Numeta G13%E/Numeta G16%E/Numeta G19%E Dosage/Direction for Use

Posology: The dosage depends on energy expenditure, the patient's weight, age, clinical status, and on the ability to metabolize the constituents of Numeta, as well as on additional energy or proteins given orally/enterally. Total electrolyte and macronutrient composition is dependent on the number of activated chambers (see Description).
The maximum daily dose should not be exceeded. Due to the static composition of the multi-chamber bag, the ability to simultaneously meet all nutrient needs of the patient may not be possible. Clinical situations may exist where patients require amounts of nutrients varying from the composition of the static bag.
The maximal recommended hourly rate of infusion and volume per day depend on the constituent. The first of these limits to be reached sets the maximum daily dose. The guidelines for maximal recommended hourly rate of infusion and volume per day are: Numeta 13%E: See Table 11.

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Numeta 16%E: See Table 12.

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Numeta 19%E: See Table 13.

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Numeta G13%E may not be appropriate for some preterm infants, as the clinical condition of the patient may require administration of individualized formulations to meet the specific needs of the patient as assessed by the clinician.
Method of administration: For instructions for preparation, and handling of the solution/emulsion for infusion, see Special precautions for disposal under Cautions for Usage.
Due to its high osmolarity, undiluted Numeta can only be administered through a central vein. However, sufficient dilution of Numeta with water for injection lowers the osmolarity and allows peripheral infusion. The tables as follows indicate how the dilution impacts osmolarity of the bags.
Examples of osmolarity for activated 2CB and activated 3CB admixtures after addition of trace elements, vitamins, and water for injection: Numeta13%E: See Table 14.

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Numeta16%E: See Table 15.

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Example of osmolarity for activated 3CB admixture after addition of trace elements, vitamins, and water for injection: Numeta19%E: See Table 16.

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Composition of the commercial trace elements preparation used: Numeta13%E and Numeta19%E: See Table 17.

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Numeta16%E: See Table 18.

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Composition of the commercial vitamin preparations used: See Table 19.

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The flow rate should be increased gradually during the first hour. Upon discontinuation of Numeta, the flow rate should be decreased gradually during the last hour. The administration flow rate must be adjusted taking into account the dose being administered, the daily volume intake, and the duration of the infusion, see Overdosage.
In preterm newborn infants, continuous parenteral administration over 24 hours is usually recommended; however, the same bag should not be activated, hung and infused longer than 24 hours. Cyclic infusions should be managed according to the patient's metabolic tolerance. Treatment with parenteral nutrition may be continued for as long as is required by the patient's clinical conditions.
This product contains electrolytes and may be further supplemented using commercial electrolyte preparations according to the physician's judgment and the clinical needs of the patient, see Special precautions for disposal under Cautions for Usage.
Vitamins and trace elements can be added according to the physician's judgment and the clinical needs of the patient, see Special precautions for disposal under Cautions for Usage.