KABIVEN IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KABIVEN IN PLASTIC CONTAINER (KABIVEN IN PLASTIC CONTAINER).
Kabiven is a parenteral nutrition formulation that provides a balanced mixture of amino acids, dextrose, and lipids to meet nutritional requirements. The amino acids serve as building blocks for protein synthesis, dextrose provides a carbohydrate source for energy, and lipids supply essential fatty acids and additional energy. Electrolytes are included to maintain fluid and electrolyte balance.
| Metabolism | Amino acids are metabolized in the liver and other tissues via transamination and deamination pathways. Dextrose is metabolized via glycolysis and subsequently enters the Krebs cycle. Lipids are metabolized via beta-oxidation. Electrolytes are utilized or excreted via renal pathways. |
| Excretion | Renal: <3% unchanged; primarily metabolized via protein catabolism; nitrogen excretion is renal (urea, ammonia); fat emulsion components are cleared by the reticuloendothelial system and metabolized. Biliary/fecal: negligible. |
| Half-life | Variable; amino acids: 0.5–1 h; lipids: 0.5–1 h (intralipid clearance); glucose: rapid. No true terminal half-life as a mixture. |
| Protein binding | Not applicable; components are nutrients: amino acids minimal binding; lipid emulsion particles bind to lipoproteins; glucose not protein-bound. |
| Volume of Distribution | Amino acids: Vd ~0.5–0.8 L/kg (total body water); lipids: Vd ~0.1 L/kg (plasma volume); glucose: Vd ~0.2 L/kg (extracellular fluid). Overall not a single Vd. |
| Bioavailability | Intravenous: 100%. |
| Onset of Action | Intravenous: immediate upon infusion; nutritional effects are not immediate; caloric effect begins within minutes; protein synthesis effects require hours to days. |
| Duration of Action | Duration depends on infusion rate and metabolic demand; continuous infusion for 24 hours maintains steady state; clinical effects (nutritional) last as long as infused. |
Intravenous infusion. Adult dose based on nutritional needs: typically 0.8-1.5 g amino acids/kg/day, 0.8-1.5 g lipids/kg/day, and 2-4 g dextrose/kg/day. Maximum infusion rate: 1.7 mL/kg/hour (Kabiven Peripher) or 2.6 mL/kg/hour (Kabiven Central).
| Dosage form | EMULSION |
| Renal impairment | Contraindicated in severe renal impairment (GFR < 25 mL/min) without renal replacement therapy. For moderate impairment (GFR 25-50 mL/min), reduce amino acid dose by 50% and monitor electrolytes. For mild impairment (GFR > 50 mL/min), no adjustment typically needed. |
| Liver impairment | Contraindicated in severe hepatic dysfunction (Child-Pugh C). For Child-Pugh A or B, reduce lipid and amino acid doses by 25-50% based on tolerance. Avoid in cholestasis. |
| Pediatric use | Weight-based: Amino acids 1-2 g/kg/day, lipids 1-3 g/kg/day, dextrose 10-20 g/kg/day (up to 30 g/kg/day in neonates). For neonates, start with 0.5 g/kg/day amino acids and increase. Infusion rate not to exceed 1.5 mL/kg/hour (Kabiven Peripher). |
| Geriatric use | Start at lower end of adult dosing range due to decreased organ function. Monitor fluid balance and electrolytes closely. Use with caution in patients with cardiac or renal impairment. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KABIVEN IN PLASTIC CONTAINER (KABIVEN IN PLASTIC CONTAINER).
| Breastfeeding | No data available on excretion in human milk. M/P ratio unknown. Caution is advised; benefits of breastfeeding should be weighed against potential risks to the infant. |
| Teratogenic Risk | Kabiven (intravenous amino acids, dextrose, and lipids) is not associated with teratogenicity in humans based on limited data. However, due to metabolic changes in pregnancy, careful monitoring is advised. No specific first, second, or third trimester risks have been identified. |
| Fetal Monitoring |
■ FDA Black Box Warning
Not for use in children < 2 years of age due to risk of aluminum toxicity.
| Serious Effects |
["Hypersensitivity to any component","Severe hyperlipidemia or lipoid nephrosis","Pathologic hyperbilirubinemia in neonates","Inborn errors of amino acid metabolism","Severe hepatic failure","Severe renal failure without dialysis","Acute myocardial infarction or stroke","Unstable diabetes mellitus"]
| Precautions | ["Death in preterm infants due to aluminum toxicity","Risk of infections from catheter-related bloodstream infections","Pulmonary embolism due to pulmonary vascular precipitates","Hepatobiliary disorders including cholestasis and steatosis","Pancreatitis","Hyperglycemia","Electrolyte imbalances","Fat overload syndrome"] |
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| Monitor maternal electrolytes, blood glucose, liver function, triglycerides, and acid-base balance. Fetal monitoring includes growth scans and assessment for metabolic disturbances if prolonged use. |
| Fertility Effects | No data on fertility effects in humans. Animal studies have not been conducted. No known impact on reproductive function. |