PRESENTATION TOPIC

Panamin-G in
IUGR,Oligohydramnious and
Malnutrition.
 OLIGOHYDRAMNIOUS
 What is amniotic fluid?
Amniotic fluid is a
clear, slightly
yellowish liquid that surrounds
the unborn baby (fetus) during
pregnancy. It is contained in
the amniotic sac (bags of water).
 What is AFI (Amniotic Fluid
Index)?
Amniotic fluid index (AFI) is a
quantitative estimate
of amniotic fluid and an
indicator of fetal well-being.
 AFI is the score (expressed in
cm) given to the amount of
amniotic fluid seen on
ultrasonography of a
pregnant uterus(womb). To
determine the AFI, doctors may
use a four-quadrant technique,
 OLIGOHYDRAMNIOUS
 An AFI between 8-18 is considered
normal. Median AFI level is
approximately 14 from week 20 to
week 35, when the amniotic fluid
begins to reduce in preparation for
birth.
 An AFI < 5-6 is considered
as oligohydramnious The exact
number can vary by gestational
age.
 An AFI > 24-25 is considered
as polyhydramnious
 Oligohydramnios is a condition in
pregnancy characterized by a
deficiency of amniotic fluid.
IMPORTANCE OF AMNIOTIC FLUID
 Amniotic fluid serves several roles during pregnancy
 -It allows the fetus to have movements in the uterus.
This helps in development of muscles and bones of the
baby
 -Fetus keeps on swallowing this fluid. This helps in
development of intestines of the baby.
 -It gives space so that fetal lungs can expand. This will
help in development of lungs of baby and baby will
breathe normally when born
 -Fetus draws its blood supply, oxygen and nutrition
from umbilical cord. Adequate amniotic fluid is
necessary for its free movement and continuous supply.
SOURCE OF AMNIOTIC FLUID
Amniotic fluid is a secretion of fluid from various
sources. The main sources are listed below
 -Membranes and placenta surrounding baby

 -Fetal skin

 -Fetal urine production

 -Fetal lung fluid

 INTRAUTRINE GROWTH
RESTRICTION (IUGR)
 Intrauterine growth restriction(IUGR)
refers to a condition in which an
unborn baby is smaller than it should
be because it is not growing at a normal
rate inside the womb.
 Complication of IUGR
 Low birth weight
 Decreased oxygen levels
 Hypoglycemia (low blood sugar)
 Low resistance to infection
 Trouble maintaining body temperature
 Abnormally high red blood cell count
 In the most severe cases, IUGR can lead
to stillbirth. It can also cause long-term
growth problems.
 Causes of Intrauterine Growth
Restriction(IUGR)
A common cause is a problem with the placenta.
Problems related to mother health are:
 Advanced diabetes

 High blood pressure or heart disease

 Kidney disease or lung disease

 Malnutrition or anemia

 Smoking, drinking alcohol, or abusing drugs

 Other possible fetal causes multiple gestation

(twins, triplets, or more).

 Symptoms of Intrauterine Growth
Restriction(IUGR)

 The main symptom of IUGR is a small gestational

age baby. Specifically, the baby's estimated weight is
below the 10th percentile -- or less than that of 90%
of babies of the same gestational age.
 Depending on the cause of IUGR, the baby may be
small all over or look malnourished. They may be
thin and pale and have loose, dry skin. The umbilical
cord is often thin and dull instead of thick and shiny.
 Not all babies that are born small have IUGR.
 IUGR DIAGNOSIS

 measuring the distance from the mother's fundus

(the top of the uterus) to the pubic bone. A lower
than expected measurement may indicate the
baby is not growing as it should.
 Ultrasound.
 Doppler flow.
 Weight checks. 
 Fetal monitoring.
 Amniocentesis.
 MALNUTRITION
Defination:
 AN ACUTE,SUB-ACUTE OR CHORONIC

STATE OF NUTRITION,IN WHICH

VARYING DEGREES OF OVER NUTRITION
AND UNDER NUTRITION WITH AND
WITHOUT INFLAMMATORY ACTIVITY
HAVE LED TO A CHANGE IN BODY
COMPOSITION AND DIMINISHED
FUNCTION
 CAUSES

Low food intake

Mental Health Problem

Digestive problem and stomach condition

Infections
 Solution of Choice
 PANAMIN-G
 2.7% AMINOACID
 5% SORBITOL
PANAMIN-G
Indications
• Recommended for provision of amino acids and
energy in patients who require intravenous nutrition
• Hypo proteinemia
• Malnutrition
• Disorders of GI tract
• Infections
• Inadequate intake or refusal to eat
• IUGR
• Oligohydramnious
 PANAMIN-G
 Dosage and administration
 500 mL via IV infusion
 50-100 minutes
 80-130 drops/minute
 In IUGR Panamin-G alternate days for 4 to 6
weeks(12 to 18 Bottles)
 In Oligohydramnious Panamin-G alternate
dayd for 2 weeks(6 Bottles)
 CONTRAINDICATIONS

 Hypersensitivity

 Hereditary fructose intolerance

 Azotemia ( is a condition that occurs when your kidneys have
been damaged by disease or an injury.)

 Congestive cardiac failure

 Severe acidosis
 Precautions

Severe
Severehepatic
hepaticdisorders
disorders
Severe
Severerenal
renalfailure
failure

Elderly
Elderlypatients
patients Diabetes
Diabetesmellitus
mellitus
 Pan-Amin G
(2.7% Amino acids + 5% Sorbitol)

Parenteral Nutrition Support

• Strength 2.7%
• Protein (g/L) 27
• Sorbitol (g/L ) 50
• Calories (Kcal /L) 308
• Non Protein Calories 200
• Nitrogen (g/L ) 4.3
• Osmolarity 507
• Pack Size (ml) 500
 ADVERSE EVENTS
 Hypersensitivity and chest discomfort

 Palpitations

 Occasional nausea and vomiting

 Chills and fever

 Electrolyte imbalance
 SOY PROTEIN

Soy protein is the only high quality plant-based protein that is

widely available.

Soy protein is a complete protein (provides adequate levels of all

of the essential amino acids to support human nutritional needs)
and is comparable in quality to milk, meat, and eggs as measured
by the protein digestibility-corrected amino acid score, which is
the globally recognized method for determining protein quality.

McGraw NJ, et al. World J Nephrol 2016 May 6; 5(3): 233-257

 COMPOSITION

Total Energy 230 kcal

Proteins 10 grams

Fats 6 grams

Carbohydrates 32 grams

Linoleic acid 3.3 grams

Insoluble fiber 6 grams

Also provides selenium, chromium and zinc

 DOSAGE & PACKAGING

 Adults:
1 sachet 2-6 times daily

Children:
Day 1: half sachet twice daily
Day 2 onwards: 1 sachet, 1-4 times a day

 Each Sachet contains 52 grams of powder mixture

 Vanilla flavor

 1 box contains 7 sachet

 MANUFACTURED BY

Otsuka Indonesia, An Otsuka Japan Group Company

Certified HALAL by: Majelis Ulama Indonesia