. . "D\u00E1vkov\u00E1n\u00ED a zp\u016Fsob pod\u00E1n\u00ED"@cs . . "D\u00E1vkov\u00E1n\u00ED\nD\u00E1vkov\u00E1n\u00ED z\u00E1vis\u00ED na energetick\u00E9m v\u00FDdeji, hmotnosti pacienta, v\u011Bku, klinick\u00E9m stavu pacienta a jeho schopnosti metabolizovat slo\u017Eky p\u0159\u00EDpravku NUMETA, jako\u017E i na dal\u0161\u00ED energii nebo proteinech podan\u00FDch peror\u00E1ln\u011B/enter\u00E1ln\u011B. Celkov\u00E9 slo\u017Een\u00ED elektrolyt\u016F a\u00A0makronutri\u010Dn\u00EDch prvk\u016F je z\u00E1visl\u00E9 na po\u010Dtu aktivovan\u00FDch komor (viz bod 2).\nMaxim\u00E1ln\u00ED doporu\u010Den\u00E1 hodinov\u00E1 rychlost infuze a denn\u00ED objem z\u00E1vis\u00ED na slo\u017Ek\u00E1ch. Prvn\u00ED z t\u011Bchto limit\u016F, kter\u00FD m\u00E1 b\u00FDt dosa\u017Een, ur\u010Duje maxim\u00E1ln\u00ED denn\u00ED d\u00E1vku. Pokyny pro maxim\u00E1ln\u00ED doporu\u010Denou hodinovou rychlost infuze a denn\u00ED objem jsou n\u00E1sleduj\u00EDc\u00ED:\n\t\n\tAktivov\u00E1ny 2KV\n(376 ml)\n\tAktivov\u00E1ny 3KV\n(500 ml)\n\tMaxim\u00E1ln\u00ED rychlost pod\u00E1v\u00E1n\u00ED infuze v\u00A0ml/kg/hod\n\t5,8\n\t5,5\n\tOdpov\u00EDd\u00E1:\n\t\n\t\n\tAminokyseliny v g/kg/hod\n\t0,20*\n\t0,14\n\tGluk\u00F3za v g/kg/hod\n\t0,12\n\t0,85\n\tLipidy v g/kg/hod\n\t0\n\t0,17*\n\tMaxim\u00E1ln\u00ED mno\u017Estv\u00ED v ml/kg/den\n\t72,3\n\t96,2\n\tOdpov\u00EDd\u00E1:\n\t\n\t\n\tAminokyseliny v g/kg/den\n\t2,5*\n\t2,5*\n\tGluk\u00F3za v g/kg/den\n\t14,9\n\t14,9\n\tLipidy v g/kg/den\n\t0\n\t3,0\n* Limituj\u00EDc\u00ED parametr podle pokyn\u016F ESPEN-ESPGHAN.\nZp\u016Fsob pod\u00E1n\u00ED\nPokyny pro p\u0159\u00EDpravu a manipulaci s\u00A0roztokem/infuzn\u00ED emulz\u00ED viz\u00A0bod\u00A06.6.\nNe\u0159ed\u011Bn\u00FD p\u0159\u00EDpravek NUMETA m\u00E1 vysokou osmolaritu, a proto jej lze pod\u00E1vat pouze do\u00A0centr\u00E1ln\u00ED \u017E\u00EDly. Nicm\u00E9n\u011B dostate\u010Dn\u00E9 na\u0159ed\u011Bn\u00ED p\u0159\u00EDpravku NUMETA vodou na injekci sn\u00ED\u017E\u00ED osmolaritu a umo\u017En\u00ED pod\u00E1n\u00ED do perifern\u00ED \u017E\u00EDly. Tabulka n\u00ED\u017Ee ukazuje, jak\u00A0na\u0159ed\u011Bn\u00ED ovlivn\u00ED osmolaritu vak\u016F.\nP\u0159\u00EDklady osmolarity u aktivovan\u00FDch 2KV a aktivovan\u00FDch 3KV sm\u011Bs\u00ED po p\u0159id\u00E1n\u00ED stopov\u00FDch prvk\u016F, vitam\u00EDn\u016F a vody na injekci:\n\t\n\tAminokyseliny a gluk\u00F3za (aktivov\u00E1ny 2KV)\n\tAminokyseliny, gluk\u00F3za a lipidy (aktivov\u00E1ny 3KV)\n\tP\u016Fvodn\u00ED objem ve vaku (ml)\n\t376\n\t500\n\tP\u016Fvodn\u00ED osmolarita (p\u0159ibli\u017En\u00E1,\u00A0mOsm/l)\n\t1585\n\t1230\n\tObjem p\u0159idan\u00E9 vody (ml)\n\t450\n\t350\n\tP\u0159idan\u00E9 stopov\u00E9 prvky *\n\t5 ml TE2\n\t5 ml TE2\n\tP\u0159idan\u00E9 vitam\u00EDny *\n\t\u00BD lahvi\u010Dky V1\n\t\u00BD lahvi\u010Dky V1 + \n\u00BD lahvi\u010Dky V2\n\tKone\u010Dn\u00FD objem po p\u0159id\u00E1n\u00ED (ml)\n\t836\n\t860\n\tOsmolarita po p\u0159id\u00E1n\u00ED \n(p\u0159ibli\u017En\u00E1, mOsm/L)\n\t715\n\t715\n* Slo\u017Een\u00ED p\u0159\u00EDpravk\u016F s vitam\u00EDny a stopov\u00FDmi prvky je pops\u00E1no n\u00ED\u017Ee.\nSlo\u017Een\u00ED b\u011B\u017En\u011B pou\u017E\u00EDvan\u00FDch komer\u010Dn\u00EDch prepar\u00E1t\u016F se stopov\u00FDmi prvky\n\tSlo\u017Een\u00ED v\u00A0jedn\u00E9 lahvi\u010Dce\n\tTE2\n(10 ml)\n\t\u017Delezo\n\t8,9 \u00B5mol nebo 0,5 mg\n\tZinek\n\t15,3 \u00B5mol nebo 1 mg\n\tSelen\n\t0,6 \u00B5mol nebo 0,05 mg\n\tM\u011B\u010F\n\t4,7 \u00B5mol nebo 0,3 mg\n\tJ\u00F3d\n\t0,4 \u00B5mol nebo 0,05 mg\n\tFluor\n\t26,3 \u00B5mol nebo 0,5 mg\n\tMolybden\n\t0,5 \u00B5mol nebo 0,05 mg\n\tMangan\n\t1,8 \u00B5mol nebo 0,1 mg\n\tKobalt\n\t2,5 \u00B5mol nebo 0,15 mg\n\tChrom\n\t0,4 \u00B5mol nebo 0,02 mg\nSlo\u017Een\u00ED b\u011B\u017En\u011B pou\u017E\u00EDvan\u00FDch vitam\u00EDnov\u00FDch p\u0159\u00EDpravk\u016F\n\tSlo\u017Een\u00ED v\u00A0jedn\u00E9 lahvi\u010Dce\n\tV1\n\tV2\n\tVitam\u00EDn B1\n\t2,5 mg\n\t-\n\tVitam\u00EDn B2\n\t3,6 mg\n\t-\n\tNikotinamid\n\t40 mg\n\t-\n\tVitam\u00EDn B6\n\t4,0 mg\n\t-\n\tKys. pantothenov\u00E1\n\t15,0 mg\n\t-\n\tBiotin\n\t60 \u00B5g\n\t-\n\tKyselina listov\u00E1\n\t400 \u00B5g\n\t-\n\tVitam\u00EDn B12\n\t5,0 \u00B5g\n\t-\n\tVitam\u00EDn C\n\t100 mg\n\t-\n\tVitam\u00EDn A\n\t-\n\t2300 IU\n\tVitam\u00EDn D\n\t-\n\t400 IU\n\tVitam\u00EDn E\n\t-\n\t7 IU\n\tVitam\u00EDn K\n\t-\n\t200 \u00B5g\nV pr\u016Fb\u011Bhu prvn\u00ED hodiny je nutn\u00E9 postupn\u011B zvy\u0161ovat rychlost pod\u00E1v\u00E1n\u00ED. P\u0159ed ukon\u010Den\u00EDm pod\u00E1v\u00E1n\u00ED p\u0159\u00EDpravku NUMETA se v\u00A0pr\u016Fb\u011Bhu posledn\u00ED hodiny rychlost pod\u00E1v\u00E1n\u00ED postupn\u011B sni\u017Euje. Rychlost pod\u00E1v\u00E1n\u00ED je nutn\u00E9 upravit podle po\u017Eadovan\u00E9 pod\u00E1van\u00E9 d\u00E1vky, denn\u00EDho\u00A0objemov\u00E9ho p\u0159\u00EDjmu infuz\u00ED a jej\u00EDho trv\u00E1n\u00ED, viz bod 4.9.\nJeden vak nesm\u00ED b\u00FDt aktivov\u00E1n, zav\u011B\u0161en a pod\u00E1v\u00E1n d\u00E9le ne\u017E 24 hodin. Infuze lze pod\u00E1vat opakovan\u011B v\u00A0souladu s\u00A0pacientovou metabolickou toleranc\u00ED.\nL\u00E9\u010Dba pomoc\u00ED parenter\u00E1ln\u00ED v\u00FD\u017Eivy m\u016F\u017Ee pokra\u010Dovat tak dlouho, jak vy\u017Eaduje klinick\u00FD stav pacienta.\nTento p\u0159\u00EDpravek obsahuje elektrolyty a lze jej d\u00E1le obohatit komer\u010Dn\u00EDmi elektrolytov\u00FDmi p\u0159\u00EDpravky v\u00A0souladu s posouzen\u00EDm l\u00E9ka\u0159e a klinick\u00FDmi pot\u0159ebami pacienta, viz bod 6.6.\nVitam\u00EDny a stopov\u00E9 prvky mohou b\u00FDt p\u0159id\u00E1ny podle zv\u00E1\u017Een\u00ED l\u00E9ka\u0159e a klinick\u00FDch pot\u0159eb pacienta, viz bod 6.6.\n"@cs . . . . . . "004.002" . . . . .