Compatibility and stability of additives in parenteral nutrition admixtures. 1998

M C Allwood, and M C Kearney
Medicines Research Unit, University of Derby, Mickleover, United Kingdom. M.C.Allwood@derby.ac.uk

The addition of additives (electrolytes, trace elements, and vitamins) to parenteral nutrition (PN) mixtures can lead to precipitation as a result of physical incompatibilities and can lead to chemical degradation of individual ingredients. The most significant cause of precipitation is excessive concentrations of calcium phosphate. The most significant cause of chemical instability is the oxidation of specific vitamins. The factors influencing calcium phosphate solubility include the commercial amino acid source, the calcium and phosphate salts used, temperature, magnesium concentration, and final volume. Precipitation can be avoided by organic phosphates. Trace element precipitation is most commonly caused by the formation of iron phosphate salts or copper cysteinate in cysteine-containing amino acid infusions. The least stable nutrient is ascorbic acid, which reacts with oxygen, and is catalyzed by copper ions. Oxygen originates from PN ingredients, the filling process, air remaining in the bag after filling, and oxygen permeation through the bag wall. Storage in multilayered bags with reduced gas permeability can protect residual ascorbic acid. Other chemical losses are caused by the reduction of thiamine by metabisulfite, and photodegradation of daylight-sensitive vitamins, especially retinol and riboflavin, during administration.

UI MeSH Term Description Entries
D010288 Parenteral Nutrition The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). Intravenous Feeding,Nutrition, Parenteral,Parenteral Feeding,Feeding, Intravenous,Feeding, Parenteral,Feedings, Intravenous,Feedings, Parenteral,Intravenous Feedings,Parenteral Feedings
D011232 Chemical Precipitation The formation of a solid in a solution as a result of a chemical reaction or the aggregation of soluble substances into complexes large enough to fall out of solution. Precipitation, Chemical
D002130 Calcium Phosphates Calcium salts of phosphoric acid. These compounds are frequently used as calcium supplements. Phosphates, Calcium
D002627 Chemistry, Physical The study of CHEMICAL PHENOMENA and processes in terms of the underlying PHYSICAL PHENOMENA and processes. Physical Chemistry,Chemistries, Physical,Physical Chemistries
D004355 Drug Stability The chemical and physical integrity of a pharmaceutical product. Drug Shelf Life,Drugs Shelf Lives,Shelf Life, Drugs,Drug Stabilities,Drugs Shelf Life,Drugs Shelf Live,Life, Drugs Shelf,Shelf Life, Drug,Shelf Live, Drugs,Shelf Lives, Drugs
D004573 Electrolytes Substances that dissociate into two or more ions, to some extent, in water. Solutions of electrolytes thus conduct an electric current and can be decomposed by it (ELECTROLYSIS). (Grant & Hackh's Chemical Dictionary, 5th ed) Electrolyte
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012995 Solubility The ability of a substance to be dissolved, i.e. to form a solution with another substance. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Solubilities
D012996 Solutions The homogeneous mixtures formed by the mixing of a solid, liquid, or gaseous substance (solute) with a liquid (the solvent), from which the dissolved substances can be recovered by physical processes. (From Grant & Hackh's Chemical Dictionary, 5th ed) Solution
D014131 Trace Elements A group of chemical elements that are needed in minute quantities for the proper growth, development, and physiology of an organism. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed) Biometal,Biometals,Trace Element,Trace Mineral,Trace Minerals,Element, Trace,Elements, Trace,Mineral, Trace,Minerals, Trace

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