Pharmacological properties
Pharmacodynamics
The main active ingredients of the drug are xylitol and sodium acetate.
Xylitol is a pentaatomic alcohol that, when administered intravenously, is quickly incorporated into the general metabolism, 80% is absorbed in the liver and accumulates in the form of glycogen.
It exhibits a pronounced anti-ketogenic effect and is a source of energy with insulin-independent metabolism.
Xylitol is a natural intermediate product of human carbohydrate metabolism, therefore it has low toxicity and good tolerance. Unlike fructose, it does not cause a decrease in the level of nucleotides (ATP, ADP, AMP) in the liver, and is also safe for administration to patients who do not tolerate fructose or have a deficiency of the enzyme fructose-1,6-diphosphatase.
Sodium acetate is a slow-acting alkalizing agent. It causes the accumulation of bases due to the metabolism of the buffered drug and is indicated for those types of metabolic acidosis in which the accumulation of excess H + occurs slowly (for example, in renal and deficient non-respiratory acidosis). When using sodium acetate, in contrast to sodium bicarbonate solution, the correction of metabolic acidosis occurs more slowly, therefore it does not cause sharp fluctuations in pH.
Pharmacokinetics. Sodium acetate is completely metabolized into an equivalent amount of sodium bicarbonate within 1.5-2 hours, does not cause the phenomena of intracellular interstitial edema of the brain and increased aggregation of platelets and erythrocytes. It is important that oxygen consumption during acetate metabolism is significantly less than during lactate metabolism, which is important for the treatment of severe shock of various origins.
Due to its composition, Xylate belongs to the group of multicomponent, multifunctional hyperosmolar solutions and, thus, has an antiketogenic, hemodynamic, detoxification, rheological, energetic, alkalizing and osmodiuretic effect.
Indication
To reduce intoxication, improve microcirculation, partially cover the need for carbohydrates that occurs in diabetes mellitus and other disorders of glucose utilization, in traumatic, surgical, hemolytic and burn shock (taking into account the osmolarity of blood and urine), in preoperative preparation and in the postoperative period, in acute blood loss, as well as in burn disease, in protracted purulent processes, in various infectious diseases and chronic toxic hepatitis.
Application
Adults are administered intravenously drip, at a rate of 50-70 drops / min, i.e. 2.1-3.0 ml / kg / h or 150-210 ml / h.
Maximum dose: adults - 2100 ml/day or 1.5 g xylitol/kg body weight per day. Maximum infusion rate - 210 ml/hour (70 drops per minute) = 0.15 g xylitol/kg body weight per hour.
In chronic and toxic hepatitis - adults 400 ml (5-6 ml/kg), intravenously drip, repeatedly during the day (monitoring of liver function indicators is necessary).
For parenteral nutrition of patients, including those with diabetes mellitus, adults are given 600-1000 ml (10-15 ml/kg of the patient's body weight), once and repeatedly during the day.
In traumatic, burn, postoperative and hemolytic shock - adults 600-1000 ml (10-15 ml/kg of patient's body weight), once and repeatedly during the day.
In acute blood loss - adults 1000-1400 ml (up to 20 ml/kg). In this case, infusions of the drug Xylat are also recommended to be carried out at the pre-hospital stage, in a specialized ambulance.
In the preoperative period and after various surgical interventions - for adults at a dose of 400-600 ml (6-10 ml/kg), intravenously drip, once or repeatedly, daily, for 3-5 days.
Contraindication
Hyperosmolar coma, anuria. Xylate should not be administered in cases where fluid infusion is contraindicated (edema, cerebral hemorrhage, thromboembolism, cardiovascular decompensation, stage III acute renal failure).
Side effects
Allergic reactions (itching, urticaria); rarely - tachycardia, increased body temperature, irritation of peripheral veins at the injection sites. It is not recommended to use the drug in case of general dehydration and disorders of water and electrolyte metabolism. A hypertensive reaction may occur, in this case, antihypertensive agents are administered under the control of the doctor.
Special instructions
To achieve a hemodynamic effect, Xylat is administered to adults intravenously at a rate of 40-60 drops/min. If necessary, a jet injection of the drug is allowed after a test by drip injection at a rate of 30 drops/min. After the injection of 15 drops, the drug is stopped, and after 3 minutes, in the absence of a reaction, it is injected jet.
The antiketogenic properties of the drug are manifested at a rate of administration equal to the rate of xylitol utilization.
In liver diseases, the drug is used under the control of liver function indicators. Since Xylat has choleretic properties, its administration in cholelithiasis should be carried out under the careful supervision of a physician. The administration of Xylat to patients with diabetes mellitus should be carried out under the control of glycemia.
Caution should be exercised in the treatment of diseases accompanied by dehydration of the body, since Xylate, as a hyperosmolar solution, can increase it due to the transfer of fluid from the tissues into the vascular bed.
Pregnancy and breastfeeding. The use of Xylat during pregnancy and breastfeeding has not been studied, and there are no data.
The ability to influence the reaction rate when driving or operating machinery. The drug is used exclusively in a hospital setting.
Interactions
The drug should not be mixed with phosphate- and carbonate-containing solutions. Xylate should not be a carrier solution for other drugs. The addition of drugs may lead to physicochemical changes.
Incompatibility. The drug should not be mixed with phosphate- and carbonate-containing solutions. The addition of drugs may lead to physicochemical changes. If such addition is necessary, it is necessary to monitor compliance with sterility, thorough mixing and interaction of drugs.
Overdose
In case of an overdose of the drug, nausea, bloating, diarrhea, abdominal pain, and disturbances in water and electrolyte balance may occur (in the form of a hypertensive reaction; in this case, antihypertensive drugs are administered under close medical supervision).
Storage conditions
At a temperature of 2-25 °C, freezing of the drug is not allowed.
