Parenteral nutrition solutions

Sodium chloride injection 0.9% Parenteral nutrition. solution (1200 mL) 81.85 mL... 

IVincompatibility Do not mix iron sucrose with other medications or add to parenteral nutrition solutions for IV infusion. 

Kamiya et al. [83] evaluated particulate contamination in 199 samples of admixed and un-admixed parenteral nutrition solution bags from 10 hospitals in Japan. Seven samples were used as controls since they had not been mixed with ampoules or vials (un-admixed samples). Size and number of particles were measured using a particle counter, and the identification of elements was carried out by scanning electron microscopy coupled to energy dispersion spectroscopy. The authors collected the residual volume of the samples (10-60 mL) after their usage. The results are presented in Table 40. 

TABLE 40 Mean (Range) of Particles Found in Mixed and Unadmixed Parenteral Nutrition Solutions Classified According to Their Size... 

Picaud, J. C., Steghens, J. P., Auxenfans, C., Barbieux, A., Laborie, S., and Claris, O. (2004), Lipid peroxidation assessment by malondialdehyde measurement in parenteral nutrition solutions for newborn infants A pilot study, Acta Paediatr., 93, 241-245. 

Laborie, S., Lavoie, J- ., Pineaut, M., and Chessex, P. (2000), Contribution of multivitamins, air and light in the generation of peroxides in adult and neonatal parenteral nutrition solutions, Ann. Pharmacother., 34, 440M45. 

Oie, S., and Kamiya, A. (2005),Particulate and microbial contamination in in-use admixed parenteral nutrition solutions, Biol. Pharm. Bull., 28,2268-2270. 

Demircan M, Ergun O, Coker C, et al. 1998. Aluminum in total parenteral nutrition solutions produces portal inflammation in rats. J Pediatr Gastroenterol Nutr 26 274-278. 

LDPE and PTFE are manufactured by processes involving little contact with metals, and should not be a major source of aluminum. On the other hand, HDPE and PP have similar manufacturing processes, based on catalysis, that involve aluminum, among other metals. The contamination risk may therefore be very high. In addition, the manufacture of the container itself can lead to aluminum contamination, considering the use of lubricants, stabilizers and other additives. For example, metal soaps, such as aluminum, magnesium, sodium, and tin, were sanctioned by the FDA to be used as stabilizers in plastic containers for parenteral nutrition solutions [76]. 

Shine B, Farwell JA. Stability and compatibility in parenteral nutrition solutions. Br J Parent Ther 1984 5 44-46. 

Chen MF, Boyce W, Triplett L. Stability of the B vitamins in mixed parenteral nutrition solution. J Parent Enter Nutr 1983 7 462-464. 

Some copper compounds have been used therapeutically in the past. Small quantities of copper salts enhance the physiological utilization of iron and are thus often present in hemopoietic formulations. Copper chloride and copper sulfate are used in parenteral nutrition solutions. The artificial radioactive copper isotope Cu has been used in mineral metabolic studies. Excess accumulation of copper can occur due to an abnormality of ceruloplasmin and causes Wilson s disease and Menkes disease, which are both characterized by copper accumulation (SEDA-22, 244) (9). 

Since chronic renal insufficiency is frequently complicated by rises in serum potassium, phosphate, and magnesium, parenteral nutrition solutions used to treat malnourished patients with chronic renal insufficiency are usually prepared with little supplementation of these cations. Four patients with chronic renal insufficiency developed significant hypophosphatemia 3-5 days after starting parenteral nutrition. Other electrolyte abnormalities included hypomagnesaemia (n = 1) and hypokalemia (n — 3) (50). Hypophosphatemia may be the most significant of the electroljde risks in this clinical setting, and the electrolytes of such patients should be monitored closely when nutritional support is begun. 

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