation, with nitrogen excreted renally as urea (80-90%). Glucose is metabolized to CO2 and water, excreted via lungs and kidneys. Electrolytes are excreted renally in proportion to intake and homeostatic regulation. |
| Half-life | Not applicable as a single entity; components have independent half-lives. Amino acids have plasma half-lives of minutes to hours depending on individual amino acid and metabolic state. Dextrose has an elimination half-life of 1.5-2.5 hours in normal glucose tolerance. Electrolytes are not described by half-life due to homeostatic regulation. |
| Protein binding | Amino acids are minimally protein bound (<10%); dextrose is not protein bound; electrolytes such as calcium and magnesium are partially bound to albumin (calcium ~50% bound, magnesium ~30% bound). Multivalent cations bind to various plasma proteins. |
| Volume of Distribution | Not a single value. Amino acids distribute into total body water (~0.6 L/kg); dextrose distributes mainly into extracellular fluid (~0.2 L/kg) but is rapidly taken up by cells; electrolytes distribute according to their physiological compartments (e.g., sodium extracellular, potassium intracellular). |
| Bioavailability | Intravenous administration yields 100% bioavailability. Not administered via other routes. |
| Onset of Action | Intravenous infusion: nutritional effects (e.g., nitrogen balance improvement) begin within 24-48 hours of continuous infusion. Electrolyte and fluid effects are immediate upon infusion. |
| Duration of Action | Duration depends on infusion rate and metabolic demand. Continuous infusion maintains nutritional support while infusing; effects on nitrogen balance persist for hours after cessation. Glucose levels return to baseline within 1-2 hours after stopping infusion in normoglycemic patients. |
| Molecular Weight | 180.16 (dextrose) to >1000 (amino acids and electrolytes) |
Intravenous administration. The dose is individualized based on patient's metabolic requirements, clinical condition, and tolerance. Typical adult dose: 1 to 2 L per day of CLINIMIX E 2.75/5 with electrolytes in 5% dextrose with calcium, infused at a rate not exceeding 4 mg/kg/min of dextrose (or as tolerated).
| Dosage form | INJECTABLE |
| Renal impairment | GFR > 50 mL/min: No adjustment needed. GFR 30-50 mL/min: Reduce volume by 50% or use a lower concentration of amino acids and electrolytes, monitor serum potassium, phosphate, and magnesium. GFR < 30 mL/min: Contraindicated or use extreme caution with dose reduction and close monitoring of electrolytes and fluid balance. |
| Liver impairment | Child-Pugh A: No adjustment needed. Child-Pugh B: Reduce amino acid dose by 50% and monitor for hyperammonemia. Child-Pugh C: Use with caution; avoid if severe hepatic encephalopathy; may require reduction or use of specialized amino acid formulations. |
| Pediatric use | Weight-based dosing: Initiate at 0.5-1 g/kg/day of amino acids, increasing gradually to a target of 2-3 g/kg/day. Dextrose: start at 5-10 mg/kg/min, increase as tolerated up to 12-15 mg/kg/min. Electrolytes: adjust based on serum levels. Total volume: typically 100-150 mL/kg/day for infants, adjusted for clinical condition. |
| Geriatric use | Elderly patients may have reduced renal and hepatic function. Start at lower end of dosing range (e.g., 1 L/day or less) and titrate slowly. Monitor fluid balance, electrolytes, and renal function closely. Avoid rapid infusion to prevent fluid overload. |
| 1st trimester | Nutritional supplementation; use if clearly needed; no known teratogenic effects from components. |
| 2nd trimester | Nutritional supplementation; use if clearly needed; monitor for electrolyte imbalances. |
| 3rd trimester | Nutritional supplementation; use if clearly needed; avoid maternal dehydration. |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX E 2.75/5 SULFITE FREE W/ ELECT IN DEXTROSE 5% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 2.75/5 SULFITE FREE W/ ELECT IN DEXTROSE 5% W/ CALCIUM IN PLASTIC CONTAINER).
| Placental transfer | Components cross placenta; essential nutrients are actively transported. |
| Breastfeeding | Excretion in milk unknown; components are normal nutrients; use with caution. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | No known teratogenic risk; components (amino acids, dextrose, electrolytes) are physiological and essential for fetal development. No trimester-specific risks identified with standard use. |
| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, acid-base status, and fluid balance. Fetal monitoring as clinically indicated; no specific fetal monitoring required. |
| Fertility Effects | No known adverse effects on fertility; provides essential nutrients necessary for reproductive function. |
■ FDA Black Box Warning
This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions which contain aluminum.
| Serious Effects |
Known hypersensitivity to any componentSevere electrolyte disordersAnuria or oliguriaInborn errors of metabolism causing contraindication to componentsSevere hepatic failure with hyperammonemiaUncontrolled hyperglycemia
| Precautions | Monitoring: serum electrolytes, blood glucose, fluid balance, liver function, renal function, and acid-base status, Risk of hyperglycemia, hyperosmolar state, and metabolic acidosis, Risk of aluminum toxicity, especially in renal impairment and premature infants, Do not administer unless solution is clear and container is undamaged, Use with caution in patients with heart failure, renal failure, or hepatic impairment |
| Food/Dietary | No direct food interactions, but parenteral nutrition may affect nutritional status. Enteral intake should be coordinated with the clinical team. Avoid concurrent administration of other IV solutions without compatibility check. |
| Clinical Pearls | CLINIMIX E 2.75/5 with electrolytes in dextrose 5% and calcium is a parenteral nutrition solution for IV use only. Monitor serum electrolytes, glucose, and renal function closely; do not administer simultaneously with blood products. Check for precipitate formation; use a dedicated line. Contains sulfite-free formulation for patients with sulfite sensitivity. |
| Patient Advice | This medication is given through a vein (IV) and should be administered only by a healthcare professional. · Report any signs of infection at the IV site, such as redness, swelling, or pain. · Inform your healthcare provider of any history of allergies, especially to sulfites. · This solution provides complete nutrition, including amino acids, electrolytes, and dextrose. You may still eat or drink if permitted by your doctor. · Blood tests will be performed regularly to monitor your electrolyte levels, blood sugar, and kidney function. |
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