A review of stability issues associated with vitamins in parenteral nutrition (original) (raw)
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JPEN. Journal of parenteral and enteral nutrition
Vitamin degradation occurring during the storage of total parenteral nutrition (TPN) mixtures is significant and affects clinical outcome. This study aimed to assess the influence of the TPN bag material, the temperature, and the duration of storage on the stability of different vitamins. Solutions of multivitamin and trace elements at recommended doses were injected into either an ethylvinyl acetate (EVA) bag or a multilayered (ML) bag filled with 2500 mL of an identical mixture of carbohydrates (1200 kcal), fat (950 kcal), and amino acids (380 kcal). The bags were then stored at 4 degrees C, 21 degrees C, or 40 degrees C. Concentrations of vitamins A, B1, C, and E were measured up to 72 hours after compounding, using high-pressure liquid chromatography. Ten percent to 30% of vitamin C degradation occurred within the first minutes after TPN compounding. Vitamin C was more stable in ML bags (half-life: 68.6 hours at 4 degrees C, 24.4 hours at 21 degrees C, and 6.8 hours at 40 degree...
Nutrition Journal, 2011
Background: The objective of this work was to study the vitamins B 1 , B 2 , B 6 and C stability in a pediatric formulation containing high amounts of calcium in the presence of organic phosphate, amino acids, glucose, sodium chloride, magnesium sulfate, pediatric vitamins and trace elements under different conditions using developed and validated analytical methods. Methods: The study was carried out during 72 h with formulations packaged in recommended storage temperature (4°C) and 25°C, with and without photoprotection.
Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper
Journal of Parenteral and Enteral Nutrition
Background: Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. Methods: Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. Results: The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. Conclusion: Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
Gastroenterology, 2009
This research workshop in 2009 grew out of a concern in the United States, Europe, and other countries with advanced medicine that it was time to revisit the parenteral requirements for a number of micronutrients. Critical questions sought to be answered included the following: Were there micronutrients not routinely added that should be part of a parenteral nutrition (PN) formula? Were other micronutrients present but in inappropriate amounts? How are various micronutrient requirements altered in the critically or chronically ill?
Approach to Parenteral Nutrition
2007
Learning Objectives • To know the different systems for parenteral nutrition; their advantages and limits; • To know the risks associated with the compounding/ready-to-use preparation of AiO PN admixtures (GMP and potential incompatibility reactions) and the pharmacist's tasks and responsibility for an admixing service; • To understand the general advice not to admix drugs to PN AiO admixtures, unless documented or of a vital need; • To understand to apply a risk assessment for adding an i.v. drug to an AiO admixture for both the influence of a drug on a PN admixture and the influence of a PN admixture on the fate of a drug. Key Messages • The all-in-one concept is a milestone in the search for safe, efficient, and convenient PN in acute and (home) long-term treatment. It has stimulated technical and pharmaceutical developments; • Standard AIO regimes are used in most cases for PN treatment of adult patients in hospital acute care. Nevertheless, individualised and tailor-made PN admixtures are also needed to meet the specific nutritional requirements of children (growth), those with severe illnesses including organ failures, and patients on a long-term (home) PN. Well designed cost-effectiveness studies are still lacking; • The compounding of AiO admixtures or the final ready-to-use preparation of industrial AIO premixes are critical pharmaceutical issues. Good manufacture practice (GMP) rules have to be respected when compounding AiO PN or admixing nutritional components and drugs. The pharmacist as the manufacturing supervisor has to take specific responsibility to guarantee quality and stability of ready-to-use prepared admixtures. As a nutrition support team member he has to define and implement standards of correct storage and handling of AiO admixtures. These standards must reflect professional state of the art practice; • Because of their complex composition and the character of o/w emulsions, PN AiO admixtures have high and potentially harmful instability risks. Instability reactions include physico-chemical Copyright © 2007 by ESPEN incompatibilities and microbial instability due to incorrect aseptic manipulation technique both of which represent avoidable medication errors. The most important incompatibility and instability reactions in AiO admixture can be classified according to their physico-chemical reaction type: emulsion deterioration, lipid peroxidation, oxidation of vitamins, and formation of insoluble precipitates. Measures to avoid them therefore need pharmaceutical expertise and advice and depend on the characteristics of the pharmaceutical nutrient or drug concerned; • AiO admixtures are not suitable as drug vehicles due to their complex formulation and the high potential for interaction in vivo and in vitro. If admixture of a drug is necessary, it is helpful to have a simple and easy to understand procedure for risk assessment, based on the degree of need for the medication and on the physico-chemical profiles of the AiO admixture and the drug.