CLINIMIX E 5/15 SULFITE FREE W/ ELECT IN DEXTROSE 15% W/ CALCIUM IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CLINIMIX E 5/15 SULFITE FREE W/ ELECT IN DEXTROSE 15% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/15 SULFITE FREE W/ ELECT IN DEXTROSE 15% W/ CALCIUM IN PLASTIC CONTAINER).
CLINIMIX E 5/15 is a parenteral nutrition solution that provides essential amino acids, electrolytes, and dextrose for intravenous use. Amino acids serve as building blocks for protein synthesis, dextrose provides calories for energy metabolism, and electrolytes maintain fluid and electrolyte balance. Calcium is essential for bone mineralization, neuromuscular function, and enzyme activation.
| Metabolism | Amino acids are metabolized in the liver via transamination, deamination, and the urea cycle. Dextrose is metabolized via glycolysis and the citric acid cycle. Electrolytes (including calcium) are not metabolized but are distributed and excreted renally. |
| Excretion | Renal excretion of amino acids and electrolytes; dextrose is metabolized to CO2 and water, with minimal renal excretion. Biliary/fecal elimination is negligible (<2%). |
| Half-life | Components have variable half-lives: amino acids ~0.5-1 h; dextrose ~2-4 h; electrolytes depend on renal function. Terminal half-life not applicable as a mixture. |
| Protein binding | Amino acids: Negligible protein binding (<5%). Dextrose: Not bound. Electrolytes: Variable (calcium ~40% bound to albumin; others minimal). |
| Volume of Distribution | Total parenteral nutrition components distribute throughout extracellular fluid; Vd ~0.2-0.3 L/kg for electrolytes and amino acids, reflecting ECF volume. |
| Bioavailability | Intravenous: 100% bioavailability. Not administered by other routes. |
| Onset of Action | Intravenous: Metabolic effects (e.g., rise in blood glucose, insulin secretion) begin within minutes to 15 minutes after infusion initiation. |
| Duration of Action | Duration depends on infusion rate; continuous infusion maintains therapeutic levels. After cessation, effects wane over 1-2 hours for glucose and amino acids. |
Intravenous infusion. Typical adult dose: 1.5–2.0 L/day of CLINIMIX E 5/15 (providing 75–100 g amino acids and 225–300 g dextrose per day) administered via central line; rate determined by glucose tolerance and fluid status.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <25 mL/min) unless on renal replacement therapy; for GFR 25–50 mL/min, reduce dose by 25–50% and monitor electrolytes; GFR >50 mL/min: no adjustment needed. |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: reduce nitrogen load by 30–50%; Class C: avoid or use with extreme caution (risk of hyperammonemia). |
| Pediatric use | Individualized based on weight and metabolic needs. Typical: 1–2 g amino acids/kg/day and 10–15 mg/kg/min dextrose; infusion rate titrated to glucose tolerance; for neonates, start at 0.5 g amino acids/kg/day and increase gradually. |
| Geriatric use | Use with caution due to higher risk of fluid overload and glucose intolerance; monitor renal function and serum electrolytes; start at lower end of dosing range (e.g., 1 L/day) and adjust based on tolerance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX E 5/15 SULFITE FREE W/ ELECT IN DEXTROSE 15% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/15 SULFITE FREE W/ ELECT IN DEXTROSE 15% W/ CALCIUM IN PLASTIC CONTAINER).
| Breastfeeding | Sodium: M/P ratio ~0.46. Amino acids, dextrose, electrolytes are normal constituents of breast milk and are not contraindicated. Intravenous administration does not warrant interruption of breastfeeding. Use with caution in mothers with metabolic disorders. No specific M/P ratio available for the combination product. |
| Teratogenic Risk | Parenteral nutrition components are generally considered essential for maternal and fetal health when oral/enteral nutrition is inadequate. No teratogenic risks have been identified at recommended doses; however, each component (amino acids, dextrose, electrolytes, vitamins) must be individually assessed. First trimester: No known structural anomalies; used as needed. Second and third trimesters: No specific fetal risks; monitor for maternal metabolic disturbances (hyperglycemia, electrolyte imbalances) which can affect fetal growth. |
■ FDA Black Box Warning
NOT FOR USE IN INFANTS OR NEONATES who are at risk of aluminum toxicity. Premature infants are particularly at risk because of immature renal function. This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration in patients with renal impairment.
| Serious Effects |
["Hypersensitivity to any component","Patients with severe hyperglycemia or insulin resistance not adequately controlled","Patients with hypercalcemia","Patients with abnormal glucose tolerance (e.g., diabetic ketoacidosis)","Infants and neonates (due to aluminum risk)","Patients with galactosemia or fructose intolerance (if contains sorbitol or fructose; CLINIMIX E contains dextrose only, but caution with glucose intolerance)","Severe electrolyte imbalances (e.g., hyperkalemia, hyperphosphatemia)"]
| Precautions | ["Risk of hyperglycemia requiring monitoring of blood glucose and insulin administration","Risk of electrolyte imbalances including hypercalcemia, hyperkalemia, and hyperphosphatemia","Risk of aluminum toxicity, especially in neonates and patients with renal impairment","Risk of infection from catheter-related bloodstream infections","Risk of fluid overload, particularly in patients with renal or cardiac insufficiency","Monitoring of liver function tests, serum electrolytes, blood glucose, and osmolality required"] |
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| Fetal Monitoring | Monitor maternal blood glucose, serum electrolytes (potassium, sodium, calcium, phosphate, magnesium), acid-base balance, liver function, and nitrogen balance. Fetal monitoring includes ultrasound for growth and amniotic fluid volume, and nonstress test if diabetic control is a concern. |
| Fertility Effects | No known adverse effects on fertility. Correction of nutritional deficiencies may improve fertility in malnourished women. |