CLINIMIX E 5/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CLINIMIX E 5/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER).
This formulation provides a balanced mixture of amino acids, dextrose, electrolytes, and calcium for parenteral nutrition. Amino acids serve as substrates for protein synthesis; dextrose provides caloric energy; electrolytes maintain acid-base and fluid balance; calcium is essential for bone mineralization and neuromuscular function.
| Metabolism | Amino acids undergo hepatic deamination and transamination; dextrose is metabolized via glycolysis and oxidative phosphorylation; electrolytes are regulated by renal and gastrointestinal mechanisms; calcium is distributed in bone and soft tissues. |
| Excretion | Renal: amino acids and dextrose metabolites are excreted renally; calcium and electrolytes are also cleared renally. Biliary/fecal: negligible. |
| Half-life | Variable; amino acids have half-lives of minutes to hours; dextrose is rapidly cleared (half-life < 30 min). No terminal elimination half-life defined for mixture. |
| Protein binding | Amino acids: minimal (10-20%); calcium: ~40% bound to albumin; dextrose: not bound. |
| Volume of Distribution | Amino acids: 0.5-1.0 L/kg (total body water); calcium: 0.2-0.3 L/kg; dextrose: 0.2 L/kg (extracellular fluid). |
| Bioavailability | Intravenous: 100%. |
| Onset of Action | Intravenous: immediate upon infusion initiation; protein synthesis begins within minutes; blood glucose elevation within 5 minutes. |
| Duration of Action | Duration depends on infusion rate; metabolic effects persist for 1-2 hours after cessation; glucose levels return to baseline within 1-2 hours. |
Dose is patient-specific based on caloric and electrolyte needs. Typical adult: 500-3000 mL intravenously over 24 hours; contains 25% dextrose (250 g/L) and 5% amino acids. Infuse via central line due to high osmolarity.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated or dose-reduce in severe renal impairment (GFR <30 mL/min) due to risk of fluid overload and electrolyte imbalances. Monitor potassium, phosphorus, and magnesium closely. |
| Liver impairment | Use with caution in severe hepatic impairment (Child-Pugh class C). May worsen hepatic encephalopathy due to amino acid load; consider specialized formulations. |
| Pediatric use | Dose individualized; typical infusion rate: 0.5-8 mg/kg/min dextrose equivalent. Calculate based on weight (kg), fluid requirements, and nutritional goals. Avoid in neonates with hyperbilirubinemia. |
| Geriatric use | Start at low end of dose range, monitor for fluid overload and electrolyte disturbances due to decreased renal function and comorbidities. Use cautious infusion rates. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CLINIMIX E 5/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER (CLINIMIX E 5/25 SULFITE FREE W/ ELECT IN DEXTROSE 25% W/ CALCIUM IN PLASTIC CONTAINER).
| Breastfeeding | CLINIMIX E 5/25 components are endogenous substances normally present in breast milk. Dextrose and amino acids infused are metabolized and do not accumulate in milk at significant levels. Electrolytes and calcium are tightly regulated. No M/P ratio available. Use is considered compatible with breastfeeding when clinically indicated. |
| Teratogenic Risk | CLINIMIX E 5/25 contains dextrose, amino acids, electrolytes, and calcium. Dextrose at high concentrations may cause maternal hyperglycemia, potentially leading to fetal hyperinsulinemia and neonatal hypoglycemia, but no direct teratogenicity in first trimester. No specific teratogenic risks from amino acids or electrolytes at therapeutic doses. Calcium administration may affect fetal calcium homeostasis if maternal levels are markedly elevated. Overall, risk is related to underlying maternal condition rather than direct drug effect. |
■ FDA Black Box Warning
Not for use in patients with known hypersensitivity to any component. Contains aluminum that may be toxic with prolonged administration in renal impairment.
| Serious Effects |
["Hypersensitivity to any component","Severe electrolyte disorders (e.g., hyperkalemia, hypercalcemia)","Severe hepatic or renal impairment","Anuria, oliguria, or dialysis dependency"]
| Precautions | ["Risk of hyperglycemia, fluid overload, electrolyte disturbances, and aluminum toxicity","Monitor serum glucose, electrolytes, liver function, and acid-base status regularly","Use with caution in hepatic or renal impairment, heart failure, and hypercalcemia","Do not administer simultaneously with blood through same tubing"] |
| Food/Dietary | No direct food interactions as this product is administered intravenously. However, patients receiving parenteral nutrition should not eat or drink unless approved by the dietitian or doctor to avoid aspiration or metabolic imbalances. Enteral intake may affect blood glucose and electrolyte levels. |
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| Fetal Monitoring | Monitor maternal blood glucose, electrolytes (including ionized calcium), and acid-base status. Assess for signs of fluid overload or electrolyte imbalance. Fetal monitoring as per gestational age for signs of distress, including non-stress test and biophysical profile if clinically indicated. Monitor neonatal blood glucose after delivery. |
| Fertility Effects | No known adverse effects on fertility. Underlying conditions requiring parenteral nutrition may impact fertility, but CLINIMIX E 5/25 itself does not impair reproductive function. |
| Clinical Pearls | This product is a dual-chamber bag containing amino acids 5%, dextrose 25%, and electrolytes including calcium. The 'Sulfite Free' designation is critical for patients with sulfite sensitivity. Calcium-containing PN must not be co-administered with ceftriaxone due to precipitation risk. Inline filter of 1.2 micron is recommended. Monitor serum calcium, phosphorus, and magnesium closely when adjusting PN. Hepatic function and triglycerides should be assessed if used for long-term nutrition. |
| Patient Advice | This medication provides complete nutrition through your vein; it is not for oral use. · You may need blood tests to monitor your sugar, electrolyte levels, and liver function. · Report any signs of infection (redness, swelling, pain) at the IV site immediately. · Do not stop or change the infusion rate without consulting your doctor. · Tell your healthcare provider about any allergies, especially to sulfites. |