Nutriflex Peri/Nutriflex Plus Special Precautions

Caution should be exercised in cases of increased serum osmolarity. Like all solutions containing carbohydrates the administration of Nutriflex Peri/Nutriflex Plus can lead to hyperglycaemia. The blood glucose level should be monitored. If there is hyperglycaemia, the rate of infusion should be reduced or insulin should be administered. If the patient is receiving other intravenous glucose solutions concurrently, the amount of additionally administered glucose has to be taken into account.
Abrupt discontinuation of high glucose infusion rates during parenteral nutrition may lead to hypoglycaemia, especially in children less than 3 years of age and in patients with disturbed glucose metabolism. In these patient groups, tapering off of glucose administration is recommended. As a precaution it is recommended that patients should be monitored for hypoglycaemia for at least 30 minutes on the first day of abrupt discontinuation of parenteral nutrition.
Refeeding or repletion of malnourished or depleted patients may cause hypokalaemia, hypophosphataemia and hypomagnesaemia. Close monitoring of serum electrolytes is mandatory. Adequate supplementation of electrolytes according to deviations from normal values is necessary. Substitution of additional energy in form of lipids may be necessary, as well an adequate supply of essential fatty acids, electrolytes, vitamins and trace elements. As Nutriflex Peri/Nutriflex Plus contains magnesium, calcium, and phosphate, care should be taken when it is co-administered with solutions containing these substances.
Patients with organ impairments: Like all large-volume infusion solutions, Nutriflex Peri/Nutriflex Plus should be administered with caution to patients with impaired cardiac or renal function. In patients with renal insufficiency, the dose must be carefully adjusted according to individual needs, severity of organ insufficiency and the kind of instituted renal replacement therapy (haemodialysis, haemofiltration etc.).
Likewise in patients with insufficiencies of liver, adrenal glands, heart and lungs the dose must be carefully adjusted according to individual needs and the severity of organ insufficiency.
Application of hyperosmolar glucose solutions in patients with damaged haematoencephalic barrier may lead to increase of intracranial/intraspinal pressure.
There is only limited experience of its use in patients with diabetes mellitus or renal failure.
Patients with metabolic disturbances: Disturbances of the fluid, electrolyte or acid-base balance must be corrected before the start of infusion.
Solutions containing sodium salts should be used with caution in patients with sodium retention (see Interactions).
Monitoring of clinical parameters: Controls of the serum electrolytes, the water balance, the acid-base balance, and of blood cell counts, coagulation status, hepatic and renal function are necessary.
An interruption of administration of the emulsion may be indicated if the blood glucose concentration rises to above 14 mmol/l (250 mg/dl) during administration.
During long-term administration also blood cell counts and blood coagulation should be monitored carefully.
Warnings and precautions concerning intravenous administration: Too rapid infusion can lead to fluid overload with pathological serum electrolyte concentrations, hyperhydration, pulmonary oedema and polyuria.
Nutriflex Peri/Nutriflex Plus should not be given simultaneously with blood in the same infusion set due to the risk of pseudoagglutination.
As with all intravenous solutions, especially for parenteral nutrition, strict aseptic precautions are necessary for the infusion of Nutriflex Peri/Nutriflex Plus.
Nutriflex Peri/Nutriflex Plus is a preparation of complex composition. It is, therefore, strongly advisable not to add other solutions or emulsions (as long as compatibility is not proven - see Incompatibilities under Cautions for Usage).
Nutriflex Peri: Infusion in peripheral veins may cause thrombophlebitis. Monitor infusion site daily for signs of thrombophlebitis.
Effects on ability to drive and use machines: Nutriflex Peri/Nutriflex Plus has no or negligible influence on the ability to drive and use machines.
Use in the elderly: Basically the same dosage as for adults applies, but caution should be exercised in patients suffering from further diseases like cardiac insufficiency or renal insufficiency that may frequently be associated with advanced age.