Infezol 100 solution inf. bottle 500 ml No. 10 - Instructions

Pharmacological properties of the drug Infezol

Pharmacodynamics. Infezol is an infusion solution that contains amino acids and electrolytes, which are physiological substances or metabolic analogues. Amino acids are components necessary for the synthesis of proteins. Xylitol is a carrier of energy; during carbohydrate metabolism, it is broken down at the liver level, while its metabolites enter the processes of glycolysis and gluconeogenesis. Solutions containing amino acids are used for parenteral nutrition along with energy carriers, electrolytes and fluid to maintain or improve the body's condition or minimize weight loss. In pathological conditions, in the absence of exogenous administration of amino acids, a typical pronounced change in the set of amino acids in the blood plasma develops, both in the absolute concentration of individual amino acids and in their percentage in the blood plasma. 1 liter of Infezol 100 solution contains amino acids - 100 g, total nitrogen - 15.6 g, pH value 5.9–6.3; osmolarity - 1030–1260 mOsm/l. The total energy value of the drug Infezol 40 - 1551 kJ/l, the drug Infezol 100 - 1700 kJ/l. Pharmacokinetics. Amino acids are completely used for protein synthesis. Excess amino acids do not accumulate, unlike fatty acids and glucose. Only a small part (5%) of them is displayed unchanged. The breakdown of amino acids occurs through deamination of the α-amino group, which is metabolized to urea and excreted in the urine. The remaining carbon skeleton enters the citric acid cycle, where it is converted to acetyl-CoA, pyruvate, or an intermediate.

Composition and release form

Infezol® 40

in glass bottles of 100, 250 and 500 ml; There are 1 or 10 bottles in a box.

Infezol® 100

in glass bottles of 250 and 500 ml; 1 or 10 bottles in a box; or in glass bottles of 1000 ml; There are 6 bottles in a box.

Indications for use of the drug Infezol

Parenteral nutrition for hypoproteinemia and fluid loss of various origins (diseases of the digestive tract with impaired protein absorption, intestinal obstruction, burn disease, intoxication, etc.), inability to receive oral nutrition (after surgery on the esophagus, stomach, etc.), if necessary, improve metabolic and reparative processes in the postoperative period. Replenishment or elimination of protein deficiency arising from increased need or costs and when protein metabolism is disrupted during digestion, absorption and excretion.

Use of the drug Infezol

Used intravenously. Dosage depends on the clinical condition of the patient and his need for amino acids, electrolytes and fluids, body weight and the degree of catabolism. In case of predominance of catabolism, it is recommended to use the upper range of the given dosage. The infusion should be started slowly and the infusion rate should be increased to the required value over the course of 1 hour. Infezol 40. Adults: IV drip at the rate of 0.6–1 g of amino acids (up to 25 ml solution/kg body weight per day), in catabolic conditions - 1.3–2 g (up to 50 ml solution /kg body weight per day). Children aged 2–18 years: 1.0–2.0 g of amino acids (up to 50 ml solution/kg body weight per day). Maximum infusion rate: 2.5 ml/kg body weight per hour equals approximately - 0.1 g amino acids/kg body weight per hour; 0.125 g xylitol/kg body weight per hour; 0.8 drops/kg body weight per minute. 175 ml/70 kg body weight per hour equals - 7 g amino acids/70 kg body weight per hour; 8.75 g xylitol/70 kg body weight per hour; 60 drops/70 kg body weight per minute. If the body's need for fluid and calories is greater, the calculated amount of Infezol 40 can be supplemented by simultaneous or alternate administration of solutions of electrolytes, glucose, etc. If partial oral nutrition is possible, the amount of Infezol 40 is reduced in accordance with the amount of fluid and calories administered orally. The drug is used until the patient is completely transferred to enteral or oral nutrition. Infezol 100. Adults: daily dose: 10–20 ml/kg body weight, which is 1–2 g amino acids/kg body weight (70–140 g amino acids or 700–1400 ml for a body weight of 70 kg). Maximum daily dose: 20 ml/kg body weight, which is 2 g amino acids/kg body weight (140 g amino acids or 1400 ml for a body weight of 70 kg). Maximum infusion rate: 1 ml/kg body weight per hour, which equals 0.1 g amino acids/kg body weight per hour (7 g amino acids or 70 ml for a body weight of 70 kg). When using the specified maximum dosage, it is not allowed to exceed such permissible limits as a daily dose of 2 g/kg body weight and an infusion rate of 0.1 g/kg body weight per hour for amino acids. During parenteral nutrition in adults, the total amount of fluid administered should not exceed 40 ml/kg body weight per day. Children: the data given is an approximate average value and should be determined individually according to the age, stage of development of the child and disease. Children aged 2–5 years: daily dose is 15 ml/kg body weight (1.5 g amino acids/kg body weight). Children aged 5–14 years: daily dose is 10 ml/kg body weight (1 g amino acids/kg body weight). Maximum infusion rate: 1 ml/kg body weight per hour (0.1 g amino acids/kg body weight per hour). Infezol 100 is administered intravenously. At a low rate of administration, the components of the drug are utilized better than with rapid administration. Duration of use - until complete transition to enteral or oral nutrition.

Infezol 100 250ml 1 pc. solution for infusion (p) 1/10

pharmachologic effect

The substrate ensures protein synthesis and energy production, normalizes acid-base balance levels.

Composition and release form Infezol 100 250ml 1 pc. solution for infusion (p) 1/10

Infezol® 40 Solution for infusion - 1 l L-alanine - 4 g glycine - 7 g L-arginine - 4.55 g L-aspartic acid - 2 g L-glutamic acid - 5 g L-histidine - 1.35 g L -isoleucine - 2.1 g L-lysine hydrochloride - 2.5 g (corresponding to 2 g L-lysine) L-methionine - 1.75 g L-leucine - 2.75 g L-phenylalanine - 3.15 g L -threonine - 1.6 g L-tryptophan - 0.5 g L-valine - 2.25 g xylitol - 50 g sodium acetate - 3.4 g potassium chloride - 1.86 g magnesium chloride - 0.51 g sodium hydroxide - 0.6 g sodium disulfite, maximum - 0.02 g (corresponding to 12.5 mg SO2) water for injection - up to 1000 ml in glass bottles of 100, 250 and 500 ml; There are 1 or 10 bottles in a box. Infezol® 100 Solution for infusion - 1 l L-alanine - 15.5 g glycine - 7.55 g L-arginine - 9.66 g L-aspartic acid - 1.91 g L-glutamic acid - 5 g L-histidine - 3.3 g L-isoleucine - 5.85 g L-lysine monoacetate - 10.02 g (corresponding to 7.1 g L-lysine) L-methionine - 4.68 g L-leucine - 6.24 g L -phenylalanine - 5.4 g L-threonine - 5 g L-tryptophan - 2 g L-valine - 5 g L-acetylcysteine ​​- 0.673 g (which corresponds to 0.5 g of L-cysteine) L-acetyltyrosine - 2 g (which corresponds to 1.62 g L-tyrosine) L-ornithine hydrochloride - 2.42 g (corresponds to 1.9 g L-ornithine) L-proline - 7.5 g L-serine - 4.3 g malic acid - 3 g sodium acetate - 3.456 g sodium chloride - 0.625 g sodium hydroxide - 1.324 g potassium chloride - 3.355 g calcium chloride - 0.735 g magnesium chloride - 1.017 g water for injection - 921.735 g in glass bottles of 250 and 500 ml; 1 or 10 bottles in a box; or in glass bottles of 1000 ml; There are 6 bottles in a box.

Description of the dosage form

Transparent, almost colorless or yellowish-tinged liquid, with a characteristic odor.

Characteristic

Infezol®40: potassium content - 25 mmol, sodium - 40.2 mmol, magnesium - 2.5 mmol, chloride - 43.6 mmol, acetate - 25 mmol, pH - 5.7-7, titratable acidity - max.+ 11.6 mmol, theoretical osmolarity - 801.8 mOsm, amount of energy - 1551 kJ, total nitrogen - 6.3 g. Infezol® 100: sodium content - 69 mmol, potassium - 45 mmol, calcium - 5 mmol, magnesium - 5 mmol, chloride - 90 mmol, acetate - 74 mmol, malate - 22.4 mmol, amino acids - 100 g, total nitrogen - 15.6 g, amount of energy - 1700 kJ/400 kcal, pH - 5.9-6.3 , theoretical osmolarity - 1145 mOsm.

Directions for use and doses

IV drip. Infezol® 40 Administer slowly to adults at the rate of 0.6-1 g of amino acids (up to 25 ml of solution) per 1 kg/day. Children - 1.5-2.5 g of amino acids (up to 60 ml) per 1 kg/day. In catabolic conditions - 1.3-2 g of amino acids (up to 50 ml) per 1 kg/day. Infezol® 100 With a maximum infusion rate - 0.1 g of amino acids (1 ml) per 1 kg of body weight per hour; The maximum dose for adults is 2 g of amino acids per 1 kg/day.

Pharmacokinetics

Amino acid metabolism occurs by deamination of the alpha amino group, which is metabolized to urea, which is excreted by the kidneys.

Indications for use Infezol 100 250ml 1 pc. solution for infusion (p) 1/10

Parenteral nutrition, fluid replenishment, protein deficiency during operations, bleeding, burns (treatment and prevention).

Contraindications

Hypersensitivity, circulatory instability with a threat to life (shock), insufficient oxygen supply to cells, acute renal failure, severe liver damage, amino acid metabolism disorders, hyperhydration, hyperkalemia.

special instructions

It is necessary to monitor water balance (against the background of parenteral nutrition, the total volume of administered fluid should not exceed 40 ml/kg/day), blood serum ionograms, blood glucose concentrations and acid-base balance. Caution should be exercised in case of increased serum osmolarity. When administered together, Infezol® 40 solution may inactivate thiamine. The solution should not be mixed with other drugs (increased risk of microbial contamination and incompatibility).

Side effects Infezol 100 250ml 1 pc. solution for infusion (p) 1/10

Nausea, vomiting, chills, sweating, tachycardia, allergic reactions.

Contraindications to the use of the drug Infezol

Absolute contraindications : unstable blood circulation with a threat to life (shock); insufficient supply of cells with oxygen (tissue hypoxia). Relative contraindications : disorders of amino acid metabolism, overhydration, hyperkalemia, hyponatremia, heart failure, severe liver or kidney failure (in the absence of sufficient diuresis), disorders of amino acid metabolism, traumatic brain injury, overhydration, methanol intoxication, hypersensitivity to sodium disulfide, acidosis . Due to insufficient experience, the use of Infezol 100 for the treatment of children under 2 years of age is not recommended.

Side effects of the drug Infezol

In isolated cases - nausea, vomiting, chills, phlebitis (especially with rapid administration); Too rapid administration of the drug can lead to the development of hyperkalemia and hyperammonemia. Due to the content of sodium disulfite in the drug, in isolated cases (especially in patients with asthma), hyperergic reactions, vomiting, diarrhea, dyspnea, asthma attacks, impaired consciousness, and shock are possible. In addition, the products of interaction of sodium disulfite with another component of the drug - tryptophan - can increase the content of bilirubin and the activity of liver enzymes in the blood plasma.

Special instructions for the use of the drug Infezol

Use only transparent solutions in undamaged bottles. The bottle must be used immediately after opening! Do not store an open bottle under any circumstances! Solutions containing amino acids should not be mixed with other drugs due to an increased risk of microbial contamination and incompatibility. When using the drug, it is necessary to monitor the water balance and electrolyte content, the concentration of glucose in the blood plasma, BOR, liver function indicators. It should be taken into account that this solution represents only one component for parenteral nutrition. To carry out total parenteral nutrition, simultaneous replacement with the use of “energy carriers” is necessary, taking into account the need for essential fatty acids, electrolytes, vitamins and microelements. Infezol is used with great caution and only after a careful assessment of the ratio of expected benefits and possible risks for disorders of amino acid metabolism, hyperhydration, hyperkalemia, hypernatremia. In case of adrenal insufficiency, hepatic, renal, cardiac and pulmonary insufficiency, individual dosing is necessary. The frequency of clinical and laboratory examinations of the patient depends on the severity of the disease. This examination is especially often recommended for conditions such as amino acid metabolism disorders, liver failure (due to the increased risk of the occurrence or progression of existing neurological disorders caused by hyperammonemia); renal failure, primarily in the presence of hyperkalemia (contributes to the development or progression of metabolic acidosis) and azotemia due to impaired renal clearance. Caution must be exercised in case of increased osmolarity of blood plasma. In case of prolonged use of the drug (several weeks), it is necessary to monitor hemogram and blood coagulation parameters. Infezol 100 contains 5.4 g/l phenylalanine, the use of the drug can be dangerous in case of phenylketonuria. The drug contains sodium disulfite, so it cannot be used for asthma (increased sensitivity to sulfites). Use for renal dysfunction. Infezol can be used for impaired renal function. For renal failure, hyperkalemia, acidosis and shock, Infezol is used after achieving sufficient diuresis. The drug is administered by long-term intravenous infusion, since the components of the drug are better absorbed than with rapid infusion. With rapid infusion, intolerance reactions are possible, as well as renal loss of amino acids with an imbalance in their balance. When using the drug, it is necessary to monitor electrolytes, plasma glucose, BOR and water balance. For long-term use, it is recommended to use it through access to the subclavian vein. Use during pregnancy and lactation. Clinical trials of Infezol during pregnancy and lactation have not been conducted. However, the available clinical experience with regard to the use of amino acid solutions for parenteral nutrition does not give reason to assume any threat to women during these periods. Before using the drug in women during pregnancy and breastfeeding, it is necessary to assess the ratio of expected benefits and possible risks. Use in children. There is insufficient data regarding the use of the drug in children under 2 years of age, so its use is not recommended. When used in children over 2 years of age, the dose is determined according to age, body weight and nosological form, but if possible, other drugs containing proteins are used for oral and enteral administration. When administering the drug, be sure to use vials with a volume corresponding to the daily dose. In addition, it is necessary to additionally introduce other “energy sources,” vitamins and microelements using dosage forms used in pediatric practice. The ability to influence reaction speed when driving vehicles or operating machinery. Until now unknown. The drug is used only in a hospital setting.

Infezol 40 250 ml solution for inf.fl.

Instructions for medical use of the drug Infezol® 40 Trade name Infezol® 40 International nonproprietary name No Dosage form Solution for infusion 100, 250, 500 ml Composition One liter of solution contains active substances: Alanine 4.00 g Glycine 7.00 g Arginine 4, 55 g Aspartic acid 2.00 g Glutamic acid 5.00 g Histidine 1.35 g Isoleucine 2.10 g Lysine hydrochloride (corresponding to 2.00 g lysine) 2.50 g Methionine 1.75 g Leucine 2.75 g Phenylalanine 3.15 g Threonine 1.60 g Tryptophan 0.50 g Valine 2.25 g Xylitol 50.00 g Sodium acetate trihydrate 3.40 g Potassium chloride 1.86 g Magnesium chloride hexahydrate 0.51 g Sodium hydroxide 0.60 g excipients: Sodium metabisulfite (corresponds to 12.5 mg SO2) 0.02 g Water for injection 931.00 g Description Transparent colorless or almost colorless liquid, practically free of visible particles, with a peculiar odor. Pharmacotherapeutic group Preparations for parenteral nutrition. ATC code B05BA 10 Pharmacological properties Pharmacokinetics Infezol® 40 is administered intravenously and therefore its bioavailability is 100%. Amino acids are completely used for protein synthesis. Excess amino acids, which are not required for the synthesis of proteins and other biomolecules, cannot be accumulated as a reserve like fatty acids and glucose. And only a small amount of them (5%) can be excreted unchanged from the body. The breakdown of amino acids occurs by deamination of the a-amino group, which is metabolized into urea and excreted through the kidneys. The remaining carbon skeleton enters the citric acid cycle, where it is converted to acetyl-CoA, acetoacetyl-CoA, pyruvate, or an intermediate. Pharmacodynamics Amino acids, carbohydrates and electrolytes are physiological substances or metabolic analogues. Electrolyte concentration: K+ - 25.0 mmol, Na+ - 40.2 mmol, Mg2+ -2.5 mmol, Cl‾ -43.6 mmol, acetate ions - 25.0 mmol Special characteristics regarding application: Theoretical osmolarity 801.8 mosm/l pH value 5.7 - 7.0 Titratable acidity: (in terms of blood pH value) max. + 11.6 mmol/l Energy content (total): 1551.0 kJ/l Total nitrogen content: 6.3 g/l Amino acids supplied intravenously serve as links for protein synthesis. Xylitol is a carrier of calories, which is broken down during carbohydrate metabolism at the liver level, and its metabolites enter the processes of glycolysis or gluconeogenesis. Indications for use - for parenteral nutrition for the purpose of preventing and treating the loss of protein and fluid by the body (for example, after operations, bleeding, burns) - in order to replenish or eliminate protein deficiency that arise as a result of an increased need for it, increased consumption or disorders protein intake during digestion, absorption and excretion Method of administration and dosage Dosage Dosage is calculated depending on the clinical condition of the patient and his need for amino acids, electrolytes and fluids (fatness and the extent of disease-induced catabolism). For adults, the recommended maximum daily dose is 25 ml/kg body weight, which corresponds to 0.6 - 1.0 g/kg body weight, for example, up to 1250 ml is administered at 50 kg body weight. In conditions where the catabolic process predominates, the maximum daily dose is 50 ml/kg body weight, which is equivalent to 1.3–2.0 g/kg body weight, for example, up to 2500 ml is administered at 50 kg body weight. Children from 3 years of age and up adolescents under 18 years of age The maximum daily dose is 50 ml/kg body weight per day, which is equivalent to 1.0 - 2.0 g/kg body weight. With a higher body need for fluid and calories, the calculated amount of Infezol® 40 can be supplemented with simultaneous or alternately introducing solutions of electrolytes, glucose, etc. If partial oral nutrition is possible, the amount of Infezol® 40 administered parenterally is correspondingly reduced by the amount of fluid and calories administered orally. Maximum infusion rate: 2 ml/kg body weight per hour, which corresponds to 0.1 g amino acids/kg body weight per hour. Note: With a long course of treatment with Infezol, it is recommended to provide access to the central vein. Before administering the solution, a visual assessment is necessary: ​​use only clear solutions in undamaged bottles! After opening the bottle, Infezol® 40 should be used immediately. Infezol® 40 is administered by long-term intravenous drip infusion. At a low rate of administration (less than 2 ml/kg body weight per hour), (slow alternation of drops), the components of the drug are utilized better than with rapid administration. If the infusion is too rapid (more than 2 ml/kg body weight per hour), intolerance reactions are possible, as well as renal loss of amino acids with an imbalance in their balance. For mild to moderate renal and liver failure, individual dosage is required. Side effects Very rare - nausea, vomiting - headache, chills, fever - irritation of the vein walls, with too rapid infusion Contraindications - hypersensitivity to the amino acids contained in the solution - hypersensitivity to the excipient sodium metabisulfite - severe liver failure - violation amino acid metabolism (for example, phenylketonuria) - metabolic acidosis - acute traumatic brain injury - methanol intoxication - hyperkalemia - shock - hypoxia - pathologically high level of one of the electrolytes contained in this solution in plasma - severe renal failure (Infezol® 40 use cannot be used or should be used only after achieving sufficient diuresis) - decompensated heart failure - acute pulmonary edema - hyperhydration - children under 3 years of age Drug interactions No cases of interaction with other drugs are known, only incompatibility. Incompatibility Due to the increased risk of microbial contamination and incompatibility, solutions containing amino acids should not be mixed with other drugs. Special Note: Sodium metabisulfite is a very reactive compound that, when administered together, can break down thiamine (vitamin B1). Therefore, their simultaneous use is not recommended. Special instructions Infezol® 40 can be used if there are indications for parenteral nutrition. It should be borne in mind that Infezol® 40 is only one of the components of parenteral nutrition. For complete parenteral nutrition, simultaneous administration of energy sources, essential fatty acids, electrolytes, vitamins and microelements is necessary. Regular monitoring of serum electrolytes, blood glucose concentration, acid-base composition, water balance, total serum protein, renal and liver parameters is necessary. Particular care must be taken in patients with heart failure in the stage of compensation, in patients with mild to moderate renal failure when administering large amounts of fluid. Use caution in case of increased serum osmolarity! Due to the fact that Infezol® 40 contains sodium metabisulfite, the drug cannot be used in patients with asthma who have an increased sensitivity to sulfites! Due to the sodium metabisulfite contained in the preparation, in isolated cases, in particular in patients suffering from asthma, hypersensitivity reactions may be observed, expressed in vomiting, diarrhea, intermittent breathing, acute asthma attacks, disturbances of consciousness or shock. These reactions can occur very differently in each individual case and can also lead to life-threatening conditions. In addition, the reaction products of sodium metabisulfite with other components of the drug - in particular with tryptophan - can cause an increase in liver fat levels, as well as bilirubin and liver enzymes in the plasma. Use in pediatrics Due to the specific requirements for amino acids, taking the drug is not recommended for children under 3 years of age. Pregnancy and lactation No trials have been conducted with Infezol® 40 in pregnant or breastfeeding women. In this regard, the use of Infezol® 40 during pregnancy or lactation is possible only if there is a direct indication and an assessment of the ratio of the expected benefit for the pregnant woman and the possible risk to the fetus Features of the effect on the ability to drive a vehicle and potentially dangerous mechanisms Not known Overdose Symptoms: in case of overdose or If the solution is administered too quickly, intolerance reactions may occur in the form of nausea, vomiting, chills and renal loss of amino acids. Too rapid administration or administration of excessive amounts of potassium-containing solutions, particularly in cases of acidosis and renal failure, can lead to hyperkalemia. The dangerous serum potassium concentration is > 6.5 mmol/L. Symptoms of hyperkalemia may be: muscle weakness, sensory disturbances, cardiac disorders (sinus bradycardia, arrhythmia, conduction disturbances, expansion of the QRS complex up to bundle branch block, sharpening of the T wave on the ECG - in patients taking digitalis preparations, changes in the T wave may be veiled). Treatment: Immediate cessation of infusion. Osmotic diuresis. In cases that pose a threat - dialysis. Release form and packaging The drug is poured into transparent glass bottles for infusion with a capacity of 100, 250 and 500 ml, made of type II glass in accordance with the European Union, sealed with pierceable rubber stoppers, made of bromobutyl rubber in accordance with the European Union. The plugs are closed with combined caps made of aluminum and polypropylene. The bottles, along with instructions for use in the state and Russian languages, are placed in cardboard boxes. Storage conditions Store in a place protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children! Shelf life: 2 years Do not use this medicinal product after the expiration date! Conditions for dispensing from pharmacies By prescription Manufacturer BERLIN-CHEMIE AG (MENARINI GROUP) Glienicker Weg 125 12489 Berlin, Germany BERLIN-CHEMIE AG (MENARINI GROUP) Glienicker Weg 125 12489 Berlin, Germany Address of the organization receiving claims from consumers on the territory of the Republic of Kazakhstan quality of products (goods): Representative office of JSC "Berlin-Chemie AG" in the Republic of Kazakhstan Phone number: +7 727 2446183, 2446184, 2446185 fax number: +7 727 2446180 email address

Overdose of the drug Infezol, symptoms and treatment

Symptoms: too rapid administration or overdose of the solution can cause hypersensitivity reactions - nausea, vomiting, chills, as well as renal loss of amino acids. Exceeding the required dosage can lead to amino acid intoxication, overhydration and electrolyte imbalance; There is a particularly high risk of developing hyperkalemia with acidosis and renal failure. The dangerous concentration of potassium in the blood serum is 6.5 mmol/l. Symptoms of hyperkalemia - muscle weakness, sensory disturbances, cardiac activity (sinus bradycardia, arrhythmia, conduction disturbances, bundle branch block, ECG - widening of the QRS up to the development of bundle branch block, pointed T ; in patients taking cardiac glycosides, T wave changes may be erased). Treatment: in order to eliminate intoxication, reduce the infusion rate, and if necessary, stop the infusion, and correct the electrolyte balance. In severe cases, the use of osmotic diuresis is indicated, in critical cases - hemodialysis.

Characteristic

Infezol®40:

potassium content - 25 mmol, sodium - 40.2 mmol, magnesium - 2.5 mmol, chloride - 43.6 mmol, acetate - 25 mmol, pH - 5.7–7, titratable acidity - max. +11.6 mmol , theoretical osmolarity - 801.8 mOsm, amount of energy - 1551 kJ, total nitrogen - 6.3 g.

Infezol® 100:

sodium content - 69 mmol, potassium - 45 mmol, calcium - 5 mmol, magnesium - 5 mmol, chloride - 90 mmol, acetate - 74 mmol, malate - 22.4 mmol, amino acids - 100 g, total nitrogen - 15.6 g , amount of energy - 1700 kJ/400 kcal, pH - 5.9–6.3, theoretical osmolarity - 1145 mOsm.