Total parenteral nutrition solutions

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. 

Mirtallo JM, Rogers KR, Johnson JA, et al. Stability of amino acids and the availability of acid in total parenteral nutrition solutions containing hydrochloric acid. Am J Hosp Pharm 1981 38 1729-1731. 

Also at risk are those with chronic renal disease infants receiving formula (particularly total parenteral nutrition solutions containing considerable Al which comes from Ca and phosphate sources) and those who consume pharmaceuticals, such as antacids containing Al (Syracuse 1999). 

Dialysate solutions should not contain more than O.OlmgAlL" (AAMI 2001). The US FDA set an upper acceptable limit of 0.025 mg AIL in large- and small-volume parenterals used in total parenteral nutrition solutions (US FDA 2000). 

Farago, S., 1983, Compatibility of antibiotics and other drugs in total parenteral nutrition solutions. Can. J. Hosp. Pharmacol. 34 43. 

Hartline, J. V., and Azchman, R. D., 1976, Vitamin A delivery in total parenteral nutrition solution. Pediatrics 58 448. 

Sayers, M. H., Johnson, D. K., Schumann, L. A., Ivery, M. F., Young, J. H., and Finch, C. A., 1983, Supplementation of total parenteral nutrition solutions with ferrous citrate, J. Parent. Enter. Nutr. 7 117. 

Vitamin analyses in elemental diets are frequently required for process and quality control. Van der Horst et al. developed reversed phase methodology to determine the water-soluble vitamins, including PN, in total parenteral nutrition solutions (103). Iwase described a HPLC method to analyze the aqueous extract from an elemental pediatric diet for PN and nicotinamide (104). Chromatography involved a two-column, double-UV detector system to allow simultaneous determination of both PN and nicotinamide (104). 

A van der Horst, HJM Martens, PNFC de Goede. Analysis of water-soluble vitamins in total parenteral nutrition solution by high pressure liquid chromatography. Pharm Week Sci 11 169-174, 1989. 

Typical biological fluids include blood and blood serum, blood plasma, urine and saliva. Measurement of calcium in serum was the first analysis to which the technique of AAS was applied and is an obvious example of how FAAS is useful for biomedical analysis. Other specimens e.g. dialysis fluids, intestinal contents, total parenteral nutrition solutions, may be analysed on rare occasions. Elements present at a sufficiently high concentration are lithium and gold when used to treat depression and rheumatoid arthritis respectively, and calcium, magnesium, iron, copper and zinc. Sodium and potassium can be determined by FAAS but are more usually measured by flame atomic emission spectroscopy or with ion selective electrodes. Other elements are present in fluids at too low a concentration to be measured by conventional FAAS with pneumatic nebulization. With other fluids, e.g. seminal plasma, cerebrospinal fluid, analysis may just be possible for a very few elements. 

Panthenol is frequently used in ointments and solutions for the treatment of burns, anal fissures, and inflammation of the conjunctiva. The vitamin has to be substituted in patients on total parenteral nutrition and in those who regularly undergo dialysis. Hypervitamin-osis has not been observed for doses up to 5 g/d (22). Furthermore, the administration of pantothenic acid leads to improved surgical wound healing due to its antiinflammatory properties. 

The composition of body fluids remains relatively constant despite the many demands placed on the body each day. On occasion, these demands cannot be met, and electrolytes and fluids must be given in an attempt to restore equilibrium. The solutions used in the management of body fluids discussed in this chapter include blood plasma, plasma protein fractions, protein substrates, energy substrates, plasma proteins, electrolytes, and miscellaneous replacement fluids. Electrolytes are electrically charged particles (ions) that are essential for normal cell function and are involved in various metabolic activities. This chapter discusses the use of electrolytes to replace one or more electrolytes that may be lost by the body. The last section of this chapter gives a brief overview of total parenteral nutrition (TPN). 

Peroxide formation has also been observed in multivitamin solutions for parenteral nutrition. Lavoie and co-workers [30] have studied the action of light, air, and composition on the stability of multivitamin formulations, and also total parenteral nutrition (TPN) admixtures containing and not containing vitamins and fatty acids. They analyzed the generation of peroxide in multivitamin solutions and in TPN for adults and neonates. The analysis of multivitamin solutions for enteral use revealed the presence of peroxides at the initial opening of the bottle. The levels were higher in Poly-Vi-Sol (vitamin A, Vitamin D, and vitamin C, vitamin Bb riboflavin, and... 

Physicochemical incompatibilities are of particular concern when parenteral administration is planned. For example, when calcium and phosphate ion concentrations are excessively high in a total parenteral nutrition (TPN) solution, precipitation will occur. Similarly, the simultaneous administration of antacids or products high in metal content may compromise the absorption of many drugs in the intestine, eg, tetracyclines. The package insert and the Handbook on Injectable Drugs (Trissel 2003) are good sources for this information. 

Brain enlargement and cerebral edema were observed upon autopsy of a boy who died after ingesting potassium dichromate (Kaufman et al. 1970). However, more chronic lower exposures to chromium(III) did not result in any somatopsychic changes in patients on total parenteral nutrition (TPN) solutions (Lovrincevic et al. 1996). In this study, the TPN patients were examined for somatopsychic responses. 

Severe negative nitrogen balance may occasionally have to be corrected by hyperalimentation or total parenteral nutrition (TPN). Intravenous solutions used in TPN contain essential and nonessential amino acids, plus a source of calories in the form of fat and carbohydrate. They "spare" the administered amino acids and allow them to be used for tissue repair. The TPN fluid must also contain all other nutritional factors required for life, including essential fatty acids, vitamins, and minerals. Severe metal and essential fatty acid deficiencies have been observed in situations in which such inclusions had not been made. 

Vargas JH, Klein GL, Ament ME, Ott SM, Sherrard DJ, Horst RL, Berquist WE, Alfrey AC, Slatopolsky E, Coburn JW. Metabolic bone disease of total parenteral nutrition course after changing from casein to amino acids in parenteral solutions with reduced aluminium content. Am J Clin Nutr 1988 48(4) 1070-8. 

Craig RM, Coy D, Green R, Meersman R, Rubin H, Janssen I. Hepatotoxicity related to total parenteral nutrition comparison of low-hpid and lipid-supplemented solutions. J Crit Care 1994 9(2) 111-13. 

Other incompatibilities include the inactivation of certain types of insulin due to the chelation of zinc, and the chelation of trace metals in total parenteral nutrition (TPN) solutions following the addition of TPN additives stabilized with disodium edetate. Calcium disodium edetate has also been reported to be incompatible with amphotericin and with hydralazine hydrochloride in infusion fluids. 

In parenteral formulations, medium-chain triglycerides have similarly been used in the production of emulsions, solutions, or suspensions intended for intravenous administration. Medium-chain triglycerides have been particularly investigated for their use in total parenteral nutrition (TPN) regimens in combination with long-chain triglycerides. ... 

Additionally, sodium bicarbonate is used in solutions as a buffering agent for erythromycin, lidocaine, local anesthetic solutions, and total parenteral nutrition (TPN) solutions. In some parenteral formulations, e.g., niacin, sodium bicarbonate is used to produce a sodium salt of the active ingredient that has enhanced solubility. Sodium bicarbonate has also been used as a freeze-drying stabilizer and in toothpastes. 

The solubility of calcium and phosphate in total parenteral nutrition (TPN) solutions is dependent on the pH of the solution. TPN solutions are, of course, clinically acceptable only when precipitation can be guaranteed not to occur. Dibasic calcium phosphate, for example, is soluble only to the extent of 0.3 g dm whereas monobasic calcium phosphate has a solubility of 18 g dm . At low pH the monobasic form predominates, while at higher pH values the dibasic form becomes available to bind with calcium and precipitates tend to form. ... 

As stated previously, contaminated products injected directly into the bloodstream or instilled into the eye cause the most serious problems. Intrathecal and epidural injections are potentially hazardous procedures. In practice, epidural injections are frequently given through a bacterial filter. Injectable and ophthalmic solutions are often simple solutions and provide Gram-negative opportunist pathogens with sufficient nutrients to multiply during storage if contaminated, a bioburden of 106 CFU as well as the production of endotoxins should be expected. Total parenteral nutrition fluids, formulated for individual patients ... 

In mineral supplementation in humans the oral route is the most commonly used, the supplement being given as a tablet, capsule, solution or as a fortified food. Injections are usually reserved for those cases where the patient is unable to eat due to damage to the gastrointestinal tract Or other reason, e.g. in patients on total parenteral nutrition it may be difficult to maintain adequate levels of iron, and supplementation by intramuscular injections of iron, for example, as a sorbitol complex will often be required. In view of the importance of the oral route it is helpful to consider the more salient general aspects of gastrointestinal absorption. 

Preparations for total parenteral nutrition (TPN) are complex formulations intended for administration by the intravenous route. TPN preparations are formulated as aqueous solutions or hydrophilic (oil-in-water) emulsions they may contain amino acids, carbohydrates, fatty acids, emulsifiers, electrolytes, trace metals, vitamins, and minerals (Hutchinson, 1998 Trissel, 2001). In certain cases, drugs are added to the preparations prior to administration. The environment is thus rather heterogeneous, and the photochemical stability of different components can vary from formulation to formulation and be hard to predict. It is necessary to perform experiments based on studies of the actual composition to obtain correct information concerning photostability of the formulation or components present. 

Chromium is a trace metal that helps maintain normal glucose metabolism and peripheral nerve function. It is used as a supplement to IV solutions given for total parenteral nutrition (TPN) to prevent depletion of endogenous stores and subsequent deficiency symptoms. 

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