CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER).
CLINIMIX E 5/10 provides essential amino acids, electrolytes, and dextrose for parenteral nutrition, supporting protein synthesis and energy metabolism. Dextrose supplies glucose for cellular energy, while amino acids serve as substrates for protein synthesis. Electrolytes maintain acid-base balance and osmotic regulation.
| Metabolism | Amino acids undergo deamination and transamination in the liver; dextrose is metabolized via glycolysis and the citric acid cycle; electrolytes are excreted or reabsorbed by the kidneys. |
| Excretion | Amino acids and electrolytes are primarily excreted renally. Dextrose is metabolized to CO2 and water, exhaled via lungs. Unmetabolized dextrose excreted renally if threshold exceeded. Less than 5% biliary/fecal. |
| Half-life | Amino acids: variable, ~1-2 hours for most, reflecting rapid metabolism and utilization. Dextrose: not applicable as endogenous molecule; infusion half-life ~15-30 minutes due to insulin-mediated clearance. Clinical context: renal impairment prolongs amino acid elimination. |
| Protein binding | Amino acids: minimal (<10%), mainly to albumin. Dextrose: not bound. Electrolytes: variably bound (e.g., calcium ~40% to albumin). |
| Volume of Distribution | Amino acids: ~0.5-1 L/kg, reflecting distribution to total body water. Dextrose: ~0.2-0.3 L/kg (extracellular). Electrolytes: Vd varies (e.g., calcium ~0.5 L/kg). |
| Bioavailability | Intravenous: 100%. |
| Onset of Action | Intravenous: immediate for calorie and nitrogen supply; clinical effects (improved nitrogen balance) within hours to days. |
| Duration of Action | Intravenous: continuous infusion required to maintain effect; short-lived (minutes to hours) after discontinuation due to rapid metabolism and excretion. |
| Molecular Weight | 180.16 (dextrose), variable for amino acids (range 75-204 Da per individual amino acid) |
Intravenous infusion. Dosage is individualized based on patient's metabolic requirements, clinical condition, and laboratory parameters. Typical adult dose: 1.5-2 g amino acids/kg/day and 10-15 g dextrose/kg/day (max 5 mg/kg/min dextrose). Rate: Infuse via central line at ≤ 3 mL/kg/hr initially, titrate up to 100-125 mL/hr. Do not exceed 125 mL/hr.
| Dosage form | INJECTABLE |
| Renal impairment | GFR > 50 mL/min: no adjustment. GFR 30-50 mL/min: reduce amino acid dose to 0.5-1 g/kg/day. GFR 15-29 mL/min: 0.5-0.8 g/kg/day. GFR < 15 mL/min (not on dialysis): restrict to 0.4-0.6 g/kg/day. Monitor electrolytes closely. |
| Liver impairment | Child-Pugh A: usual dose. Child-Pugh B: reduce amino acid dose by 25-50% and monitor ammonia levels. Child-Pugh C: avoid or use with extreme caution; use specially formulated solutions (e.g., branched-chain amino acid enriched). |
| Pediatric use | Intravenous infusion. Neonates: 1.5-3 g amino acids/kg/day, dextrose 4-8 mg/kg/min. Infants: 2-3 g amino acids/kg/day, dextrose 10-15 mg/kg/min. Children: 1.5-2 g amino acids/kg/day, dextrose 5-10 mg/kg/min. Rate adjusted per tolerance and fluid requirements. |
| Geriatric use | Elderly patients may have reduced renal function; start at lower end of dosing range (e.g., 1.0-1.5 g amino acids/kg/day and 5-10 g dextrose/kg/day). Monitor glucose, electrolytes, and renal function closely. Adjust rate to avoid fluid overload. |
| 1st trimester | Generally considered safe when used to meet maternal and fetal nutritional requirements; dextrose and amino acids are essential nutrients. Use only if clearly needed. |
| 2nd trimester | Safe for maternal nutritional support; adjust electrolyte composition as needed due to physiological changes. |
| 3rd trimester | Safe for use; monitor for fluid overload and electrolyte imbalances, particularly in preeclampsia. |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER).
| Placental transfer | Dextrose and amino acids cross the placenta freely via facilitated diffusion and active transport, respectively. Calcium crosses via active transport. No known adverse fetal effects at therapeutic doses. |
| Breastfeeding | Dextrose and amino acids are normal constituents of breast milk. Intravenous administration of these nutrients is compatible with breastfeeding. However, monitor maternal fluid and electrolyte status. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | CLINIMIX E 5/10 SULFITE FREE W/ ELECT IN DEXTROSE 10% W/ CALCIUM IN PLASTIC CONTAINER is a parenteral nutrition solution. Dextrose and electrolytes are essential nutrients; no teratogenic risk is expected with appropriate use. However, calcium gluconate may cause fetal hypocalcemia if maternal levels are imbalanced. First trimester: no known teratogenicity. Second trimester: metabolic disturbances may occur if maternal homeostasis is disrupted. Third trimester: risk of neonatal hypoglycemia if maternal glucose levels are high; risk of fetal hypercalcemia or hypocalcemia if calcium levels are abnormal. |
| Fetal Monitoring | Monitor maternal serum electrolytes (sodium, potassium, chloride, calcium, magnesium, phosphate), glucose, acid-base status, and renal function. Assess fetal well-being via ultrasound for growth and amniotic fluid volume. Monitor neonatal glucose and calcium levels postpartum. |
| Fertility Effects | No known adverse effects on fertility. Components are essential nutrients; proper nutritional status supports reproductive function. Overuse or imbalance may cause metabolic disturbances that could theoretically impair fertility. |
■ FDA Black Box Warning
This product contains aluminum that may be toxic. Patients with impaired kidney function, including premature neonates, may accumulate aluminum at levels associated with CNS and bone toxicity.
| Serious Effects |
Hyperglycemia with severe dehydrationHypersensitivity to any componentSevere electrolyte abnormalities (e.g., hypercalcemia)Severe hepatic impairment with encephalopathyInborn errors of amino acid metabolism
| Precautions | Monitor serum glucose, electrolytes, and acid-base status; risk of hyperglycemia, electrolyte imbalances, and metabolic acidosis; use caution in renal or hepatic impairment; aluminum toxicity risk with prolonged use. |
| Food/Dietary | No oral food or enteral feedings while receiving this parenteral nutrition unless specifically prescribed. Avoid alcohol, which can worsen electrolyte imbalances or liver stress. Some components may interact with anticoagulants (e.g., vitamin K in amino acids) but no specific food restrictions. |
| Clinical Pearls | CLINIMIX E 5/10 is a dual-chamber bag containing amino acids with electrolytes and dextrose. Do not use if the bag has been frozen or if the solution is discolored or contains particulates. Invert the bag to mix the contents thoroughly before administration. Do not administer simultaneously with blood through the same infusion set due to risk of pseudogglutination. Monitor serum glucose, electrolytes, and fluid balance closely, especially in patients with renal impairment, diabetes, or fluid overload. Use a dedicated line or a filter if required per protocol. |
| Patient Advice | This medication is a sterile solution that provides nutrition and calories through a vein. It should only be administered by a healthcare professional. · Tell your doctor if you have kidney problems, diabetes, or fluid retention, as they may need to adjust the dosage. · Report any signs of infection at the IV site (redness, swelling, pain), fever, chills, or difficulty breathing. · Do not eat or drink anything unless instructed by your doctor, as this solution is meant to replace or supplement oral nutrition. · You may need regular blood tests to monitor your blood sugar, electrolyte levels, and kidney function. |
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