TRAVASOL 4.25% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER
Clinical safety rating
cautionComprehensive clinical and safety monograph for TRAVASOL 4.25% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER (TRAVASOL 4.25% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER).
Total parenteral nutrition (TPN) solution providing essential amino acids, electrolytes, and dextrose. Dextrose supplies calories to spare protein catabolism; amino acids support protein synthesis; electrolytes maintain acid-base and fluid balance.
| Metabolism | Dextrose is metabolized via glycolysis and the citric acid cycle to carbon dioxide and water, with insulin-mediated uptake. Amino acids are metabolized via deamination and transamination, with nitrogen excreted as urea. Electrolytes are excreted or retained as needed. |
| Excretion | Amino acids and dextrose are metabolized; excess nitrogen is excreted as urea via renal route (approximately 90% of nitrogen output). Electrolytes are excreted renally. Biliary/fecal elimination is minimal (<5%). |
| Half-life | Not applicable as a single entity; components have various half-lives. Glucose has a plasma half-life of approximately 1.5-2 hours. Amino acids have variable half-lives (minutes to hours). Clinical context: continuous infusion maintains steady state. |
| Protein binding | Amino acids: minimal binding (<20%) to albumin. Dextrose: not bound. Electrolytes: variable (calcium ~45% bound to albumin; magnesium ~30% bound; others minimally bound). |
| Volume of Distribution | Amino acids: Vd ~0.3-0.6 L/kg, reflecting distribution to total body water. Dextrose: Vd ~0.2 L/kg (extracellular fluid). Electrolytes: Vd varies (sodium ~0.5 L/kg, potassium ~0.6 L/kg, calcium ~0.5 L/kg, magnesium ~0.6 L/kg). |
| Bioavailability | Intravenous: 100% bioavailable. |
| Onset of Action | Intravenous: immediate onset for hemodynamic effects (dextrose) and amino acid availability; clinical effects (metabolic support) begin within minutes. |
| Duration of Action | Duration depends on infusion rate; effects persist during infusion. After discontinuation, metabolic effects wane over hours. Dextrose effect lasts 2-3 hours post-infusion. |
| Molecular Weight | Variable; components: dextrose 180.16 Da, amino acids (e.g., alanine 89.09 Da, glycine 75.07 Da, etc.), electrolytes (Na+ 22.99 Da, K+ 39.10 Da, etc.). No single molecular weight for the mixture. |
Intravenous administration of 1.5-2.5 L/day in divided doses, adjusted based on metabolic needs, fluid status, and electrolytes. Typical rate: 100-200 mL/hour via central line.
| Dosage form | INJECTABLE |
| Renal impairment | GFR <30 mL/min: reduce volume by 20-50% and monitor electrolytes closely. GFR <15 mL/min: avoid use or use with extreme caution; consider renal replacement therapy. |
| Liver impairment | Child-Pugh Class B: reduce protein load by 25-50% and monitor ammonia. Child-Pugh Class C: avoid use due to risk of hepatic encephalopathy. |
| Pediatric use | Weight-based: 100-150 mL/kg/day for children, adjusted for age and clinical condition. Initiate at 50-75 mL/kg/day and titrate. Use with caution in neonates due to immature renal function. |
| Geriatric use | Elderly patients: use lower initial doses (75-100 mL/hour) and titrate slowly. Monitor fluid overload, electrolyte imbalances, and renal function closely due to decreased physiological reserve. |
| 1st trimester | No known teratogenic effects; used as necessary for IV nutrition when oral/enteral intake is inadequate. Dextrose may affect maternal glucose control; monitor blood glucose. Amino acids and electrolytes are essential for fetal development, but risks of maternal metabolic disturbances must be considered. |
| 2nd trimester | Generally considered safe when clinically indicated. Monitor maternal electrolytes, glucose, and acid-base balance to avoid fetal distress. |
| 3rd trimester | Safe when administered under medical supervision. High dextrose load may cause maternal hyperglycemia and fetal hyperinsulinism; monitor closely in gestational diabetes or impaired glucose tolerance. |
Clinical note
Comprehensive clinical and safety monograph for TRAVASOL 4.25% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER (TRAVASOL 4.25% SULFITE FREE W/ ELECTROLYTES IN DEXTROSE 25% IN PLASTIC CONTAINER).
| Placental transfer | Amino acids, dextrose, and electrolytes are actively transported across the placenta to support fetal nutrition. The components are physiological and essential for fetal growth. No specific barrier to transfer; transfer is regulated by maternal-fetal gradients and placental transporters. |
| Breastfeeding | Excreted in breast milk as normal physiological components (amino acids, dextrose, electrolytes). No specific adverse effects reported. However, intravenous infusion may affect maternal hydration and metabolic status, which could influence milk composition. Use caution if maternal glucose or electrolyte disturbances occur. |
| Lactation Rating | L2 (Probably Compatible) |
| Teratogenic Risk | Travasol 4.25% with electrolytes in dextrose 25% is a parenteral nutrition solution. No teratogenicity studies exist in humans. In animal studies, dextrose and amino acids have not been associated with teratogenic effects at clinical doses. Dextrose may cause fetal hyperinsulinemia and hypoglycemia if maternal hyperglycemia occurs, particularly in third trimester. Electrolytes are transferred across placenta and may affect fetal electrolyte balance if maternal levels are abnormal. Overall risk is low with appropriate maternal monitoring. |
| Fetal Monitoring | Monitor maternal serum electrolytes, glucose, acid-base status, and fluid balance. Fetal surveillance including ultrasound for growth and amniotic fluid volume if prolonged use. Blood glucose monitoring in pregnancy to avoid maternal hyperglycemia. Fetal heart rate monitoring if maternal metabolic abnormalities occur. |
| Fertility Effects | No known effects on fertility from components at recommended doses. Amino acids and dextrose are essential nutrients; electrolyte imbalance could theoretically impact reproductive function but not reported. |
■ FDA Black Box Warning
Not for injection into low-flow or central veins; risk of air embolism if administration set is not properly purged. Fatalities have occurred due to air embolism or thrombosis from central venous catheter placement.
| Serious Effects |
Severe hypersensitivity to any componentInborn errors of amino acid metabolism (e.g., maple syrup urine disease, phenylketonuria)Severe hyperglycemia or diabetic ketoacidosis (unless specifically managed)Severe electrolyte imbalances before correctionPulmonary edema or severe fluid overloadAnuria or oliguria not related to dehydration
| Precautions | Risk of hyperglycemia, osmotic diuresis, and hyperosmolar coma; monitor serum glucose, electrolytes, and fluid balance. Central line infection, sepsis, air embolism, thrombosis. Electrolyte imbalances (hyperkalemia, hypercalcemia). Aluminum toxicity in renal impairment. |
| Food/Dietary | No oral food interactions as this is an intravenous nutritional supplement. However, if the patient is also taking oral nutrition, monitor total caloric and electrolyte intake to avoid imbalances. |
| Clinical Pearls | TRAVASOL 4.25% sulfite-free with electrolytes in dextrose 25% is a high-osmolality total parenteral nutrition (TPN) solution. It must be administered via a central venous catheter due to its high dextrose concentration (25%) to reduce the risk of thrombophlebitis. Monitor serum glucose closely as hyperglycemia is common; insulin may need to be added to the TPN or administered separately. Check electrolytes daily, particularly potassium, phosphorus, and magnesium, as refeeding syndrome can occur in malnourished patients. The absence of sulfite is important for patients with sulfite sensitivity. Do not add other medications without verifying compatibility. |
| Patient Advice | This solution provides complete nutrition through a central vein. It contains high glucose and electrolytes. Report any signs of infection at the catheter site (redness, swelling, pain) or symptoms of high blood sugar (increased thirst, frequent urination, confusion). · Do not stop the infusion or change the rate without consulting your healthcare provider. Sudden cessation can cause dangerous low blood sugar. · Tell your doctor if you have a history of sulfite allergy, even though this product is sulfite-free. · This medication is for intravenous use only and is not for home administration unless under strict medical supervision. |
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