Nutrinil PD-4 Solution

Adult dosage

For intraperitoneal administration only, not for intravenous use. This drug is intended for single-use only. Administer to the patient at an appropriate rate, with dosage adjustments in accordance with a physician's prescription. Treatment modality, frequency of treatment, volume modification, exchange times of dialysis fluid should be under the supervision of the prescribing physician. The physician should adjust treatment methods, frequency of administration, exchange volumes, duration, and timing of dialysis based on the patient's symptoms. Recommended dietary protein intake for adults undergoing dialysis is approximately 1.2 g/kg or more. A 1.1% Amino Acid 2 Liter Bag of Nutrinil provides 22g of amino acids, corresponding to 0.30g/kg/day for a 70kg adult.

This drug should not be administered to patients who have recently undergone abdominal surgery or have gastrointestinal problems. It should also be avoided in patients with high blood urea levels, uremia, or hypokalemia. Patients with hypersensitivity to any amino acids or additives included in this drug, metabolic acidosis, congenital amino acid metabolism disorders, hepatic dysfunction, or a history of myocardial infarction should not receive it. Caution is also required for patients with structural defects that may reduce the effectiveness of peritoneal dialysis or those with lost peritoneal function. This drug should be used cautiously in patients with unresolved acidosis, severe liver dysfunction, hyperammonemia, or hypersensitivity to specific amino acids. Patients with surgery, infection, tumors, malformations, trauma in the peritoneum or abdomen also require caution. Furthermore, patients who have undergone aortic graft surgery, those with severe pulmonary disease, or patients taking cardiac glycosides should carefully monitor their blood potassium, calcium, and magnesium levels. During peritoneal dialysis, complications such as abdominal infection, electrolyte imbalance, metabolic acidosis, nitrogen excess, abdominal distension, dyspnea, blood pressure abnormalities, and gastrointestinal symptoms may occur. In particular, catheter site infections, anemia, acidosis, hypokalemia, depression, nausea, vomiting, loss of appetite, weakness, increased blood urea, abdominal pain, peritonitis, cloudy peritoneal fluid, leakage, abdominal discomfort, vascular edema, pruritus, catheter-related complications, fever, malaise, abdominal cavity infection, electrolyte and fluid imbalances, metabolic acidosis, hypernitrogenemia, distension, and fullness can be commonly reported. As peritonitis, hypersensitivity reactions, abdominal pain, vascular edema, and catheter complications can also occur, patients should consult their doctor immediately if abnormal symptoms appear. During treatment, fluid and electrolyte balance, acid-base balance, and nitrogen balance should be regularly monitored, and the patient's condition should be reevaluated every three months. If signs of peritonitis are observed, appropriate treatment should be administered immediately, and the mixed solution should be used right away. Patients performing self-peritoneal dialysis should receive specialized training, as serious complications like peritoneal sclerosis may occur rarely. Proteins, amino acids, and water-soluble vitamins can be lost during dialysis, so supplementation may be necessary if needed. Overadministration of peritoneal dialysis fluid may cause abdominal distension or pain and dyspnea, so in case of overadministration, the dialysis fluid should be expelled immediately. Careful monitoring of the patient's weight and fluid status is essential to manage hydration, ensuring it is neither excessive nor insufficient. The amino acids contained in this drug can be converted to urea during metabolism, which may worsen the symptoms of uremia, so in cases where dialysis is insufficient, medication should be discontinued or dialysis dosage adjusted upon symptom occurrence. Since this drug does not contain potassium, the risk of hyperkalemia is low; however, in cases of hypokalemia, potassium supplementation may be necessary as directed by a physician. If hypersensitivity symptoms appear, peritoneal administration should be ceased immediately. While no interaction studies with other drugs have been conducted, caution should be exercised regarding dosage adjustments as serum concentration may vary during dialysis. Patients taking digitalis glycosides should closely monitor their potassium levels, and diabetic patients should manage insulin dosage or blood sugar levels with care. Adequate safety data regarding the use in pregnant or lactating women is lacking, thus physicians should carefully evaluate the risks and benefits for each individual patient before prescribing. Safety and efficacy in pediatric patients have not been established, hence caution is advised in their use. In cases of overdose, fluid overload and electrolyte abnormalities may occur; therefore, in cases of fluid excess, treatment should be conducted using hyperosmolar dialysis solutions or by adjusting the volume of dialysis fluid, and electrolyte abnormalities should be treated accordingly based on test results. Potassium supplementation may be required in case of hypokalemia. When administering, complete aseptic procedures must be followed, and the dialysis solution should be checked to ensure it is clear and without abnormalities before use. Solutions showing discoloration, turbidity, particles, or damaged packaging should not be used. The solution should be used as soon as possible after opening and should be warmed to body temperature using a designated heating device, as heating in a microwave or using water may pose risks to the patient. Any remaining solution should be disposed of.

Serious side effects

Severe allergic reactions (hypersensitivity), respiratory problems (dyspnea), infections (bacterial peritonitis, sepsis), severe edema (fluid overload), liver abnormalities (liver function impairment), no serious neurological symptoms specified.

Mild side effects

• Catheter site infection
• anemia
• acidosis
• fluid overload
• hypokalemia
• fluid deficit
• depression
• dyspnea
• nausea
• vomiting

This drug should be stored in a cool place below 30 degrees, away from direct sunlight. This helps to maintain the drug's efficacy for a longer period.

Appearance

A pale yellow transparent peritoneal dialysis solution contained in a pale yellow polyvinyl chloride plastic container

Package unit

2000ml/pack