Drug Data Generic Name: Ketoanalogue rade Name: Ketosterile !

atient"s Dose: 1 tab PO TID Minimum Dose: 1 tab thrice a day Ma#imum Dose: 8 tabs thrice a day Contents: Ketoanalogues and essential amino acids Availabilit$: tablets Route/s for Administration PO

Classification herapeutic: Supplements !harmacologic: % !regnanc$ Categor$ Ris&: Not established

Mechanism of Action !harmacod$namics: The plasma kinetics of amino acids and their integration in metabolic path ays are ell established! It should ne"ertheless be noted that# in uremic patients# the plasma disturbances do not seem to depend on digested amino acid intake# and that the post$absorpti"e kinetics seems to be distributed "ery early in the de"elopment of the disease! In normal indi"iduals# there is an increase in the plasma le"el of ketoanalogues# 1% min after oral ingestion! These le"els reach "alues that are appro&imately ' times higher than the initial le"el! Peak le"els are reached ithin (%$)% min and normal le"els are reached again after *% min! +astrointestinal absorption is thus "ery rapid! In the plasma a simultaneous increase in le"els of the ketoanalogue and the corresponding amino acid sho that transamination of the ketoanalogues are "ery rapid! Due to natural path ays of disposal of ,$ketonic acids in the organism# it is probable that e&ogenous intakes are "ery rapidly integrated into metabolic cycles! Ketoacids follo the same catabolic path ays as the classical amino acids! No specific study on ketoacid e&cretion has been performed to date! !harmaco&inetics: Absorption: -bsorption in the gastrointestinal tract! Distribution: .idely distributed Metabolism ' E#cretion: /etaboli0ed by the li"er# e&creted by the li"er! ime Reaction !rofile Route PO (ns et 1% min !ea & (%$ )% min Durati on unkno n

Indication General Indication: Pre"ention and therapy of damages due to faulty or deficient protein metabolism in chronic renal insufficiency in connection ith limited protein food of 23% g4day 5for adults6! !atient"s Actual Indication: Supplements indicated for patients ha"ing urologic problems like chronic kidney disease!

Contraindication Contraindicated in: 7ypercalcemia# disturbed amino acid metabolism! In case of hereditary phenylketonuria# it has to be taken into account that ketoanalogue contains phenylalanine! Disturbed amino acid metabolism !recaution: Ketolog should be taken during meals to allo proper absorption and metabolism into the corresponding amino acids! The serum calcium le"els should be monitored regularly! 8nsure the sufficient supply ith calories! +se in pregnanc$: No e&perience has been made so far ith the application in pregnancy! +se in children: No e&perience has been made so far ith the application in pediatry! Interaction: Drug%Drug: Simultaneous administration of medicaments containing calcium 5eg# acetolyte6 may lead to pathological increases of the serum calcium le"el or intensification! -s the uremic symptoms impro"e under Ketolog# a possible administration of aluminum hydro&ide should be reduced! Pay attention to a reduction of serum phosphate! Do not take drugs together ith Ketolog that form sparingly soluble compounds ith calcium 5eg# tetracyclines6 in order not to interfere

Adverse Effect/Reaction 7ypercalcemia may de"elop!

Nursing Responsibilities 9efore: 1!-ssess electrolyte le"els (!8&plain therapeutic "alue of drug ;!-ssess allergy to the drug 3!<aution patient of the different side effects '! -ssess "ital signs )! Proper preparation of the drug During: 1! =erify patient>s identity (! -dminister ith food to pre"ent +I upset ;! -dminister drug at right time# route# and dosage 3! -d"ise to s allo the tablet hole '! /onitor "ital signs After: 1! Document administration of drug (! Instruct patient to report immediately if symptoms of hypercalcemia occurs like muscle eakness# constipation ;! /onitor calcium le"els! 3! /onitor for signs of hypercalcemia and electrolyte le"els! '! /onitor "ital signs especially cardiac changes!

)alf%*ife: 1nkno n