title: Physical stability of a total nutrient admixture for total parenteral nutrition.
abstract: The stability of a total nutrient admixture (TNA) has been postulated to be less than 7 days in refrigerated storage. When a TNA destabilizes, lipid particles coalesce and enlarge. Liposomes larger than 6 microns can obstruct pulmonary capillaries. A TNA containing 1500 ml of 7% Vamin, 1000 ml of 50% dextrose and 500 ml of 10% Intralipid, including the usual electrolytes, minerals and vitamins, was studied. Liposome size was measured in the original Intralipid and the TNA at intervals up to 14 days at 4 degrees C followed by 2 days at 22 degrees C. There was a small increase in liposome size up to 16 days. However, the number of particles larger than 6 microns was insignificant (by light microscopy, 3.9 +/- 2.4 [+/- SD] per 20 high-power fields; by Coulter counter, 99.8% smaller than 1.9 microns, with 0% larger than 6 microns; and by electron microscopy, 100% smaller than 2.0 microns). The osmolality and pH of the TNA were 1472 +/- 31 mOsm/kg and 5.5 +/- 0.1 respectively (mean +/- SD), with no significant change during the study times. The authors concluded that this TNA remains physically stable when refrigerated for 14 days and at room temperature for a further 2 days.
authors.affiliation: Department of Surgery, University of Toronto, Ont.
authors.forename: M
authors.initials: M
authors.lastname: Deitel
authors.forename: L C
authors.initials: LC
authors.lastname: Smith
authors.forename: K L
authors.initials: KL
authors.lastname: Friedman
authors.forename: P J
authors.initials: PJ
authors.lastname: Lea
authors.forename: D J
authors.initials: DJ
authors.lastname: Grant
authors.forename: H K
authors.initials: HK
authors.lastname: Giang
authors.forename: B
authors.initials: B
authors.lastname: Calvieri
authors.forename: J
authors.initials: J
authors.lastname: Go
authors.forename: T B
authors.initials: TB
authors.lastname: To
mesh_terms: D000596:Amino Acids; D003080:Cold Temperature; D004355:Drug Stability; D004356:Drug Storage; D004573:Electrolytes; D005069:Evaluation Studies as Topic; D005947:Glucose; D006863:Hydrogen-Ion Concentration; D008081:Liposomes; D008855:Microscopy, Electron, Scanning; D057947:Parenteral Nutrition Solutions; D010289:Parenteral Nutrition, Total; D010316:Particle Size; D012996:Solutions; D013997:Time Factors
chemical_list: D000596:Amino Acids; D004573:Electrolytes; D008081:Liposomes; D057947:Parenteral Nutrition Solutions; D012996:Solutions; C545824:amino-acid, glucose, and electrolyte solution; D005947:Glucose