the invention provides intradialytic parenteral nutrition ( idpn ) solutions with low carbohydrate and low volume . the idpn solutions of the invention allow medical personnel to engage in reduced carbohydrate management for mhd patients when they receive idpn . moreover , the idpn solutions of the invention are particularly effective for treating malnutrition in mhd patients who have glucose management difficulties including patients that are insulin resistant , who have type i diabetes or pancreatitis . also , the reduction of carbohydrate in the idpn solutions of the invention favors anabolism over catabolism , thus effectively treating malnutrition . in preferred embodiments , the idpn solutions of the invention have reduced volume , so as to reduce side effects associated with high infusion volumes including dyspnea , increased respiratory rate , rhonchi edema , hypertension , and anxiety . the idpn solutions of the invention are especially appropriate for patients that have adequate caloric intake but not protein intake . further , the idpn solutions of the invention can be administered to normal weight or obese patients . preferably , the idpn solutions of the invention contain carbohydrate and amino acids . in some embodiments of the idpn solution of the invention , the solution also contains lipids . in other embodiments of the idpn solution of the invention , the solution also contains micronutrients such as vitamins , trace elements and / or minerals . in other embodiments of the idpn solution of the invention , the solution also contains pharmaceuticals such as insulin . in preferred embodiments , of the idpn solution of the invention , pharmaceuticals are coadministered with the idpn , but are not part of the idpn solution . for example , insulin can be administered subcutaneously in a separate injection . preferably , the carbohydrate contained in the idpn solutions of the invention dextrose ( d - glucose ). the amino acids contained in the idpn solutions of the invention include combinations of two or more of the standard 20 amino acids . preferably , all 20 of the amino acids are administered in the idpn solutions of the invention . more preferably , 17 amino acids are used . preferably , the solution of amino acids used to make the idpn solution of the invention is a concentrated solution and is used in the invention due to the benefits of low volume . preferably the concentrated solution contains 15 g / ml of amino acids . more preferably , the concentrated solution contains 20 g / ml of amino acids . preferably , the idpn solutions of the invention contain between 0 . 02 and 0 . 10 g / ml of dextrose in solution . preferably , the idpn solutions of the invention contain between 0 . 04 and 0 . 08 g / ml of dextrose in solution . more preferably , the idpn solutions of the invention contain between 0 . 05 and 0 . 07 g / ml of dextrose in solution . more preferably the idpn solutions of the invention contains between 0 . 055 and 0 . 065 g / ml of dextrose in solution . in various embodiments of the idpn solutions of the invention , the solutions contain 0 . 02 , 0 . 03 , 0 . 04 , 0 . 05 , 0 . 06 , 0 . 07 , 0 . 08 , 0 . 09 or 0 . 10 g / ml of dextrose in solution . in other embodiments of the idpn solutions of the invention , the solutions contain 0 . 055 , 0 . 056 , 0 . 057 , 0 . 058 , 0 . 059 , 0 . 060 , 0 . 061 , 0 . 062 , 0 . 063 , 0 . 064 or 0 . 065 g / ml of dextrose in solution . preferably , the idpn solutions of the invention are packaged in sterile containers for administration to patients . preferably , the sterile containers are bags used for parenteral administration of idpn solutions to a patient . preferably the bags hold between 100 ml of idpn solution and 2 liters of idpn solution . more preferably , the bags hold between 300 ml or 1 liter of idpn solution . more preferably , the bags hold between 419 ml of idpn solution and 809 ml of idpn solution . more preferably , the bags hold between 350 ml and 635 ml of solution . preferably , the idpn solutions of the invention are packaged in sterile containers so that the sterile container holds one dose of idpn solution for administration to a patient . preferably the dose of idpn solution has a volume between 100 ml of idpn solution and 2 liters of idpn solution . more preferably , the dose of idpn solution has a volume between 350 ml or 635 ml of idpn solution . more preferably , the dose of idpn solution has a volume of 300 , 342 , 350 , 383 , 400 , 419 , 427 , 450 , 483 , 500 , 540 , 550 , 600 , 613 , 635 , 700 or 809 ml . in conjunction with a volume associated with the idpn solution of the invention , the term “ about ” means +/− 10 ml per dose . preferably , a dose of the idpn solution of the invention contains between 10 and 50 g of dextrose . more preferably , a dose of the idpn solution contains between 20 and 45 g of dextrose . more preferably , a dose of the idpn solution contains 20 , 23 , 26 , 30 , 35 and 41 g of dextrose . in conjunction with an amount of dextrose associated with the idpn solution of the invention , the term “ about ” means +/− 1 g per dose . in some embodiments of the idpn solution of the invention , the amount of dextrose in the idpn solution is dependent upon the mass of the patient receiving the idpn treatment . generally , the ipdn solution of the invention contains a dose of dextrose less than 1 g / kg of body mass of the patient . for example , a patient with a mass between 34 and 39 kg would receive an idpn solution containing 20 g of dextrose , a patient with a body mass between 40 and 44 kg would receive an idpn solution containing 23 g of dextrose , a patient with a body mass between 45 and 51 kg would receive an idpn solution containing 26 g of dextrose , a patient with a body mass between 52 and 59 kg would receive an idpn solution containing 30 g of dextrose , a patient with a body mass between 60 and 69 kg would receive an idpn solution containing 35 g of dextrose , and a patient with a body mass of 70 kg , or greater , would receive an idpn solution containing 41 g of dextrose preferably , the idpn solutions of the invention contain between 0 . 10 and 0 . 20 g / ml of amino acids in solution . preferably the idpn solutions of the invention contain between 0 . 12 and 0 . 18 g / ml of amino acids in solution . more preferably the idpn solutions of the invention contains between 0 . 15 and 0 . 17 g / ml of amino acids in solution . in various embodiments of the idpn solutions of the invention , the solutions contain 0 . 10 , 0 . 11 , 0 . 12 , 0 . 13 , 0 . 14 , 0 . 15 , 0 . 16 , 0 . 17 , 0 . 18 , 0 . 19 or 0 . 20 g / ml of dextrose in solution . in other embodiments of the idpn solutions of the invention , the solutions contain 0 . 150 , 0 . 151 , 0 . 152 , 0 . 153 , 0 . 154 , 0 . 155 , 0 . 156 , 0 . 157 , 0 . 158 , 0 . 159 , 0 . 160 , 0 . 161 , 0 . 162 , 0 . 163 , 0 . 164 , 0 . 165 , 0 . 166 , 0 . 167 , 0 . 168 , 0 . 169 or 0 . 170 g / ml of amino acids in solution . preferably , a dose of the idpn solution of the invention contains between 30 and 120 g of amino acids . more preferably , a dose of the idpn solution contains between 51 and 110 g of amino acids . more preferably , a dose of the idpn solution contains 50 , 52 , 52 . 5 , 55 , 60 , 65 , 68 , 70 , 75 , 78 , 80 , 85 , 90 , 95 , 100 , 105 and 110 g of amino acids . in conjunction with an amount of amino acids associated with the idpn solution of the invention , the term “ about ” means +/− 3 g per dose . in some embodiments of the idpn solution of the invention , the amount of amino acids in a dose of the idpn solution is dependent upon the mass of the patient receiving the idpn treatment . for example , a patient with a body mass between 34 and 39 kg would receive an idpn solution containing 51 g of amino acids , a patient with a body mass between 40 and 44 kg would receive an idpn solution containing 60 g of amino acids , a patient with a body mass between 45 and 51 kg would receive an idpn solution containing 68 g of amino acids , a patient with a body mass between 52 and 59 kg would receive an idpn solution containing 78 g of amino acids , a patient with a body mass between 60 and 69 kg would receive an idpn solution containing 90 g of amino acids , and a patient with a body mass of 70 kg , or greater , would receive an idpn solution containing 105 g of amino acids . in some embodiments of the idpn solution of the invention , the solution also contain lipids . preferably the lipids are emulsions of purified vegetable oil from soybean ( intraliipid ® from kabi vitrum or travamulsion ® from travenol ) or safflower oil ( liposyn ® from abbott ). idpn solutions of the invention with lipids contain 5 - 30 % lipid by volume . preferably , idpn solutions of the invention with lipids contain 10 - 20 % lipid by volume . lipids should not be added to ipdn solutions administered to patients with hyperlipemia , acute pancreatitis , lipid nephrosis or allergic reactions to eggs . in preferred embodiments of the idpn solution of the invention , the solution is lipid free . in some embodiments of the idpn solution of the invention , the solution also contains micronutrients such as vitamins , trace elements and / or minerals . vitamins and minerals that are optionally added to the idpn solutions of the invention include water soluble vitamins such as vitamin c , folic acid , vitamin b 1 , and vitamin b 6 , as well as multivitamins lacking vitamin k , and trace elements such as zinc , selenium , copper , chromium , and manganese . minerals also include mineral salts such as sodium phosphate , and magnesium sulfate . in some embodiments of the idpn solution of the invention , the solution also contains pharmaceutical compositions . one example of a pharmaceutical composition appropriate for inclusion in the ipdn solution of the invention is insulin . in some embodiments , insulin is added to the idpn solution just prior to administration to the patient , because many solution container materials will absorb insulin . preferably , insulin is coadministered independent of the idpn solution . for example , the insulin can be subcutaneously injected during treatment with idpn . preferably 5 - 20 units of insulin is added with one dose of idpn . preferably , the idpn solution of the invention is administered to dialysis patients who are suffering from malnutrition . a dialysis patient suffering from malnutrition can be identified by detecting evidence of protein or energy malnutrition and inadequate dietary protein intake , evidence of the inability to administer or tolerate adequate oral nutrition inclusive of supplements and tube feeding , and evidence that the combination or oral and / or enteral intake when combined with idpn will meet the patient &# 39 ; s nutritional needs . administration of the idpn solution of the invention generally coincides with the start of hemodialysis on a patient . during idpn solution administration the patient should be monitored for glucose tolerance , protein status and / or fat status . glucose monitoring includes blood glucose level before , during and after idpn administration and monitoring the patient for symptoms of hyper or hypoglycemia . the symptoms of hyperglycemia include nausea , thirst , headache , vomiting and weakness . the symptoms of hypoglycemia include headache , dizziness , tremors , cold sweat , confusion , and faintness . the presence of hyper or hypoglycemia can then be confirmed through blood sugar analysis , such as via a fingerstick or arterial glucose level . to treat hyperglycemia , insulin is administered . to treat hypoglycemia the patient should receive 20 - 30 g of simple carbohydrates orally . protein monitoring includes the monitoring of blood urea nitrogen ( bun ) prior to dialysis and kt / v which is a measure of dialysis adequacy . fat monitoring includes a pre - dialysis triglyceride test prior to lipid infusion and then another following first lipid infusion to ensure that the patient is clearing lipids from the bloodstream . also , sodium , potassium , phosphorus and magnesium levels should be monitored for the presence of refeeding syndrome . generally , the idpn solution of the invention is administered through a port post dialyzer of the dialysis machine being used to perform hemodialysis on the patient . in a preferred embodiment , the idpn infusion is performed through the venous chamber of the dialysis machine . examples of routes of parenteral administration include intravenous , intradermal , subcutaneous , and intraperitoneal administration . any pharmaceutically acceptable carrier can be used in conjunction with the idpn solution of the invention . the idpn solution of the invention can be administered in the same manner prior art idpn solutions have been administered . the following idpn formulas were developed . these formulas are administered to a mhd patient requiring 3 . 25 hours or longer dialysis treatment time . the formulas are fat free and micronutrient free , but these components could easily be added .
the invention provides intradialytic parenteral nutrition solutions with low carbohydrate for the treatment of malnutrition in dialysis patients . the idpn solutions of the invention are particularly advantageous for the treatment of malnutrition in patients who are diabetic or suffer from other glucose management related pathologies or patients who require strict fluid management .