Kabiven/Kabiven Peripheral Dosage/Direction for Use

The ability to eliminate fat and metabolize glucose should govern the dosage and infusion rate (see Precautions).
Dosage: The dose should be individualized and the choice of bag size should be made with regard to the patient's clinical condition, body weight and nutritional requirements.
Adults: The nitrogen requirements for maintenance of body protein mass depend on the patient's condition (eg, nutritional state and degree of catabolic stress). The requirements are 0.10-0.15 g nitrogen/kg body weight/day in the normal nutritional state (or in conditions with mild metabolic stress - for Kabiven only). In patients with moderate to high metabolic stress with or without malnutrition, the requirements are in the range of 0.15-0.30 g nitrogen/kg body weight/day (1-2 g amino acid/kg body weight/day). The corresponding commonly accepted requirements are 2-6 g for glucose and 1-2 g for fat.
The dose range of Kabiven 0.10-0.20 g nitrogen/kg body weight/day (0.7-1.3 g amino acid/kg body weight/day), covers the need of the majority of the patients. This corresponds to 19-38 mL Kabiven/kg body weight/day. For a 70-kg patient this is equivalent to 1330-2660 mL Kabiven/day.
The dose range of Kabiven Peripheral 0.10-0.15 g nitrogen/kg body weight/day (0.7-1.0 g amino acid/kg body weight/day) and a total energy of 20-30 kcal body weight/day corresponds to approximately 27-40 mL Kabiven Peripheral/kg body weight/day.
The total energy requirement depends on the patient's clinical condition and is most often between 25-35 kcal/kg body weight/day (for Kabiven), or 20-30 kcal/kg body weight/day (for Kabiven Peripheral). In obese patients the dose should be based on the estimated ideal weight.
Kabiven is produced in 2 sizes intended for patients with high (for Kabiven only), moderately increased, basal, or low nutritional requirements. To provide total parenteral nutrition, the addition of trace elements, vitamins and supplemental electrolytes may be required.
Children: The ability to metabolize individual nutrients must determine the dosage.
In general the infusion of Kabiven for small children (2-10 years) should start with a low dose ie, 12.5-25 mL/kg (corresponding to 0.49-0.98 g fat/kg/day, 0.41-0.83 g amino acids/kg/day and 1.2-2.4 g glucose/kg/day) and increased by 10-15 mL/kg/day up to maximum dosage of 40 mL/kg/day.
The infusion of Kabiven Peripheral for small children (2-10 years) should start with a low dose ie 14-28 mL/kg (corresponding to 0.49-0.98 g fat/kg/day, 0.34-0.67 g amino acids/kg/day and 0.95-1.9 g glucose/kg/day) and increased by 10-15 mL/kg/day up to maximum dosage of 40 mL/kg/day.
For children >10 years the dosage for adults can be applied.
The use of Kabiven/Kabiven Peripheral is not recommended in children <2 years in whom the amino acid cysteine may be considered conditionally essential.
Infusion Rate: The maximum infusion rate for glucose is 0.25 g/kg body weight/hr. Amino acid dosage should not exceed 0.1 g/kg body weight/hr. Fat dosage should not provide >0.15 g/kg body weight/hr.
The infusion rate should not exceed 2.6 mL/kg body weight/hr (corresponding to 0.25 g glucose, 0.09 g amino acid and 0.1 g fat/kg body weight) (for Kabiven), or 3.7 mL/kg body weight/hr (corresponding to 0.25 g glucose, 0.09 g amino acids, 0.13 g fat/kg body weight) (for Kabiven Peripheral). The recommended infusion period is 12-24 hrs.
Maximum Daily Dose: Kabiven: 40 mL/kg body weight/day. This is equal to 1 bag (largest size) to a 64 kg-patient and will provide 1.3 g amino acids/kg/day (0.21 g nitrogen/kg/day), 31 kcal/kg/day non-protein energy (3.9 g glucose/kg/day and 1.6 g fat/kg/day).
Kabiven Peripheral: 40 mL/kg body weight/day. This is equal to 1 bag (largest size) to a 64 kg-patient and will provide 0.96 g amino acids/kg body weight/day (0.16 g nitrogen/kg body weight/day), 25 kcal/kg body weight/day non-protein energy (2.7 g glucose/kg body weight/day and 1.4 g fat/kg body weight/day).
The maximum daily dose varies with the clinical condition of the patient and may even change from day to day.
Administration: Infusion may be continued for as long as required by the patient's clinical condition.
Kabiven: IV infusion only into a central vein.
Kabiven Peripheral: IV infusion into a peripheral or central vein.
In order to minimize the risk of thrombophlebitis for peripheral application, daily rotation of infusion site is recommended.