clinical nutrition general brochure

Your Nutrition Partner to improve Life

Clinical Nutrition

The important role of adequate nutrition during hospital stay is well documented by several diff erent studies. These studies suggest that up to 60% of patients in hospitals are suff ering from malnutrition which is often the cause for serious compli-cations such as an increasing risk of sepsis, infection, infl amma-tion or organ failure. The consequences of these complications are reduced wound healing leading to a signifi cantly uprated morbidity and mortality. To avoid these consequences an appropriate nutritional therapy is an indispensable condition especially for critically ill patients.

The right nutrition system will not only minimize the risk of morbidity and mortality by strengthening your patients immune system and organ functions, but also lead to a sooner recovery. This will reduce the duration of hospital stay and in the end the costs for treatment.

Nowadays clinical nutrition is widely accepted in clinical practice. The lifesaving characteristics of the adequate nutrition can not be denied so it became an important part of the overall treat-ment package.

Your nutrition partner to improve life

References:

1. Wilson et al. Prevalence and causes of undernutrition in medical outpatients. Am J Med 1998; 104; 56-63 2. Norman et al. Clin Nutr (2008) 27; 5-15 3. Stratton et al. (2003) Wallingford: CAB International 4. Neumayer et al. J Surg Res (2001) 95; 73-77 5. Lawson (2002) Clin Nutr (2003) 22(1); 39-46

There are diff erent ways of clinical nutrition: enteral, parenteral or a combination of both. The right way of clinical nutrition always depends on the patients gut function and his general physiological condition.

The determination of the nutritional status should be part of each physical examination in order to identify risk patients to evaluate their risk and to defi ne an individual nutrition therapy. The NuTRIscreen-App includes diff erent screening tools, such as "NRS-2002" (Nutrition Risk Score), the "MUST" (Malnutrition Universal Screening Tool) and the "SGA" (Subjective Global Assessment). The NuTRIscreen-App is available at the App Store.

The NuTRIscreen-App:

2

Clinical Nutrition

Consequences of malnutrition2,3:

n Increased hospital stay

n Increased morbidity and mortality

n Increase in infectious complications

n Reduced wound healing

early and sufficientnutrition

days

no adequatenutrition

14

16

12

10

8

2

4

6

0

nutritionsupplement

%

control

40

30

20

10

0

Complication rate in orthopedic patients5Average length of hospital stay in surgical patients in relation to nutritional support4

10–60 % malnutrition based on 5.120 patients1

Enteral nutrition support is needed if the patient is unable, un- willing or not allowed to take adequate nutrition from normal food.

Use of the gastrointestinal tract for nutrition support allows a physiological utilization of nutrients. Parenteral nutrition on the other hand bypasses the gastrointestinal tract and is given intravenously, either via peripheral or central venous line.Our ready-to-use systems offer standardized nutrition regimes, required by most of enterally or parenterally fed patients. Patient-tailored prescriptions are only necessary in specific clinical situations. Therefore the wide product range and the possibility of making additions allows a highly flexible adaptation to specific patient needs.

3

Nutritional care is a concept which includes several aspects and these must be managed in a seamless way to ensure that the right patients receive the right nutritional support at the right time and in the right place.

It is fundamental that nutritional care is based on each patient's individual nutritional requirements and preferences. Any patient who is undernourished or at risk for undernutrition should have a nutritional care plan. The integrated concept of nutritional support offered by B. Braun – enteral and parenteral nutrition going hand in hand – creates a solid platform for different kinds of nutritional treatments, allowing health care specialists to choose from a wide product range, to meet the fundamental requirements of the body.

Parenteral NutritionThe parenteral nutrition therapy can be realized with premixed “convenience” solutions or by patient-tailored nutrition. The standardized parenteral nutrition (NuTRIflex® System) is suitable for most of the parenterally fed patients, and has significant advantages by preventing therapeutical errors and reducing work load and total costs for the preparation of nutritional regimens.6

For specific clinical situations (e.g. patients with severe metabolic derangements or organ dysfunctions) and for neonatology, a patient-tailored nutrition therapy based on different single nutritional solutions is required.

Parenteral and enteral ...

6. Pichard et al. Clin. Nutr. (2000) 19(4); 245-251

4

Clinical Nutrition

Enteral NutritionB. Braun offers a wide range of enteral nutrition products that cover different indications and routes of application. Enteral nutrition allows a physiological utilisation of nutrients and is believed to promote gut function and prevent transloca-tion of intestinal bacteria. However, choosing the right feeding method and formula to achieve quality nutritional care is a daily challenge of health care practitioners and dietitians around the world. There are different ways to get access to the gastrointestinal tract, whatever routes of application you are looking for.

... it is all about nutrition

B. Braun offers a broad range of pump or gravity application sets as well as naso-gastric or naso-intestinal tubes.The formulas of enteral nutrition products are a ready to admin-ister mixture of important nutrients like proteins, carbohydrates, fats, vitamins and minerals that can be used as a sole source of nutrition or as a supplement. The composition can be a standard formula, reflecting the nutrition needs of a healthy patient, or adapted to a specific disease and/or digestive disor-der (disease specific formula). B. Braun formulas are a safe and effective source of nutrition reflecting the requirements of patients and health care professionals alike.

5

Enteral Nutrition

Parenteral Nutrition

Insulin Pump

Space Control User Interface

Clinical nutritionModern nutrition therapy involves premixed “convenience”solutions or nutrition solutions specially made for the patient.B. Braun standardized nutrition solutions are suitable for mostenteral and parenteral feeding of patients. This approach off erssignifi cant benefi ts as it prevents errors in administering theright therapy during the routine of daily clinical practice.Standardization also reduces nurse’s workloads and the totalcost of preparation.

Enteral nutritionB. Braun off ers standard and special diets for enteral nutrition inglass bottles and bags. For the delivery of enteral nutrition solu-tions, we also off er resealable nutrition bags which have a fi xed,attached tube for the Infusomat® Space.

Infusomat® Space – also ideal for clinical nutritionWith this system, beds equipped with the Space system do notneed additional nutrition pumps. Not only does this save staff time, because additional user trainings are no more required, it also cuts the cost of maintenance and service.

Binding forward-looking technology …

Your benefi ts:

n Protect your budgets by using Infusomat® Space also for enteral nutrition

n Prevent mix-up of enteral lines and IV access ports

n Reduce nurse’s workloads and the total cost of preparation with ready-to-use 2- or 3-chamber bags

n End messy dripping of sticky fl uids with PrimeStop

n No additional training required

Successful therapy requires adequate clinical nutrition – which is why we consider parenteral and enteral nutrition as an integral part of modern fl uid management systems.

6

Clinical Nutrition

… with highest treatment quality

B. Braun Space GlucoseControl:

n The solution to achieve safe and reproducible blood glucose control

n Automatic Integration of Nutrition

n More safety in daily clinical workfl ow

n Optimized workfl ow and simplifi ed treatment decision for more safety in daily use

Get in touch with the future B. Braun Space GlucoseControl realizes safe and reliable glucose levels in critically ill patients with a significantly reduced risk of hyper- and hypoglycemia.

With its intelligent dosage algorithm, the B. Braun Space GlucoseControl integrates enteral and parenteral nutrition and exactly determines insulin rate and next sampling time – helping you to easily control complex work processes for a safer future with minimized episodes of potentially dangerous hyperglycemia and hypoglycemia.

Glucose (mmol/l)

20

15

10

5

Conventional Glucose Control B. Braun Space GlucoseControl

Strict Glucose Control within a range of 4.4–6.1 mmol/l (80–110 mg/dl)

Time (hours)

2. Input of glucose value into SpaceControl

1. Blood sampling and analysis

Automatic calculation of appropriate insulin rate and next sampling time

3. Confi rmation of suggested insulin rate

Automaticconsideration of nutrition data

Automaticinsulin application

7

The NuTRIflex® System is the “ready-to-infuse” multi chamber bag system for Total Parenteral Nutrition (TPN).The NuTRIflex® System consists of 2- and 3-chamber bags for peripheral and central venous application, including volume restricted and electrolyte-free versions.

2-chamber bags Provide different formulations with amino acids, carbohydrates and electrolytes. According to individual patient requirements, lipids (e.g. Lipidem®/Lipoplus®), can be added via the lipid addi-tive port.

Port systemnLow risk for needle stick injury nEasy to grip and firm fittingnNo leakage after removalnStable ports made of hard plastic nSelf-sealing

3-chamber bags The 3-chamber bags provide different formulations and bag volumes with amino acids, carbohydrates and fat and are available with or without electrolytes.On individual needs trace elements (e.g. Tracutil®) and othermicronutrients can be added via the additive port.NuTRIflex® Lipid including a MCT/LCT lipid emulsion.

The NuTRIflex® system for your convenienceConvenience with Safety

NuTRIflex® Lipid 3-chamber bag

Lipid

Amino Acid

Glucose

Nutriflex® 2-chamber bag

Glucose

Amino Acid

Latex-free

PVC-free

Latex-free

PVC-free

DEHP-free

8


The steps:

Mix – add – mix – infuse

Remove the overwrap and mix the upper left chamber (Glucose) with the lower cham-ber (Amino Acid).

Press the upper rightchamber (lipid emulsion) to mix with the lower chamber.

Then electrolytes, traceelements and vitamins can beadded via the additive port (redcap). Needles with the size of0.8 -1.2 mm can be used.

Finally, mix thoroughly before inserting the giving set.

User benefits

nIncrease patient safety, through visual check

nEnvironmental and patient-friendly bag material (no PVC, no DEHP and no latex)

nConvenient, cost-effective and safe

Safety aspect

After adding the additives to the clear solution, a visual check is possible.

1.

4.

2. 3.

9

Nutriflex®Sterile solution for intravenous nutrition containing amino acids, carbohydrates and elec-trolytes in a 2-chamber bag.

Product rangeNutriflex® perinPeripheral parenteral nutritionnSupplemented nutrition or in combination with enteral feedingnFor Low Glucose Nutrition (LGN) TherapyNutriflex® basalnParenteral nutrition in situations with basal nutrition requirementsnFor central venous accessNutriflex® plusnParenteral nutrition in situations with moderately increased requirementsnFor central venous accessNutriflex® special nVolume-restricted parenteral nutrition for ICU patientsnIn situations with high nutritional requirementsAll Nutriflex® - 2-chamber bags nFlexibility to choose and add the fat component (e.g. Lipoplus®, Lipofundin®)

CharacteristicsnDifferent balanced regimens for peripheral and central venous applicationnReliable source of protein and caloriesnSupplies electrolytesnEasy and safe handlingnFlexibility to add fat easily to complete parenteral nutrition from one bagn24-month shelf life at room temperature

Accessories nNutriflex® Transfer Set (Art. No. 212 9043)nLight Protection Cover: Nutriflex® 1000 ml (Art. No. 212 9035) Nutriflex® 1500 ml, 2000 ml (Art. No. 211 2112)

1. Trade name in some countries: Medialipide®, Vasolipid®2. Trade name in some countries: Lipidem®

2-chamber bags

Composition 1000 ml

Nutriflex® peri

Nutriflex® basal

Nutriflex®plus

Nutriflex® special

Amino acids g 40 32 48 70

Nitrogen* g 5.7 4.6 6.8 10.0

Glucose g 80 125 150 240

Electrolytes + + + +

Total energy kcal 480 630 790 1240

Non-Protein energy kcal 320 500 600 960

Presentations** ml 1000, 2000 1000, 2000 1000, 2000 1000, 1500

* due to the specific amino acid pattern, 14 g N ≈ 100 g amino acids; ** may differ from country to country

Nutrifl ex®

nPN regimens for individual fat requirements

nFlexibility in adding optional lipid emulsions such as Lipoplus®2 or Lipofundin® MCT/LCT1

10

Clinical NutritionParenteral Nutrition

Nutriflex® – global portfolio overview*

Nutriflex® 2-chamber bag peri basal plus special

Cont

ent

Volume (ml) 1000 2000 1000 2000 1000 2000 1000 1500

Amino acids (g) 40 80 32 64 48.1 96.2 70 105

Nitrogen (g) 5.7 11.4 4.6 9.2 6.8 13.6 10 15

Glucose (g) 80 160 125 250 150 300 240 360

Total energy (kcal) 480 960 630 1255 790 1580 1240 1860

Osmolarity (mOsm/l) 900 900 1150 1150 1400 1400 2100 2100

Electrolytes (mmol)

Sodium 27 54 49.9 99.8 37.2 74.2 40.5 60.8

Potassium 15 30 30 60 25 50 25.7 38.6

Calcium 2.5 5.0 3.6 7.2 3.6 7.2 4.1 6.2

Magnesium 4.0 8.0 5.7 11.4 5.7 11.4 5.0 7.5

Phosphate 5.7 11.4 12.8 25.6 20.0 40.0 14.7 22.1

Chloride 31.6 63.2 50 100 35.5 71 49.5 74.3

Acetate 19.5 39 35 70 22.9 45.8 22 33

PLEASE NOTE: Additions to Nutriflex® may increase (e.g. electrolyte concentrates) or decrease (e.g. lipids) its osmolarity. Vitamins and trace elements should be added just prior to use!

There may be some degradation during shelf life. See manufacturer´s recommendation. *Not all versions and bag volumes will be marketed in each country.

11

1. Trade name in some countries: Medialipide®, Vasolipid®

3-chamber bags

NuTRIflex® LipidSterile solution for IV nutrition containing amino acids, car-bohydrates and lipids in a 3-chamber bag – available with and without electrolytes.

Product rangeNuTRIflex® Lipid peri nPeripheral parenteral nutrition nSupplementary nutrition nIn combination with enteral nutrition nSpecially designed for Low Glucose Nutrition (LGN) Therapy (peripheral and central venous)NuTRIflex® Lipid plus nCentral venous parenteral nutrition for moderately increased requirements nEasy to calculate: 1 ml = 1 kcalNuTRIflex® Lipid special nIf volume-restricted parenteral nutrition is required nIn situations with high nutritional demands n625 ml version as ICU starter bag and for combined enteral/parenteral nutritionNuTRIflex® Lipid without electrolytes (plus and special) nFor individualized electrolyte administration

Characteristics nAllows the simultaneous administration of required nutrients out of one container nContains MCT/LCT1 lipid emulsion nElectrolyte-containing versions cover the basic needs for electrolytes and zinc nElectrolyte-free versions for individualized electrolyte administration nEasy and safe handling n24-month shelf life at room temperature

Accessories n Light Protection Cover:

NuTRIflex® Lipid 1250 ml, 1875 ml, 2500 ml (Art. No. 211 2112) NuTRIflex® Lipid 625 ml (Art. No. 212 9035)

Composition 1250 ml

NuTRIflex® Lipid peri

NuTRIflex® Lipid plus

without electrolytes

NuTRIflex® Lipid plus

NuTRIflex® Lipid special

without electrolytes

NuTRIflex® Lipid special

Amino acids g 40 48 48 71.8 71.8

Nitrogen* g 5.7 6.8 6.8 10 10

Glucose g 80 150 150 180 180

Lipids (MCT/LCT) g 50 50 50 50 50

Electrolytes + - + - +

Total energy kcal 955 1265 1265 1475 1475

Non-Protein calories kcal 795 1075 1075 1195 1195

Presentations** ml 1250, 1875, 2500 1250, 1875, 2500 1250, 1875, 2500 1250, 1875, 2500 625, 1250, 1875, 2500

* due to the specific amino acid pattern, 14 g N ≈ 100 g amino acids; ** may differ from country to country

NuTRIflex® Lipid

nEasy and safe parenteral nutrition

nMetabolic advantages through simultaneous administration of nutrients

nCompatibility and stability data offer safe limits for the addition of further required minerals, vitamins and trace elements

nThe only 3-chamber bag with MCT/LCT1 lipid emulsion

nReduces work load and total cost for TPN

nNuTRIflex® Lipid special 625 ml - as ”ICU starter bag” – for combined enteral/parenteral nutrition – as basic ”all-in-one” bag for children (>2 years)

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NuTRIflex® Lipid 3-chamber bag peri plus a) special a)

Cont

ent

Volume (ml) 1250 1875 2500 1250 1875 2500 625 1250 1875 2500

Amino acids (g) 40 60 80 48 72 96 35.9 71.8 107.7 143.6

Nitrogen (g) 5.7 8.6 11.4 6.8 10.2 13.6 5 10 15 20

Glucose (g) 80 120 160 150 225 300 90 180 270 360

Lipids (g) 50 75 100 50 75 100 25 50 75 100

Total energy (kcal) 955 1435 1910 1265 1900 2530 740 1475 2215 2950

Osmolarity (mOsm/l) 840 840 840 1215 1215 1215 1545 1545 1545 1545

Electrolytes (mmol)

Sodium 50 75 100 50 75 100 33.5 67 100.5 134

Potassium 30 45 60 35 52.5 70 23.5 47 70.5 94

Calcium 3.0 4.5 6.0 4.0 6.0 8.0 2.65 5.3 7.95 10.6

Magnesium 3.0 4.5 6.0 4.0 6.0 8.0 2.65 5.3 7.95 10.6

Phosphate 7.5 11.25 15.0 15.0 22.5 30.0 10.0 20.0 30.0 40.0

Chloride 48 72 96 45 67.5 90 30 60 90 120

Acetate 40 60 80 45 67.5 90 30 60 90 120

Zinc 0.03 0.045 0.06 0.03 0.045 0.06 0.02 0.04 0.06 0.08

PLEASE NOTE: Additions to NuTRIflex® Lipid may increase its osmolarity. Vitamins and trace elements should be added just prior to use! There may be some degradation during shelf life. See manufacturer’s recommendation.a)NuTRIflex® Lipid plus and special also exist as electrolyte-free versions (e-fr. plus/special: 1055/1330 mOsm/l). *Not all versions and bag volumes will be marketed in each country.

NuTRIflex® Lipid – global portfolio overview*

2500 ml

1875 ml

1250 ml

625 ml

NuTRIflex® Lipid Special in a 625 ml bag

This unique size is especially suited for:nPatients requiring an incremental increase in TPN during their first days on ICUnCombining enteral and parenteral nutritionnChildren (> 2 years) as a basic “all-in-one” bag for convenient TPN

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Patient-tailored regimensCritically ill, significantly catabolic, malnourished patients with compromised metabolic and organ functions (e.g. liver or renal insufficient patients) sometimes require patient-tailored TPN because their nutrient requirements are specific and tend to vary significantly from patient to patient and during each patient's hospital stay.

Traditionally, this kind of nutrition therapy is prepared at the hospital pharmacy by compounding the different required com-ponents into one mixing bag. This procedure is time-consuming and requires extensive technical equipment and pharmaceutical know-how.

Against this background, the NuTRIflex® System allows hospital compounding services to focus on those 10%–20% critically ill patients requiring patient-tailored nutrition support.

The single bottle system …

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Product rangenAminoplasmal® B. Braun: Amino acid solutions for parenteral nutritionnAminoplasmal® Hepa: Amino acid solution for parenteral nutrition in severe liver disease and for the therapy of hepatic encephalopathy

Compounding of a Nutrimix® mixing bag


… for parenteral nutrition

nLipoplus®/Lipidem®: Modern fat emulsion based on medium and long chain triglycerides including -3 fatty acidsnLipofundin® MCT/LCT 1: Fat emulsion on the basis of medium and long chain triglyceridesnGlucose Braun: Glucose solution for providing energynTracutil®: Trace element additivenNutrimix®: EVA mixing bags

User benefi ts

nWide range of product versions for patient-tailored TPN

nExcellent stability in TPN admixtures

nWell balanced MCT/LCT lipid emulsion with -3 fatty acids

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Aminoplasmal® B. BraunAmino acid solution for parenteral nutrition.

Aminoplasmal® Hepa 10%Amino acid solution for parenteral nutrition for patients with severe liver diseases and for treatment of hepatic encephalopathy.

CharacteristicsnSpecific amino acid pattern adapted to the specific needs of patients with liver insufficiencynHigh concentration of branched chain amino acidsnReduced aromatic amino acid and methionine content

Characteristicsn5%, 10% and 15% amino acid concentrationsnBalanced content of essential and non-essential amino acidsnAmino acid pattern for patients > 2 years of age nAvailable also as electrolyte free versions nVery good stability in all-in-one mixtures nCompatible with Lipoplus®3 and Lipofundin® MCT/LCT4

containing all-in-one mixtures nElectrolyte free versions do not contain chloride

3. Trade name in some countries: Lipidem® 4. Trade name in some countries: Medialipide®, Vasolipid®

Amino acids

Composition 1000 ml

Aminoplasmal® B. Braun 5% E

Aminoplasmal® B. Braun Aminoplasmal® Aminoplasmal® Hepa 10%10% 10% E 15% 15% E

Amino acids g 50 100 100 150 150 100

Nitrogen g 8 16 24 15.3

Electrolytes + - + - + -

Energy kcal 200 400 600 400

Presentations* ml 250, 500, 1000 250, 500, 1000 500, 1000 500

* may differ from country to country

Aminoplasmal® B. Braun

nMaintenance of equilibrium of amino acids in blood1

n Excellent stability in TPN mixtures2

Aminoplasmal® Hepa

nNormalization of cirrhosis-induced amino acid imbalances

nImproved clinical situation in hepatic encephalopathy

nAllows to provide adequate protein supply to patients suffering from liver insufficiency

1. Berard MP, Hankard R, Cynober L; Amini acid metabolism during parenteral nutrition in healthy volunteers: evaluation of a new amino acid solution; Clin Nutr 2001 20(5) 407-414 2. Driscoll DF; Physicochemical stability of highly concentrated all-in-one mixtures intended for fluid restricted patients; Clin Nutr Vol 21, Supplement 1, Aug 2002

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Lipoplus®2 or Lipidem®New generation of lipid emulsion.

In addition to the well known characteristics of Lipofundin® MCT/LCT 1, Lipoplus®2 has a well-balanced 3 : 6 ratio of 1: 2.7, achieved by adding highly purified fish oil -3 fatty acid triglycerides.

Lipofundin® MCT/LCT1

Fat emulsion for parenteral nutrition on the basis of medi-um and long chain triglycerides.

Administration of LCT as source of essential (polyunsaturated) fatty acids for structural com-ponents of cell membranes and as precursors of eicosanoids.

MCT as preferential fuel for the body with physicochemical and metabolic advantages.

CharacteristicsnRegistered for use in neonates and childrennFor peripheral and central venous applicationnExcellent stability in TPN admixturesnSupplemented with Vitamin E

CharacteristicsnContains MCT (coconut), LCT (soybean) and -3 triglycerides (fish oil)nFor peripheral and central venous applicationnExcellent stability in all-in-one admixturesnSupplemented with vitamin EnThe combination with Nutriflex® 2-chamber bag allows quick, easy and stable preparation of all-in-one regimens1. Trade name in some countries: Medialipide®, Vasolipid®

Lipid emulsions

Composition 1000 mlLipofundin®

MCT/LCT1 10%Lipofundin®

MCT/LCT1 20%Lipoplus® 20% or Lipidem® 20%

Soybean oil (LCT) g 50 100 80

MCT oil (coconut) g 50 100 100

Omega-3 acid triglycerides g – – 20

Egg yolk lecithin g 8 12 12

Glycerol g 25 25 25

Total energy kcal 1022 1908 1910

α-Tocopherol (Vitamin E) mg 85±20 170±40 190±30

Presentations* ml 100, 250, 500 100, 250, 500 100, 250, 500



nProtects liver, lung and immune function

nImproves protein economy

nSuperior stability improves safety

nOne lipid emulsion for all patients

nAntioxidative protection to prevent peroxidative damages

Lipoplus®2

nInfl ammation-modulating eff ects - reduced length of hospital stay3, 4

- improves oxygenation index4

2. Trade name in some countries: Lipidem®3. Wichmann et al. Crit Care Med 2007; 35, 700-7064. Barbosa VM et al. Crit Care. 2010;14(1):R5. Epub 2010 Jan 19

17

Glucose BraunGlucose solutions for providing energy (and fluid) in parenteral nutrition.

CharacteristicsnBasic component in parenteral nutrition nDelivers approximately 4 kcal/g glucose nWide range of concentrations available

Tracutil®Trace element additive for adults. Used as a supplement in parenteral nutrition.

CharacteristicsnBalanced mixture of the 9 trace elements Iron, Zinc, Manganese, Copper, Chromium, Molybdenum, Selenium, Fluoride and Iodide nMeets the daily requirements of essential trace elements

Glucose solutions and trace elements

Composition® Glucose1000 ml 10% 20% 30% 40% 50% 70%Glucose g 100 200 300 400 500 700

Energy kcal 400 800 1200 1600 2000 2800

Presentations* Ecoflac® plus 500 ml; glass bottle 500 ml/1000 ml


Composition® Tracutil mg/10 ml µmol/10 ml

Iron 2 35

Zinc 3.3 50

Manganese 0.55 10

Copper 0.76 12

Chromium 0.01 0.2

Molybdenum 0.01 0.1

Selenium 0.02 0.3

Fluoride 0.57 30

Iodide 0.13 1

Presentation* 5 x 10 Ampoule


Glucose Braun

nEssential energy source for organs and tissues

Tracutil®

nSupply of trace elements in parenteral nutrition of adults

nCompatible with a wide range of nutritional admixtures

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Nutrimix® Traditional EVA mixing bag for easy and safe handling.

Nutrimix® Barrier Mixing Bag made of Multi-Layer Film to protect individual TPN preparations from oxidation.

Nutrimix® DC Dual chamber bag for stable separate storage of individu-al TPN preparation.

Mixing bag

Nutrimix®

n100% Latex-free and DEHP-free, specially suitable for fat-contai-ning TPN regimens

nAdditive injection port with closure cap

nDetachable transfer set with lock connector

nSterile outlet port with snap-off cap

nEasy and safe handling

Nutrimix® Barrier

n100% Latex-free and DEHP-free, specially suitable for fat-containing TPN regimens

nProlongs the stability of oxygen-sensitive compounds (e.g. vitamins)

nEnsures longer shelf life of compounded regimens

nSterile outlet port with snap-off cap ensures easy and safe handling

Nutrimix® DC

n100%-Latex free and DEHP-free, specially suitable for fat-containing TPN regimens

nDual chamber allows preparation with separate storage e.g. of amino acid-glucose mixture separate from lipid emulsion and therefore longer storage of compounded lipid-con-taining TPN formulations

nHigh flow filling port

nSterile outlet port with snap-off cap to ensure easy and safe handling

Presentations* Volume Filling lines Units/Packages Packages/Carton Code No. (REF)

Nutrimix® 0.2/0 200 ml 0 1 25 2112145

Nutrimix® 0.5/0 500 ml 0 1 25 2112146

Nutrimix® 1/0 1000 ml 0 1 25 2112147

Nutrimix® 2/3 2000 ml 3 1 25 2112150

Nutrimix® 3/3 3000 ml 3 1 25 2112151

Nutrimix® Barrier 3/0 3000 ml 0 5 25 2112444



Nutrimix® Barrier 0,5/0 500 ml 0 5 50 2112441

Nutrimix® Barrier 0,2/0 200 ml 0 5 50 2112440

Nutrimix® Dual Chamber Bags (2500 + 500 ml)

3000 ml 01

25 2112446

Nutrimix® Dual Chamber Bags (1250 + 250 ml)

1500 ml 01

25 2112445

Transfer Set 0 4 1 25 2112449


19

20

Enteral Nutrition – well-being and quality …

Enteral Nutrition

21

Nutricomp® liquidsLiquid enteral nutrition diets like Nutricomp® from B. Braun contain macro- and micronutrients adapted to the patients needs. Nutricomp fomulae come in different formats such as bags, plastic or glass bottles that can be applied as oral nutri-tional supplements or as tube feeding.

Characteristicsn Different formulae for individual needs of patients (standard and special diets)n Allows the adequate application of all macro- and micronutrients (nutritionally complete dietary food)n Fat from different sources, depending on patient’s needsn -3 fatty acids from fish oil n Fibre containing versions (most variations with prebiotic fibre)

n Variations high in energy and protein for patients with (combined protein-) energy malnutritionn Diabetes product containing carbohydrates from starch, rich in monounsaturated fatty acids, fortified with antioxidantsn Versions containing MCT oil for patients with impaired lipid digestionn Further products adapted to special metabolic conditions

… through complete and balanced nutrition

Tube feedTube feedSip feed

normal digestion and absorptionnormal di-gestion and absorption

normal metabolic condition pathological metabolism

malabsorption and

maldigestion

fi brecontra-

indicated or

inadvisable

high energy needs, fi bre

contra-indicated

orinadvisable

rich in fi bre

high energy and protein needs, fi bre

contra-indicated

orinadvisable

high energy and protein needs, rich

in fi bre

fat mal-absorption, steatorrhea

diabetes mellitus

hepatic disease

post-traumatic metabolic condition, respiratory

failure

impaired immune function,

stress, HIV-infection,

cancer, chronic

infl ammatory diseases

severe disorders

of digestion and

assimilation, pancreas failure

Nutricomp® Standard

Nutricomp® Drink Plus


Fibre

Nutricomp® Energy

Nutricomp® Energy Fibre

Nutricomp® MCT

Nutricomp® Standard Fibre D

Nutricomp® Hepa

Nutricomp® Intensiv

Nutricomp® Immun

Nutricomp® MCT

Nutricomp® Peptid

22

Nutricomp® StandardNutricomp® Standard FibreStandard diet without or with 1.5% fibre (special prebiotic composition).

CharacteristicsnCaloric density: 1 ml = 1 kcal

nHigh quality protein: 60% milk protein 40% soy protein

nFat as a combination of soy oil, rapeseed oil (only Standard Fibre) MCT and fish oilnRatio of 3: 6: 9 fatty acids: Standard: 1: 5.6: 2.1 Standard Fibre: 1: 3.3: 3.5

Nutricomp® EnergyNutricomp® Energy FibreSpecial diet high in energy and protein without or with fibre (2.0% special prebiotic composition).

CharacteristicsnCaloric density: 1 ml = 1.5 kcal


nFat as a combination of MCT (50%), rapeseed oil and fish oilnRatio of 3: 6: 9 fatty acids: Energy: 1: 1.2: 2.6 Energy Fibre: 1: 1.2: 2.5

Sip feed Tube feed

Composition 1000 ml



Nutricomp® Standard Fibre

Nutricomp® Energy


Total energy kcal 1500 1000 1040 1500 1560

Protein g 60 38 38 75 75

Fat g 50 33 33 50 50

Carbohydrates g 200 138 138 188 188

Fibre g 0 0 15 0 20

Caloric distribution % kcal16: 30: 54: 0 15: 30: 55: 0 15: 29: 53: 3 20: 30: 50: 0 20: 29: 48: 3

(Protein : Fat : Carbohydrate : Fibre)

Presentations1 500 ml bag

(neutral)500 ml bag

(neutral)500 ml bag

(neutral)500 ml bag

(neutral)

200 ml plastic bottle(vanilla, chocolate, straw-

berry, banana, mixed)

500 ml glass bottle (neutral, vanilla,

cara mel, strawberry)

500 ml glass bottle (neutral)

500 ml glass bottle

(neutral)

500 ml glass bottle

(neutral)

1. May differ from country to country

Enteral Nutrition – nutritionally complete …

Nutricomp® Drink PlusStandard diet high in energy without fibre.


nHigh quality protein: milk protein (70.8%) soy protein (29%)

nFat as a combination of rapeseed oil, sunflower oil, MCT and fish oilnRatio of 3: 6: 9 fatty acids: 1: 3.3: 5.0 fatty acids: 1: 3.3: 5.0

Enteral Nutrition

23

… food for special medical purposes

Nutricomp® Standard Fibre DSpecial diet adapted to nutri-tional needs of patients with diabetes mellitus with starch and 2.0% fibre (high amount of soluble fibre).



nFat from sunflower oil, fish oil and rapeseed oilnRatio of 3: 6: 9 fatty acids: 1: 2.1: 9.1nRich in MUFA (60% of fat energy)

nWith antioxidants

Nutricomp® MCTSpecial diet adapted to nutri-tional needs of patients with impaired lipid digestion.



nFat from MCT (60%) and soy oil (40%)nRatio of 3: 6: 9 fatty acids: 1: 7: 2.7

Nutricomp® HepaSpecial diet adapted to nutri-tional needs of patients with impaired liver function withlow amount of fibre.


nSpecific amino acid pattern: milk protein branched-chain amino acids

nFat from MCT (50%) and soy oil (43%)nRatio of 3: 6: 9 fatty acids: 1: 7: 3

Tube feed

Nutricomp® Standard Fibre D

Nutricomp® MCT

Nutricomp® Hepa

Composition 1000 ml

1030 1300 1300 kcal Total energy

41 56 40 g Protein

35 44 58 g Fat

129 171 155 g Carbohydrates

15 0 5.6 g Fibre

16: 31: 49: 4 17: 30: 53: 0 12: 40: 48: 0% kcal Caloric distribution (Protein : Fat : Carbohydrate : Fibre)

500 ml bag (neutral) 500 ml bag (neutral) 500 ml bag (chocolate) Presentations1



500 ml glass bottle (chocolate)

24

Nutricomp® ImmunSpecial diet adapted to nutri-tional needs of patients with impaired immune functions with fibre.


nHigh quality protein: 61% milk protein 38% wheat protein hydrolysate nSpecial amino acid pattern

nFat as a combination of MCT (42%) rapeseed oil, sunflower oil, fish oil nRatio of 3: 6: 9 fatty acids: 1: 2.9: 4.4

nRich in glutamine: 30 g per 1.995 kcal (1500 ml)

nFortified with antioxidants

Nutricomp® PeptidSpecial diet adapted to nutri-tional needs of patients with maldigestion and malabsorp-tion.

CharacteristicsnCaloric density: 1 ml = 1 kcal

nHigh quality protein: 45% milk protein 55% soy protein and gelatinenProtein as defined oligopeptides: free amino acids oligopeptides

nFat as a combination of MCT (44%) and soy oil (47%), milk fatnRatio of 3: 6: 9 fatty acids: 1: 6.9: 3.2

Food for special medical purposes

Tube feed

Composition 1000 ml


Nutricomp® Immun

Nutricomp® Peptid

Total energy kcal 1300 1360 1000

Protein g 65 66.8 38

Fat g 58 37 11.2

Carbohydrates g 130 183.4 188

Fibre g 0 13.4 0

Caloric distribution % kcal20: 40: 40 : 0 20: 24: 54: 2 14: 12: 74: 0

(Protein : Fat : Carbohydrate : Fibre)

Presentations1 500 ml bag



500 ml glass bottle

1. May differ from country to country

Nutricomp® IntensivSpecial diet adapted to nutri-tional needs of patients with posttraumatic metabolism, respiratory failure.



nFat from MCT (51%) and soy oil (47%)nRatio of 3: 6: 9 fatty acids: 1: 7: 2.7

Enteral Nutrition

25

Enteroport® plus Enteral nutrition pump for controlled gastric and intesti-nal application of tube feeding diets. For inpatient and outpa-tient use.

CharacteristicsnEasy to operate and for mobile usenSmall size, low weight (450 g)nOperating modes: continuous application, volume / time selection, bolus applicationnInfusion rate: 1-400 ml/h, bolus volume: 1-1000 mlnIntegrated safety functions with acoustic and visual alarmsnMemory functionnRechargeable batteries, mains input

Pump administration sets

CharacteristicsnDEHP freenCombined cone and female Luer-Lock connector with closure capnConformity to DIN EN 1615 nY-adapter for Luer syringesnLength: 210 cmnRoller clamp and drip chamber

Presentations* Art. No.

Enteroport® plus 230 V 8710350

Supportstand 8721670

Pole clamp 8721061



Enteroport® plus Set 500 8721726



Enteroport® plus Set FL 8721688

Enteroport® plus Set Multispike 8721750

Enteroport® plus Set Universal Adapter 8721744


Enteroport® plus Set with storage bag (500, 1000, 2500 ml)

Enteroport® plus Set FL with connector for crown cork bottles

Enteroport® plus Set Multispike for use with bags

Enteroport® plus Set Universal Adapter for crown cork and wide neck bottles and bags

Enteral Nutrition application sets:Enteroport® plus and accessories

26

Infusomat® Space SystemThe ICU-Solution for Clinical Nutrition

Infusomat® Space – ideal for clinical nutritionHospitals equipped with a Space system do not require additional pumps dedicated to nutrition. Not only does this save staff time, because additional user trainings are no more required, it also cuts the cost of maintenance and service.

Enteral Nutrition

27

User benefi ts

The only multifunctional enteral line which supports safe system compatibility of an "allround pump".

User benefi ts

The only enteral line which supports the use of patient tailored EN and safe system compatibility of an "allround pump".

Infusomat® Space LineType Enteral Nutritionwith integrated nutrition bag

Infusomat® Space Line Type Enteral Nutrition with universal connector

Patient Tailored SolutionnWith integrated 1000 ml nutrition bagnWith mix-up proof patient connectornScaled cone adapternNeedle-free Y-Port with integrated BCVnDEHP-Free

Ready-to-Use solutionsnAdapter for most ready-to-use containersnWith mix-up proof patient connectornScaled cone adapternPVC-free

For crown cap of glass bottles.

For wide neck (screw cap) of plastic bottles.


Infusomat® Space LineType Enteral Nutrition, with 1000 ml nutrition bag

8250839SP


Infusomat® Space LineType Enteral Nutrition, with universal connector

8250857SP


28

Enterofix® 1000Bag for fluid application to be used with Multispike connector.

CharacteristicsnStorage bag (1000 ml)nConnection with Multispike connector (e.g. Enteroport® plus Set Multispike, Nutrifix® Multispike)

Nutrifix®Gravity administration sets.

Enteral Nutrition application sets


Nutrifix® 1000 9240677

Nutrifix® 2500 9240685

Nutrifix® FL 9240669

Nutrifix® Multispike 9240632

Nutrifix® Universal Adapter 9240621



Enterofix® 1000 9240799

CharacteristicsnDEHP freenCombined cone and female Luer-Lock connector with closure capnConformity to DIN EN 1615

Nutrifix® Set with storage bag (1000, 2500 ml)

Nutrifix® FL with connector for crown cork bottles

Nutrifix® Multispike for use with bags

Nutrifix® Universal Adapter for crown cork and wide neck bottles and bags

Enteral Nutrition

29

Nutritub®Polyurethane feeding tubes for long-term naso-gastric and naso-intestinal tube feeding.

CharacteristicsnMade of soft polyurethane, flexible, without softenersnRadiopaque stripes, length markingsnFunnel connector with integrated syringe adapter, male Luer-Lock connectornSome tubes are equipped with a styletnIntestinal tubes have weighted ends

Gastric and duodenal tubesNaso-gastric and naso- intestinal PVC tubes for short term use.

CharacteristicsnClosed endsnTwo or four lateral eyesnRadiopaque stripenGastric tube CH 16 equipped with a stylet

Nasal tubes


Nutritub® Paed LL CH 6 60 cm 9246509

Nutritub® Gastral LL CH 8 100 cm 9246517

Nutritub® Gastral LL/M CH 8 100 cm 9246525

Nutritub® Gastral TR/M CH 8 100 cm 9246533

Nutritub® Gastral TR/M CH 12 100 cm 9246541

Nutritub® Gastral TR CH 15 100 cm 9246550

Nutritub® Intestinal TR/M CH 8 120 cm 9246576

Nutritub® Intestinal TR/M CH 12 120 cm 9246584


Duodenal tube TR CH14 122 cm 4371143



Gastric tube L CH4.5 38 cm 4396049

Gastric tube L CH4.5 50 cm 4396057

Gastric tube L CH6 50 cm 4396154





Gastric tube TR/M CH16 80 cm 4372166

L = Luer, TR = funnel connector, TR/M = funnel connector/Mandrin (stylet)


LL = Luer-Lock; TR = funnel connector; LL/M = Luer-Lock/Mandrin (stylet),

TR/M = funnel connector/Mandrin (stylet)

30

Product Description Parenteral Nutrition

Aminoplasmal® Hepa 10%Composition Each 1000 ml contains:

Isoleucine 8.80 gLeucine 13.60 gLysine Acetate 10.60 g (equivalent to Lysine 7.51 g)Methionine 1.20 gPhenylalanine 1.60 gThreonine 4.60 gTryptophan 1.50 gValine 10.60 gArginine 8.80 gHistidine 4.70 gGlycine 6.30 gAlanine 8.30 gProline 7.10 gAspartic Acid 2.50 gAsparagine · H

2O 0.55 g

(equivalent to Asparagine 0.48 g)

Acetylcysteine 0.80 g (equivalent to Cysteine 0.59 g)Glutamic Acid 5.70 gOrnithine Hydrochloride 1.66 g(equivalent to Ornithine 1.35 g)Serine 3.70 gAcetyltyrosine 0.86 g (equivalent to Tyrosine 0.67 g)Water for Injections to 1000 mlTotal amino acids 100 g/lTotal nitrogen 15.3 g/lCaloric value: 1675 kJ/l 400 kcal/lOsmolarity: 875 mOsm/lElectrolytes:Acetate 51 mmol/lChloride 10 mmol/l

Indications:Treatment of hepatic encephalo pathy. Parenteral nutrition in liver diseases when hepatic en-cephalopathy is either imminent or already manifest. Normalisation of amino acid imbalances arising from severe liver diseases.Contraindications:Disturbances of amino acid metabolism of other than hepatic origin, acidosis, overhydration, hypokalaemia.Precautions:Clinical supervision should include regular checks of fluid balance and serum electrolytes. Carbohydrates and electrolytes are to be supplemented as required. Caution is to be exercised in patients with hyponatraemia or with increased serum osmolarity.Unusally rapid infusion rates may produce signs of intolerance and renal amino acid losses result ing in amino acid imbalances.In cases of concurrent renal insufficiency the dos-

age of amino acids has to be adapted to the serum urea and creatinine values. Amino acid therapy is not a substitute for estab li shed thera-peutic measures, such as purging, administration of lactulose and/or gut sterilising antibiotics, in the treatment of hepatic encephalo pathy.It is not recommended that any additives be incorporated into Aminoplasmal® Hepa-10% solution, but should preferably be given in stand-ard carbohydrate or electrolyte solutions. How-ever, if admixture with Aminoplasmal® Hepa-10% is essential, then the compatibility of the additive must be checked before administration.Side-effectsProvided contraindications, dosage recommenda-tions and precautions are observed, side-effects are not anticipated.Subject to sales by pharmacists only.

B. Braun Melsungen AG 34209 Melsungen, Germany

Specific Product Information may differ from country to country

Aminoplasmal® B. BraunComposition Aminoplasmal® B. BraunEach 1000 ml contains: 5%E 10% 10%E

Amino acids: (g) Isoleucine 2.50 5.00 5.00Leucine 4.45 8.90 8.90Lysine acetate 2.87 5.74 5.74 (equivalent to Lysine) 2.03 4.07 4.07Lysine monohydrate 1.56 3.12 3.12 (equivalent to Lysine) 3.42 2.78 2.78Methionine 2.20 4.40 4.40Phenylalanine 2.35 4.70 4.70Threonine 2.10 4.20 4.20Tryptophan 0.80 1.60 1.60Valine 3.10 6.20 6.20Arginine 5.75 11.50 11.50Histidine 1.50 3.00 3.00Alanine 5.25 10.50 10.50Glycine 6.00 12.00 12.00Aspartic acid 2.80 5.60 5.60Glutamic acid 3.60 7.20 7.20Proline 2.75 5.50 5.50Serine 1.15 2.30 2.30Tyrosine 0.40 0.40 0.40

5%E 10% 10%E

Total amino acids (g) 50 100 100 Total Nitrogen (g) 8 16 16 Caloric value (kcal) 200 400 400 Theoretical osmolarity (mOsmo/L) 588 864 1,021 pH 5.7 – 6.3 5.7 – 6.3 5.7 – 6.3

Electrolytes (mmol) Sodium 50 - 50Potassium 25 - 25Magnesium 2.5 - 2.5Phosphate 10 - 10Acetate 35 - 46Chloride 45 - 52

Therapeutic indications: Supply of substrate for protein synthesis in parenteral nutrition.

Contraindication: Severe circulation disorders with vital threat (i.e. shock); Cellular oxygen deficiency (hypoxia) or acidosis; On account of its amino acid composition, is not to be administered in infants and children up to the completed 2nd year.

Special warnings and special precautions for use: Aminoplasmal® B. Braun 10% should only be adminis-tered after careful benefit-risk assessment in the presence of: disorders of amino acid metabolism, hyper-hydration, hypokalaemia, hyponatraemia.

B. Braun Melsungen AG34209 Melsungen, Germany

Aminoplasmal®-15%/15%EComposition Aminoplasmal®Each 1000 ml contains: 15% 15%E

Active ingredients (g) Isoleucine 5.85 5.85Leucine 11.40 11.40Lysine Monohydrate 8.93 8.93 (equivalent to Lysine 7.95 g) Methionine 5.70 5.70Phenylalanine 5.70 5.70Threonine 5.40 5.40Tryptophan 2.10 2.10Valine 7.20 7.20Arginine 16.05 16.05Histidine 5.25 5.25Glycine 19.20 19.20Alanine 22.35 22.35Proline 7.35 7.35Aspartic Acid 7.95 7.95Acetylcysteine 0.50 0.50 (equivalent to Cysteine 0.37 g) Glutamic Acid 16.20 16.20 Serine 3.00 3.00 Tyrosine 0.50 0.50

ExcipientsSodium hydroxide, disodium edetate, water for injections

Total amino acids (g) 150g 150g Total nitrogen (g) 24.0g 24.0g Caloric value (kcal) 600 600 Theoretical osmolarity (mOsmol) 1290 1480 Titration acidity (to pH 7.4) 30 mmol 30 mmol pH 5.5 – 7.0 5.5 – 7.0

15% 15%E

Electrolytes (mmol) Sodium - 50Potassium - 30Magnesium - 2,6Phosphate - 9,0Acetate - 35Chloride - 36

Indications: Supply of substrate for protein synthesis in the setting of parenteral nutrition. In parenteral nutrition, amino acid infusions should always be accompanied by administration of sufficient amounts of caloric solutions, e.g. carbohydrate solutions.

Contraindications Aminoplasmal® – 15% must not be used when there are - Disorders of amino acid metabolism; - Acute renal failure with increased non-protein nitrogen concentrations in the serum; - Advanced liver disease; - Acidosis; - Hyperhydration; - Hyponatraemia; - Hypokalaemia; - Dangerous circulation disorders (shock); This solution should not be given to neonates, infants, and children up to the completed 2nd year as the nutrient relations do not properly meet the special paediatric requirements.

Precautions for use and special warnings: - Individual dosage regimens must be established for patients with hepatic and renal insufficiency. - Caution is to be exercised in patients with increased serum osmolarity. - Clinical supervision should include regular checks of fluid balance, serum electrolytes, blood glucose and

acid-base balance.



31



Composition1000 ml emulsion contain Lipofundin® Lipofundin® MCT/LCT 10% MCT/LCT 20%Soybean oil 50.0 g 100.0 gMediumchain Triglycerides 50.0 g 100.0 gGlycerol 25.0 g 25.0 gEgg yolk phospholipids* 8.0 g 12.0 g

Sodium Oleate, α-Tocopherol*, Water for injectionsCaloric Value (kcal): 1022 1908Theor. osmolarity (mOsmo/L) 345 380pH: 6.5-8.8 6.5-8.5

* The amount of egg yolk phospholipids and α-toco pherol can vary is some countries. Please refer to the country representative. Soybean oil is a refined natural product containing neutral triglycer-ides of predominantly unsaturated fatty acids. Medium-chain triglycerides are a mixture of neutral triglycerides of mainly caprylic (about 60%) and capric acid (about 40%).

Indications:Lipofundin® MCT/LCT is indicated as a source of calories and essential fatty acids for patients requir-ing parenteral nutrition.

Contraindications:The administration of Lipofundin® MCT/LCT is con-traindicated in patients demonstrating disturbances in normal fat metabolism such as pathologic hyper-lipaemia, lipoid nephrosis, or acute pancreatitis if accompanied by hyperlipaemia. It is further con-traindicated in patients with ketoacidosis or hypox-ia, in thromboembolism and in acute shock states.

Precautions for use:Caution should be exercised in administering intra-venous fat emulsions in patients with metabolic acidosis, severe liver damage, pulmonary disease, sepsis, diseases of the reticuloendothelial system, anaemia or blood coagulation disorders or when there is danger of fat embolism. Administration of Lipofundin® MCT/LCT should be accompanied by simultaneous carbohydrate infusions making up to

40% (at least) of the total calorie in take. When Lipofundin® MCT/LCT is administered, the patient's capacity to eliminate the infused fat from the circulation must be monitored. The lipaemia must clear between daily infusions. Especially where fat emulsions are administered for extended periods of time, the patient's haemogram, blood coagula-tion, liver function and platelet count should be closely monitored. Paediatric patients: studies have shown the safety and effectiveness of Lipofundin® MCT/LCT as part of total parenteral nutrition in neonates and older children.Lipofundin® MCT/LCT has been aproved for usage in this patient population in some countries. Registration procedures are currently pursued in other countries. As long as approval has not been obtained in a specific country it is up to the judge-ment of the responsible physician whether or not to use Lipofundin® MCT/LCT in this patient group.Use in pregnancy and lactation The safety of Lipofundin® MCT/LCT during pregnancy and lactation has not been assessed, but its use dur-

ing these periods is not considered to constitute a hazard. Nevertheless, medicines should not be used in pregnancy, especially during the first trimester, unless the expected benefit is thought to outweigh any possible risk to the foetus.

Special warnings:The too rapid infusion of fat emulsions can cause fluid and/or fat overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, pulmonary oedema, impaired pul-monary diffusion capacity. A too rapid infusion of Lipofundin® MCT/LCT can also cause hyperketonae-mia and/or metabolic acidosis, especially when car-bohydrates are not administered simultaneously.

Subject to sale by pharmacists only.




Glucose Intravenous Infusion CompositionEach 1000 ml solution contains:

Glucose 10% 20% 30% 40% 50% 70%Glucose (g) 100 200 300 400 500 700As glucose monohydrate (g) 110 220 330 440 550 770Carbohydrate contents (g) 100 200 300 400 500 700Caloric value (kJ/ 1675/ 3350/ 5025/ 6700/ 8375/ 11725/ kcal) 400 800 1200 1600 2000 2800 Theor. Osmolarity (mOsm/l) 555 1100 1665 2220 2770 3880

Indications:- Energy supply by means of glucose- Carbohydrate component in parenteral nutrition- Therapy of hypoglycaemia

Contraindications:- Elevated blood sugar concentration (hyperglycaemia)- Decreased blood potassium concentration (hypokalaemia)- High concentration of acid substances in blood (acidosis)- Hyperhydration- Simultaneous sodium and water deficiency (hypotonic dehydration)

Special warnings and precautions for useThis solution should only be administered with caution to patients with increased serum osmolarity. Patient monitoring should include regular checks of the blood glucose level, depending on the prevailing metabolic condition and the administered dose. Patient monitoring should also include regular checks of the water balance, the serum electrolyte concentrations – in particular serum potassium – and the acid-base balance.

Glucose Infusions should not be administered through the same infusion equipment, simultaneously with, before, or after administration of blood, because of the possibility of pseudo-agglutination.



32

Nutriflex®CompositionNutriflex® (mixed and ready for use 1000 ml)Active ingredientsNutriflex® peri basal plus special (40/80) (32/125) (48/150) (70/240)L-isoleucine 2.34 g 1.88 g 2.82 g 4.11 gL-leucine 3.13 g 2.50 g 3.76 g 5.48 gL-lysine HCl 2.84 g 2.27 g 3.41 g 4.97 g(equivalent to L-lysine) 2.27 g 1.82 g 2.73 g 3.98 gL-methionine 1.96 g 1.56 g 2.35 g 3.42 gL-phenylalanine 3.51 g 2.81 g 4.21 g 6.15 gL-threonine 1.82 g 1.45 g 2.18 g 3.18 gL-tryptophan 0.57 g 0.46 g 0.68 g 1.00 gL-valine 2.60 g 2.08 g 3.12 g 4.54 gArginine glutamate 4.98 g 3.98 g 5.98 g 8.72 g(equivalent to Arginine 2.70 g 2.16 g 3.24 g 4.73 gand to Glutamic acid) 2.28 g 1.82 g 2.74 g 3.99 gL-histidine · HCl · H

2O 1.69 g 1.35 g 2.03 g 2.96 g

(equivalent to Histidine) 1.25 g 1.00 g 1.50 g 2.19 gL-alanine 4.85 g 3.88 g 5.82 g 8.49 gL-aspartic acid 1.50 g 1.20 g 1.80 g 2.63 gL-(+)-glutamic acid 1.22 g 0.98 g 1.47 g 2.15 gAmino acetic acid 1.65 g 1.32 g 1.98 g 2.89 gL-proline 3.40 g 2.72 g 4.08 g 5.95 gL-serine 3.00 g 2.40 g 3.60 g 5.25 gGlucose · H

2O 88.00 g 137.50 g 165.00 g 264.00 g

(equivalent to anhydrous glucose) 80.00 g 125.00 g 150.00 g 240.00 g

Sodium chloride 0.17 g 1.40 g – –Calcium chloride · 2H

2O 0.37 g 0.53 g 0.53 g 0.60 g

Magnesium acetate · 4H2O 0.86 g 1.23 g 1.23 g 1.08 g

Sodium dihydrogen phosphate · 2H2O – – 3.12 g –

Potassium dihydrogen phosphate 0.78 g 1.74 g – 2.00 gSodium acetate · 3H

2O 1.56 g 3.20 g 1.56 g 1.63 g

Potassium hydroxide 0.52 g 0.96 g 1.40 g 0.62 gSodium hydroxide 0.50 g 0.10 g 0.23 g 1.14 gWater for injections to 1000 ml 1000 ml 1000 ml 1000 ml

Nutriflex® peri basal plus special (40/80) (32/125) (48/150) (70/240) Total amino acids (g/l) 40 32 48 70 Total nitrogen (g/l) 5.7 4.6 6.8 10.0 Total carbohydrates (g/l) 80 125 150 240 Total energy kJ/l 2010 2640 3310 5190 (kcal/l) (480) (630) (790) (1240) Non-protein energy kJ/l 1340 2090 2510 4020(kcal/l) (320) (500) (600) (960) Osmolarity (mOsm/l) 900 1140 1400 2100

Electrolytes: mmol mmol mmol mmol Na+ 27.0 49.9 37.2 40.5 K+ 15.0 30.0 25.0 25.7 Ca++ 2.5 3.6 3.6 4.1 Mg++ 4.0 5.7 5.7 5.0 Cl– 31.6 50.0 35.5 49.5 H

2PO

4

– 5.7 12.8 20.0 14.7 Acetate 19.5 35.0 22.9 22.0

IndicationParenteral nutrition.ContraindicationsNutriflex® is contraindicated in cases of hyperglycaemia, disorders of amino acid metabolism, manifest congestive cardiac failure, untreated shock, overhydration, enhanced plasma potassium levels, acidosis. In hepatic or renal insufficiency the dosage is to be individually adjusted. Because of the specific composi-tion of the nutrients the use of Nutriflex® in newborns, infants and children up to the 2nd year of life is not recommended.PrecautionsSerum ionogram, water balance, blood glucose levels and acid-base balance are to be monitored. Possible intolerance reactions (nausea, vomiting, chills) and renal loss of glucose and amino acids with subsequent amino acid imbalances are due to a too rapid infusion rate.Adverse reactionsAdverse reactions are not to be expected, and besides have not been reported so far, if contraindications, dosage recommendations, warnings and precautions are observed.




Lipoplus®/ Lipidem® 20%Composition1000 ml of emulsion contains:Medium-chain triglycerides: 100.0 gSoybean oil, refined: 80.0 gOmega-3-acid triglycerides: 20.0 gEssential fatty acid content per liter:Linoleic acid (omega-6): 48.0 - 58.0 gAlpha-linolenic acid (omega-3): 5.0 - 11.0 gEicosa-pentaenoic acid and docosahexaenoic acid: 8.6 - 17.2 gCaloric content per liter: 7900 kJ ≈ 1910 kcalOsmolality: approx. 410 mOsm/kgTitration acidity or alkalinity (to pH 7.4): less than 0.5 mmol/l NaOH or HClpH: 6.5 - 8.5Indications:Source of calories and essential omega-6 fatty acids and omega-3 fatty acids as a component of a parenteral nutrition regimen for adults.Contraindications:Lipoplus® must not be used in any of the following conditions:– Severe hyperlipidemia– Serious blood clotting disorders– Acidosis– Intrahepatic cholestasis– Severe liver failure– Severe kidney failure– Acute phase of myocardial infarction or stroke– Acute thromboembolic disease, fat embolism– Known hypersensitivity to egg, fish, or soybean proteinThe following conditions are general contraindications to parenteral nutrition.– Unstable hemodynamic status with compromised vital functions (conditions of collapse and shock)– Fluid overload– Acute pulmonary edema

Special warnings and precautions for use

Before infusing a fat emulsion together with other solutions via a Y connector or bypass set, the compati-bility of these fluids should be checked, especially when co-administering carrier solutions to which drugs have been added. Particular caution should be exercised when co-infusing solutions that contain divalent electrolytes (such as calcium).The emulsion should always be brought to room temperature prior to infusion.If filters are used, these must be permeable to fat emulsions.Serum triglycerides should be monitored during the infusion of Lipoplus®. In patients with suspected dis-orders of lipid metabolism, fasting lipemia should be ruled out before the start of the infusion. Hypertriglyceridemia 12 hours after the administration of fat is also indicative of abnormal lipid metabolism.Transient hypertriglyceridemia or elevated blood glucose levels may arise from the patient's metabolic status. If the plasma triglyceride concentration rises to more than 3 mmol/l during administration of the fat emulsion, it is recommended to reduce the infusion rate. If the plasma triglyceride concentration still remains higher than 3 mmol/l, the infusion should be stopped until the plasma triglyceride concentration normalizes.Electrolytes, water balance or body weight, acid-base balance, blood glucose levels, and, during long-term administration, blood counts, coagulation status, and liver function should be monitored.There is as yet no clinical experience of the use of Lipoplus® in children, and there is only limited experi-ence of its use in patients with diabetes mellitus or renal impairment.There is as yet only limited experience of the use of Lipoplus® for periods longer than seven days.Caution should be exercised in patients with conditions associated with impaired lipid metabolism, such as renal insufficiency, uncontrolled diabetes mellitus, pancreatitis, hepatic insufficiency, hypothyroidism (in the presence of hypertriglyceridemia), and sepsis.Lipids may interfere with certain laboratory tests (such as bilirubin, lactate dehydrogenase, oxygen saturation) when the blood sample is taken before the lipids have been eliminated from the bloodstream. In most patients this takes 5 to 6 hours beyond the end of the infusion.The use of fat emulsions as the sole source of calories may give rise to metabolic acidosis. This may be avoided by the concurrent infusion of carbohydrates. It is therefore recommended to infuse an adequate quantity of intravenous carbohydrates or an amino acid solution containing carbohydrates along with the fat emulsion.Vitamin E can interfere with the effect of vitamin K in clotting factor synthesis. This should be borne in mind in patients with blood clotting disorders or suspected vitamin K deficiency.





33


NuTRIflex® LipidCompositionNuTRIflex® Lipid (mixed and ready for use 1250 ml)Active ingredients NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid peri plus plus without special special without electrolytes electrolytesIsoleucine 2.34 g 2.82 g 2.82 g 4.105 g 4.10 gLeucine 3.13 g 3.76 g 3.76 g 5.48 g 5.48 gLysinehydrate – – 3.065 g – 4.47 g Lysine – – 2.73 g – 3.98 gLysine hydro- 2.84 g 3.41 g – 4.975 g –chloride Lysine 2.26 g 2.73 g – 3.98 g –Methionine 1.96 g 2.35 g 2.35 g 3.42 g 3.42 gPhenylalanine 3.51 g 4.21 g 4.21 g 6.145 g 6.145 gThreonine 1.82 g 2.18 g 2.18 g 3.175 g 3.175 gTryptophan 0.57 g 0.68 g 0.68 g 1.00 g 1.00 gValine 2.60 g 3.12 g 3.12 g 4.505 g 4.505 gArginine 2.70 g 3.24 g 3.24 g 4.725 g 4.725 gHistidine 1.69 g 2.03 g – 2.96 g –hydrochloride monohydrate Histidine 1.25 g 1.50 g 1.50 g 2.19 g 2.19 gAlanine 4.85 g 5.82 g 5.82 g 8.49 g 8.49 gAspartic acid 1.50 g 1.80 g 1.80 g 2.625 g 2.625 gGlutamic acid 3.50 g 4.21 g 4.21 g 6.135 g 6.135 gGlycine 1.65 g 1.98 g 1.98 g 2.89 g 2.89 g( aminoaceticacid)Proline 3.40 g 4.08 g 4.08 g 5.95 g 5.95 gSerine 3.00 g 3.60 g 3.60 g 5.25 g 5.25 gGlucose mono- 88.0 g 165.0 g 165.0 g 198.0 g 198.0 ghydrate Anhydrous 80.0 g 150.0 g 150.0 g 180.0 g 180.0 gglucoseSoya bean oil 25.0 g 25.0 g 25.0 g 25.0 g 25.0 gMedium chain 25.0 g 25.0 g 25.0 g 25.0 g 25.0 gtriglycerides

NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid NuTRIflex® Lipid peri plus plus without special special without electrolytes electrolytesSodium 1.170 g 2.34 g – 3.120 g –dihydrogenphosphatedihydrateSodium 0.800 g 0.976 g – 1.464 g –hydroxideSodium chloride 1.081 g 0.503 g – 0.473 g –Sodium ace- 0.544 g 0.277 g – 0.313 g –tate trihydratePotassium 2.943 g 3.434 g – 4.611 g –acetateMagnesium 0.644 g 0.858 g – 1.137 g –acetate tetra-hydrate Calcium chlo- 0.441 g 0.588 g – 0.779 g –ride dihydrateZinc acetate 6.6 mg 6.58 mg – 8.78 mg –di-hydrate Total amino acids 40 g 48 g 48 g 71.8 g 71.8 gTotal nitrogen 5.7 g 6.8 g 6.8 g 10 g 10 gTotal glucose 80 g 150 g 150 g 180 g 180 gTotal lipids 50 g 50 g 50 g 50 g 50 gTotal energy 4000/955 5300/1265 5300/1265 6175/1475 6175/1475(KJ/Kcal)Non-Protein 3330/795 4500/1075 4500/1075 5005/1195 5005/1195energy (KJ/Kcal)Osmolality 920 1540 1350 2090 1840(mOsm/kg)Osmolarity (theoret.) 840 1215 1055 1545 1330(mOsm/l) Electrolytes: mmol mmol – mmol –Sodium 50 50 – 67 –Potassium 30 35 – 47 –Calcium 3.0 4.0 – 5.3 –Magnesium 3.0 4.0 – 5.3 –Zinc 0.03 0.03 – 0.04 –Chloride 48 45 – 60 –Phosphate 7.5 15 – 20 –Acetate 40 45 – 60 –

IndicationsWhen oral or enteral feeding is not possible, insufficient or contraindicated.ContraindicationsAcute shock, acute phase of myocardial and cerebral infarction, severe disorders of blood coagulation, acute thrombo-embolism or fat embolism, irreversible liver damage, intrahepatic cholestasis, severe urae-mia when dialysis facilities are not available, disorders of lipid metabolism such as pathological hyperli-paemia and conditions associated with triglyceride accumulation during parenteral nutrition, inborn errors of amino acid metabolism, untreated or complicated diabetes mellitus, especially in the presence of coma related to keto-acidosis or diabetic precoma.These infusions should not be given to neonates and infants up to the age of 24 months.PrecautionsShould be administered with caution to patients with cardiac or renal dysfunction. Disorders of the fluid, electrolyte, and acid-base balance, e.g., overhydration, hyperkalaemia, acidosis, should be corrected before adminis tration. Too rapid infusion can cause fluid overloading resulting in overhydration, congested states, pulmonary oedema, impaired pulmonary diffusion capacity.Give with caution in conditions of impaired lipid metabolism as in renal insufficiency, diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism (if hypertriglyceridaemic), sepsis and in conditions of altered amino acid metabolism.As with other solutions containing glucose, administration of NuTRIflex® Lipid formulations may lead to hyperglycaemia. Blood glucose levels should be monitored and the rate of infusion adjusted or insulin should be administered if hyperglycaemia occurs.The patient’s capacity to eliminate the infused fat from the circulation should be monitored. Especially where the product is administered for extended periods of time, the patient’s haemogram, blood coagula-tion, liver function, and platelet count should be regularly monitored.

In patients suspected to have disorders of fat metabolism, fasting lipaemia should be excluded. In the case of fasting hypertriglyceridaemia the administration of fat is contraindicated. Likewise, hypertriglycer-idaemia 12 hours after fat infusion indicates disorders of fat metabolism.Fluid, electrolyte, and acid-base balance should be monitored.As with all parenteral solutions administered through a peripheral/central venous catheter, strict aseptic precautions should be taken. Care should be taken to avoid complications of catheterisation including air embolism and venous thrombosis.Undesirable effectsUndesirable effects related to the components of NuTRIflex® Lipid peri, NuTRIflex® Lipid plus, NuTRIflex® Lipid plus without electrolytes, NuTRIflex® Lipid special and NuTRIflex® Lipid special without electrolytes are rare. Those that do occur are usually reversible and subside when therapy is discontinued.Nausea or vomiting may occasionally occur. In the event of a forced infusion an osmotic diuresis might occur as a result of the high osmolality.During infusion in very rare cases the amino acids might cause hyperazotaemia and acidosis.Immediate (acute) reactions related to the lipid are dyspnoea, cyanosis, allergic reactions, hyperlipaemia, hypercoagulability of the blood, nausea, vomiting, headache, flushing, hyperthermia, sweating, chills, sleepiness, chest and back pain. The infusion should be stopped in these cases. The infusion can be resumed after the disappearance of the symptoms and/or the elevated serum triglyceride levels with reduced dose and/or reduced infusion rate. Close monitoring of the patient’s general condition and his/her plasma triglyceride levels is recommended.Subject to medical prescription.



34


Trac u til®Com po si tion1 ampoule of 10 ml con tainsActive ingre dients:Iron (II) chlor id · 4 H

2O 6.958 mg

(equiv a lent to 35.0 µmol of iron)Zinc chlo ride, anhy drous 6.815 mg(equiv a lent to 50.0 µmol of zinc)Man ga nese (II) chlo ride · 4 H

2O 1.979 mg

(equiv a lent to 10.0 µmol of man ga nese)Cop per (II) chlo ride · 2 H

2O 2.046 mg

(equiv a lent to 12.0 µmol of cop per)Chro mi um (III) chlo ride · 6 H

2O 0.053 mg

(equiv a lent to 0.2 µmol of chro mi um)Sodi um mol yb date · 2 H

2O 0.0242 mg

(equiv a lent to 0.1 µmol of molyb de num)

Sodi um selen ite · 5 H2O 0.0789 mg

(equiv a lent to 0.3 µmol of sele ni um)Sodi um flu o ride 1.260 mg(equiv a lent to 30.0 µmol of flu o ride)Potas sium iodide) 0.166 mg (equiv a lent to 1.0 µmol of iodide)Exci pients:Hydro chlor ic acid, water for injec tions.Ther a peu tic indi ca tionsPro vi sion of basic trace ele ment require ments dur ing long-term paren ter al nutri tion in adult patients.Con tra-indi ca tions Increased serum lev els of the trace ele ments con tained in Trac u til®. Trac u til® should not be admin is tered to new born infants, infants and chil dren.

Notes:Care is to be taken in cases of impaired liver or kidney function which requires a check of the serum concentrations and, where appropriate, reduction of the dose.Caution is also necessary in case of Wilson’s disease and disturbed iron storage (i.e. haemosiderosis or haemochromatosis) because copper and iron sup-plementation may cause an additional accumula-tion of these elements in such cases.Spe cial warn ings and spe cial pre cau tions for useIn case of bil iary tract dis ease admin is tra tion of Trac u til® may lead to an accu mu la tion of cop per and man ga nese. Chro mi um defi cien cy leads to a decrease in glu cose tol er ance, which improves again after chro mi um sup ple men ta tion. For this

rea son, patients suf fer ing from insu lin-depen dent dia betes mel lit us and chro mi um defi cien cy may require a reduc tion in the amount of insu lin they receive dur ing admin is tra tion of Trac u til®.Use in preg nan cy and lac ta tion:There is no data avail able on admin is tra tion dur ing preg nan cy or in the lac ta tion peri od. The ben e fits must there fore be care ful ly weighed against the risks.Unde sir able effectsIndi vid u al cases of anaph y lac tic reac tions to paren ter al ly admin is tered iron have been report ed.Dis pens ing clas sifi ca tionSub ject to med i cal pre scrip tion.


35

Enteral Nutrition

Product Description Enteral Nutrition

Nutricomp® Standard Nutricomp® Standard Fibre Nutricomp® Energy

Nutrition information

per 100 ml 500 ml

Energy 421 kJ 2105 kJ

100 kcal 500 kcal

Protein (milk and soy) 3.8 g 18.8 g

Carbohydrates, of which 13.8 g 68.8 gn sugar 0.44 g 2.2 gn Lactose 0.005 g 0.025 g

Fat, of which 3.3 g 16.7 gn saturated fatty acids 0.99 g 5 g

of which MCT 0.5 g 2.5 g

n essential fatty acids 1.7 g 8.5 g

n -3 fatty acids 0.26 g 1.3 g

Fibre 0 g 0 g

Water 84 ml 420 ml

Sodium 0,1 g 0,5 g

Potassium 150 mg 750 mg

Calcium 75 mg 375 mg

Magnesium 20 mg 100 mg

Phosphorus 65 mg 325 mg

Chloride 100 mg 500 mg

Iron 1.2 mg 6 mg

Zinc 1.2 mg 6 mg

Copper 150 µg 750 µg

Iodine 13 µg 65 µg

Chromium 7 µg 35 µg

Fluoride 0.1 mg 0.5 mg

Manganese 0.2 mg 1 mg

Molybdenum 10 µg 50 µg

Selenium 7 µg 35 µg

Vitamin A (RE) 90 µg 450 µg

Vitamin D 1 µg 5 µg

Vitamin E (-TE) 1.5 mg 7.5 mg

Vitamin K 7 µg 35 µg

Vitamin B1

0.2 mg 1 mg

Vitamin B2 0.2 mg 1 mg

Vitamin B6

0.2 mg 1 mg

Vitamin B12 0.3 µg 1.5 µg

Vitamin C 10 mg 50 mg

Niacin (NE) 1.8 mg 9 mg

Folic acid 30 µg 150 µg

Pantothenic acid 0.6 mg 3 mg

Biotin 5 µg 25 µg

Choline 30 mg 150 mg

Natural mixtureof carotenoids – –Beta-Carotene 0.1 mg 0.5 mg


per 100 ml 500 ml


104 kcal 520 kcal


Carbohydrates, of which 13.8 g 68.8 gn sugar 1.5 g 7.3 gn Lactose 0.008 g 0.04 g

Fat, of which 3.3 g 16.7 gn saturated fatty acids 0.92 g 4.6 g




Fibre 1.5 g 7.5 g

Water 83 ml 415 ml

Sodium 0,1 g 0,5 g






Iron 1.2 mg 6 mg

Zinc 1.2 mg 6 mg












Vitamin B1

0.2 mg 1 mg


Vitamin B6

0.2 mg 1 mg






Biotin 5 µg 25 µg




per 100 ml 500 ml


150 kcal 750 kcal

Protein (casein) 7.5 g 38 g

Carbohydrates, of which 18.8 g 94 gn sugar 1.9 g 9.5 gn Lactose 0.02 g 0.1 g

Fat, of which 5 g 25 gn saturated fatty acids 3 g 15 g

of which MCT 2.6 g 13 g

n essential fatty acids 0.6 g 3 g

n -3 fatty acids 0.4 g 2 g

Fibre 0 g 0 g

Water 76 ml 380 ml

Sodium 0,15 g 0,75 g


Calcium 112.5 mg 562.5 mg


Phosphorus 97.5 mg 487.5 mg


Iron 1.8 mg 9 mg

Zinc 2.25 mg 11.25 mg


Iodine 19.5 µg 97.5 µg

Chromium 10.5 µg 52.5 µg


Manganese 0.3 mg 1.5 mg


Selenium 13.5 µg 67.5 µg


Vitamin D 1.5 µg 7.5 µg


Vitamin K 10.5 µg 52.5 µg

Vitamin B1

0.3 mg 1.5 mg

Vitamin B2 0.3 mg 1.5 mg

Vitamin B6

0.3 mg 1.5 mg



Niacin (NE) 2.7 mg 13.5 mg


Pantothenic acid 0.9 mg 4.5 mg

Biotin 7.5 µg 37.5 µg





per 100 ml 200 ml


150 kcal 300 kcal

Protein (milk and soy) 6.0 g 12 g

Carbohydrates, of which 20 g 40 gn sugar 5.3 g 11 g

of which 3.8 g 7.6 gn Lactose ≤0.15 g ≤0.75 g

Fat, of which 5.0 g 10 gn saturated fatty acids 1.2 g 2.4 g


n monounsaturated fatty acids

2.2 g 1.9 g

n polyunsaturated fatty acids 1.6 g 3.2 g

of which -3 fatty acids 0.36 g 0.72 g

Fibre <0.1 g –

Water 75 ml 151 ml

Sodium 0.1 g 0.2 g






Iron 1.7 mg 3.3 mg

Zinc 1.2 mg 2.4 mg







Selenium 8.3 µg 17 µg





Vitamin B1

0.18 mg 0.36 mg


Vitamin B6

0.22 mg 0.44 mg






Biotin 8.0 µg 16 µg

Choline 30 mg 60 mgBeta-Carotene – –

36



Nutricomp® Standard Fibre D Nutricomp® MCT Nutricomp® Hepa


per 100 ml 500 ml


156 kcal 780 kcal


Carbohydrates, of which 18.8 g 94 gn sugar 1.6 g 8.2 gn Lactose 0.02 g 0.1 g

Fat, of which 5 g 25 gn saturated fatty acids 3 g 15 g


n essential fatty acids 0.6 g 3 g

n -3 fatty acids 0.4 g 2 g

Fibre 2 g 10 g

Water 75 ml 375 ml



Calcium 112.5 mg 562.5 mg


Phosphorus 97.5 mg 487.5 mg


Iron 1.8 mg 9 mg

Zinc 2.25 mg 11.25 mg


Iodine 19.5 µg 97.5 µg

Chromium 10.5 µg 52.5 µg




Selenium 13.5 µg 67.5 µg




Vitamin K 10.5 µg 52.5 µg

Vitamin B1

0.3 mg 1.5 mg


Vitamin B6

0.3 mg 1.5 mg






Biotin 7.5 µg 37.5 µg


Natural mixtureof carotenoids – –

Beta-Carotene 0.15 mg 0.75 mg


per 100 ml 500 ml


103 kcal 515 kcal


Carbohydrates, of which 12.9 g 64.5 gn sugar 0.5 g 2.4 gn Lactose 0.007 g 0.035 gn starch 12.3 g 61.5 g

Fat, of which 3.5 g 17.5 gn saturated fatty acids 0.6 g 3.2 gn monounsaturated

fatty acids 2.2 g 11 gn essential fatty acids 0.5 g 2.5 g


Fibre 2.0 g 10 g

Water 83,4 ml 417 ml

Sodium 0,1 g 0,5 g






Iron 1.2 mg 6 mg

Zinc 1.2 mg 6 mg










Vitamin E (-TE) 3 mg 15 mg


Vitamin B1

0.2 mg 1 mg


Vitamin B6

0.2 mg 1 mg






Biotin 5 µg 25 µg


Natural mixtureof carotenoids 0.24 mg 1.2 mgBeta-Carotene 0.1 mg 0.5 mg


per 100 ml 500 ml


130 kcal 650 kcal


Carbohydrates, of which 17 g 86 gn sugar 1.7 g 8.5 gn Lactose 0.008 g 0.04 g

Fat, of which 4.4 g 22 gn saturated fatty acids 3 g 15 g


n essential fatty acids 1 g 5 g

Fibre <0.1 g

Water 79 ml 395 ml



Calcium 97.5 mg 488 mg


Phosphorus 84.5 mg 423 mg


Iron 1.56 mg 7.8 mg

Zinc 1.56 mg 7.8 mg



Chromium 9.1 µg 46 µg







Vitamin E (-TE) 2 mg 9.8 mg

Vitamin K 9.1 µg 46 µg

Vitamin B1

0.26 mg 1.3 mg


Vitamin B6

0.26 mg 1.3 mg

Vitamin B12 0.39 µg 2 µg









per 100 ml 500 ml


130 kcal 650 kcal

Protein (milk) of which 4 g 20 gn branched chain

amino acids 1.8 g 9 g

Carbohydrates, of which 15.5 g 77.5 gn sugar 1.6 g 8 gn Lactose 0.05 g 0.25 g

Fat, of which 5.8 g 29 gn saturated fatty acids 3.5 g 17.5 g

of which MCT 3 g 14.8 g


Fibre 0.6 g 2.8

Water 74 ml 370 ml







Iron 1.56 mg 7.8 mg

Zinc 1.56 mg 7.8 mg


Iodine 16.9 µg 85 µg










Vitamin B1

0.26 mg 1.3 mg


Vitamin B6

0.26 mg 1.3 mg









Enteral Nutrition

37

Nutricomp® Immun Nutricomp® Peptid


per 100 ml 500 ml


136 kcal 680 kcal

Protein

(wheat protein hydrolysate

and milk protein) 6.67 g 33.4 gn of which glutamine 2.0 g 10 g

Carbohydrates, of which 18.3 g 91.7 gn sugar 1.8 g 9.2 g

n Lactose 0.014 g 0.07 g





Fibre 1.3 g 6.7 g

Water 78 ml 390 ml

Sodium 0.13 g 0.67 g



Magnesium 26.6 mg 133 mg



Iron 1.6 mg 8 mg

Zinc 2 mg 10 mg


Iodine 17.3 µg 86 µg




Molybdenum 13.3 µg 67 µg




Vitamin E (-TE) 4 mg 20 mg


Vitamin B1

0.27 mg 1.3 mg


Vitamin B6

0.27 mg 1.3 mg


Vitamin C 26.6 mg 133 mg


Folic acid 39.9 µg 200 µg



Choline 40 mg 200 mgBeta-Carotene 0.13 mg 0.7 mg


per 100 ml 500 ml


100 kcal 500 kcal

Protein

(hydrolysate from

milk, soy, gelatine) 3.8 g 19 g

Carbohydrates, of which 18.8 g 94 gn sugar 0.9 g 4.5 g

n Lactose 0.35 g 1.75 g




Fibre <0.1 g –

Water 84 ml 420 ml

Sodium 0.14 g 0.7 g






Iron 0.9 mg 4.5 mg

Zinc 0.75 mg 3.8 mg










Vitamin E (-TE) 0.6 mg 3 mg


Vitamin B1

0.08 mg 0.38 mg


Vitamin B6

0.1 mg 0.5 mg


Vitamin C 4.5 mg 23 mg

Niacin (NE) 1 mg 5 mg



Biotin 5 µg 25 µg

Choline 20 mg 100 mgBeta-Carotene – –




per 100 ml 500 ml


130 kcal 650 kcal


Carbohydrates, of which 13 g 65 gn sugar 1.3 g 6.7 gn Lactose 0.009 g 0.045 g

Fat, of which 5.8 g 29 gn saturated fatty acids 3.5 g 18 g

of which MCT 3 g 15 g


Fibre <0.1 g 2.8

Water 79 ml 397 ml







Iron 1.56 mg 7.8 mg

Zinc 1.56 mg 7.8 mg










Vitamin E (-TE) 2 mg 9.8 mg


Vitamin B1

0.26 mg 1.3 mg


Vitamin B6

0.26 mg 1.3 mg









38

Notes

Enteral Nutrition

39

Notes

clinical nutrition general brochure

Documents

include regular

completed

moderately

additional

scaled cone

specific product

impaired lipid

central venous