TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER (TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER).
TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% is a parenteral nutrition solution providing calories (dextrose), amino acids (for protein synthesis), and electrolytes for maintenance of acid-base balance and cellular function. Dextrose is metabolized to glucose, which undergoes glycolysis and oxidative phosphorylation. Amino acids are used for protein synthesis and as an energy source. Electrolytes correct or prevent deficiencies.
| Metabolism | Dextrose is metabolized via glycolysis and enters the citric acid cycle. Amino acids are deaminated and oxidized for energy or used in protein synthesis. Electrolytes are not metabolized but are excreted or utilized in physiological processes. |
| Excretion | Primarily renal (glomerular filtration). Dextrose is completely metabolized; electrolytes (sodium, chloride, potassium, calcium, magnesium, acetate) are excreted via kidneys. Acetate is metabolized to bicarbonate. No significant biliary/fecal elimination. |
| Half-life | Dextrose: rapid, minutes (insulin dependent); amino acids: 20-30 min for free pool turnover; electrolytes: distribution half-life 2-4 hours, elimination depends on renal function. Clinical: continuous infusion maintains steady state. |
| Protein binding | Minimal (<10%). Dextrose and electrolytes not significantly protein bound. Amino acids: low binding (albumin, variable by amino acid). |
| Volume of Distribution | Dextrose: ~0.2 L/kg (total body water). Amino acids: 0.5-1 L/kg (free amino acid pool). Electrolytes: distribute according to body water compartments (e.g., Na+ 0.6 L/kg, K+ 4 L/kg). Clinically: reflects distribution into extracellular and intracellular spaces. |
| Bioavailability | IV: 100% (complete bioavailability). Not administered via other routes; oral or enteral would result in variable absorption and first-pass metabolism (not applicable). |
| Onset of Action | IV: Immediate. Dextrose raises blood glucose within minutes; amino acids enter circulation immediately; electrolytes act within seconds to minutes. |
| Duration of Action | Continuous infusion: duration equals infusion time plus post-infusion equilibration (1-2 hours). No sustained effect after discontinuation. Clinical: requires continuous administration for nutritional support. |
Intravenous infusion only. Adult dose determined by nutritional requirements and metabolic tolerance. Typical dose: 500-2000 mL/day infused continuously or intermittently, with dextrose dosage not exceeding 0.5 g/kg/h. Final concentration of dextrose and amino acids must be monitored.
| Dosage form | INJECTABLE |
| Renal impairment | In acute kidney injury or chronic kidney disease (GFR <30 mL/min/1.73 m²): reduce total daily amino acid dose to 0.6-0.8 g/kg/day with close monitoring of serum electrolytes and acid-base balance. GFR 30-50 mL/min/1.73 m²: standard dosing may be used with caution. Avoid in patients with severe renal failure without appropriate electrolyte adjustment. |
| Liver impairment | Child-Pugh class B or C cirrhosis: reduce or avoid use. Initiate at 50% of standard dose, titrate slowly based on tolerance and serum ammonia levels. Monitor for signs of hepatic encephalopathy. |
| Pediatric use | Weight-based dosing: Neonates and infants: 2-3 g amino acids/kg/day. Children: 1-2 g amino acids/kg/day. Dextrose infusion rate should not exceed 12-14 mg/kg/min in neonates, 8-10 mg/kg/min in older children. Adjust electrolytes based on age and renal function. |
| Geriatric use | In elderly patients, start at low end of dosing range due to age-related decline in renal function. Monitor fluid balance, electrolytes, and renal function closely. Typical adult dose may be used if renal function is normal, but individualize based on comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER (TRAVASOL 2.75% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER).
| Breastfeeding | Dextrose and electrolytes are normal constituents of breast milk and are not expected to cause harm to the nursing infant. The M/P ratio is not applicable as dextrose and electrolytes are endogenous substances and do not concentrate in milk. Use during lactation is considered compatible with breastfeeding when clinically indicated. |
| Teratogenic Risk | No adequate studies in pregnant women. Animal reproduction studies not conducted. This formulation contains dextrose and electrolytes used for parenteral nutrition; teratogenic risk is considered low based on essential nutrient requirements. However, intravenous infusions during pregnancy should be administered with caution to avoid fluid overload and electrolyte imbalances that could affect the fetus. No specific fetal risks for first, second, or third trimester are identified beyond those associated with maternal metabolic disturbances. |
■ FDA Black Box Warning
Contains sulfites that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible individuals. Sulfite sensitivity is seen more frequently in asthmatic patients. Solutions with dextrose concentrations of 25% are hypertonic and may cause phlebitis or thrombosis when administered via peripheral vein.
| Serious Effects |
["Hypersensitivity to any component of the solution","Severe sulfite sensitivity","Patients with intracranial or intraspinal hemorrhage, anemia, or anemia of unknown etiology (due to potential for increased neural injury in presence of dextrose)","Severe hyperglycemia or hyperosmolar states","Severe electrolyte or acid-base imbalances uncorrected prior to administration","Patients with known metabolic disorders precluding use of dextrose or amino acids (e.g., maple syrup urine disease, phenylketonuria)"]
| Precautions | ["Risk of infection due to catheter placement and maintenance","Monitor for metabolic complications such as hyperglycemia, hypoglycemia, hyperosmolarity, electrolyte imbalances, acid-base disturbances, and azotemia","Use with caution in patients with renal insufficiency, hepatic failure, or cardiac failure due to fluid and electrolyte load","Sulfite sensitivity may cause allergic reactions","Extravasation may cause tissue necrosis","Do not administer simultaneously with blood through the same infusion set due to risk of agglutination"] |
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| Fetal Monitoring | Monitor maternal serum glucose, electrolytes, fluid balance, and renal function regularly during infusion. Assess for signs of hyperglycemia, electrolyte abnormalities, or fluid overload (e.g., edema, pulmonary congestion). Fetal monitoring (e.g., nonstress test or biophysical profile) is recommended if maternal metabolic instability occurs. In prolonged parenteral nutrition, monitor intrauterine growth and amniotic fluid volume. |
| Fertility Effects | No known adverse effects on fertility from dextrose or electrolyte components. However, parenteral nutrition may be used in conditions that themselves affect fertility (e.g., malnutrition, malabsorption). No specific data on impact of this formulation on fertility. |