CLINIMIX E 5/20 SULFITE FREE W/ ELECT IN 20% DEXTROSE W/ CALCIUM IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for CLINIMIX E 5/20 SULFITE FREE W/ ELECT IN 20% DEXTROSE W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/20 SULFITE FREE W/ ELECT IN 20% DEXTROSE W/ CALCIUM IN PLASTIC CONTAINER).
Parenteral nutrition providing essential amino acids, electrolytes, and dextrose for caloric support and protein synthesis.
| Metabolism | Amino acids are metabolized via transamination, deamination, and urea cycle; dextrose undergoes glycolysis and oxidative phosphorylation. |
| Excretion | Components are primarily metabolized; nitrogen waste excreted renally as urea (85-90%), with minimal biliary/fecal elimination (<5%). Electrolytes and dextrose are fully metabolized or excreted renally. |
| Half-life | Amino acids: 0.5-2 hours (rapid clearance dependent on metabolic demand). Glucose: ~2-4 hours in euglycemic states. No single terminal half-life due to mixture. |
| Protein binding | Amino acids: low to moderate (<20%, mostly albumin). Calcium: ~40% bound to albumin. No binding for dextrose or electrolytes. Not clinically significant. |
| Volume of Distribution | Amino acids: 0.5-1 L/kg (distributes throughout total body water). Dextrose: ~0.2 L/kg (limited to extracellular fluid). Calcium: ~0.3 L/kg. Overall Vd approximates 0.4-0.6 L/kg. |
| Bioavailability | IV only: 100% bioavailable. Not applicable for oral, IM, or other routes. |
| Onset of Action | IV infusion: Metabolic effects (e.g., nitrogen retention, plasma amino acid elevation) begin within 15-30 minutes of infusion initiation. |
| Duration of Action | Duration depends on infusion rate and metabolic state; post-infusion, metabolic effects (e.g., serum glucose elevation) persist for 1-2 hours after cessation. Continuous infusion titrated to patient response. |
| Molecular Weight | 180.16 (dextrose, anhydrous); calcium gluconate 430.37; others vary. |
Intravenous. Adult: 2 L/day (providing 100 g protein and 400 g dextrose) or as per metabolic needs. Rate: 100 mL/hr initially, adjusted based on tolerance and glucose monitoring.
| Dosage form | INJECTABLE |
| Renal impairment | GFR >50: standard dose; GFR 10-50: reduce to 0.8-1.0 g/kg/day protein equivalent; GFR <10: 0.6-0.8 g/kg/day protein equivalent. Monitor potassium, phosphorus, magnesium. |
| Liver impairment | Child-Pugh A: standard dose; Child-Pugh B: reduce protein to 0.8-1.0 g/kg/day; Child-Pugh C: 0.6-0.8 g/kg/day protein, monitor ammonia. Avoid in severe encephalopathy. |
| Pediatric use | Weight-based: 0.5-1.0 g protein/kg/day and 5-10 mg dextrose/kg/min (max 15 mg/kg/min). Adjust for age and condition. Initiate at lower rate, titrate. |
| Geriatric use | Start at lower rate (50-75 mL/hr) due to decreased renal function; monitor glucose, electrolytes, and volume status. Adjust protein based on renal function. |
| 1st trimester | Use only if clearly needed; no known teratogenicity at standard infusion rates. |
| 2nd trimester | Use only if clearly needed; monitor fluid and electrolyte balance. |
| 3rd trimester | Use only if clearly needed; avoid fluid overload and electrolyte disturbances. |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX E 5/20 SULFITE FREE W/ ELECT IN 20% DEXTROSE W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/20 SULFITE FREE W/ ELECT IN 20% DEXTROSE W/ CALCIUM IN PLASTIC CONTAINER).
| Placental transfer | Calcium and dextrose cross placenta; degree depends on maternal levels. |
| Breastfeeding | Excretion into breast milk unknown; calcium and dextrose are normal milk constituents. Use with caution. |
| Lactation Rating | L3 - Limited data |
| Teratogenic Risk | Parenteral nutrition (PN) with amino acids, dextrose, electrolytes, and calcium is considered essential for maternal and fetal health when oral/enteral nutrition is inadequate. No teratogenic effects are reported with standard PN; however, risks are related to underlying maternal malnutrition or metabolic derangements. Components—dextrose, amino acids, electrolytes—are physiological. Calcium is regulated by maternal homeostasis. No trimester-specific fetal risks from PN itself, but hyperglycemia (dextrose) can cause fetal macrosomia, neonatal hypoglycemia; electrolyte imbalances (e.g., hypocalcemia) may affect fetal bone development. Avoid hypercalcemia; monitor maternal glucose and electrolytes. |
| Fetal Monitoring | Monitor maternal serum glucose (q6h initially, then daily if stable), electrolytes (Na, K, Cl, Mg, Ca, P), renal function, liver function, acid-base status, triglycerides, and fluid balance. Adjust PN composition based on labs. For fetus: ultrasound for growth if hyperglycemia present; fetal heart rate monitoring if maternal metabolic instability. During labor, monitor glucose closely to avoid neonatal hypoglycemia. |
| Fertility Effects | PN restores nutritional status in malnourished women, potentially improving fertility by reversing amenorrhea and anovulation associated with malnutrition. No direct adverse effects on fertility from PN components. Adequate nutrition is essential for reproductive function. |
■ FDA Black Box Warning
Not for use in patients with hypersensitivity to any component; contains aluminum which may be toxic with prolonged use, particularly in renal impairment.
| Serious Effects |
HypercalcemiaSevere renal impairmentAnuriaHypersensitivity to any componentSevere hepatic failure with hyperammonemia
| Precautions | Monitor serum electrolytes, blood glucose, fluid balance, and renal function; risk of hyperglycemia, electrolyte imbalances, and aluminum toxicity. |
| Food/Dietary | No direct food interactions as this is intravenous. However, oral intake should be avoided during total parenteral nutrition unless clinically indicated. Enteral nutrition may interact with absorption if given concurrently. |
| Clinical Pearls | CLINIMIX E 5/20 is a dual-chamber bag containing amino acids, electrolytes, and dextrose. It must be mixed and used within 24 hours. Monitor serum electrolytes, glucose, and renal function. Do not administer simultaneously with blood through same infusion set due to risk of pseudoagglutination. Use inline filter. Avoid in patients with severe electrolyte disorders, hyperglycemia, or hepatic coma. |
| Patient Advice | This medication is a complete nutrition solution given intravenously. · You will be monitored for blood sugar, electrolyte levels, and kidney function. · Report any signs of allergic reaction, fever, or swelling at the infusion site. · Do not eat or drink anything unless directed by your healthcare provider. · Inform your doctor if you have diabetes, kidney disease, or any allergies. |
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