title: Extraction of diethylhexylphthalate by home total parenteral nutrition from polyvinyl chloride infusion lines commonly used in the home.
abstract: OBJECTIVE
  Recently, our group detected that polyvinyl chloride (PVC) perfusion lines leach large amounts of the toxic plasticizer diethylhexylphthalate (DEHP) under conditions typical of intensive care units. In the present study, we investigated the extraction of DEHP from PVC connecting tubes that are commonly used for total parenteral nutrition (TPN) solutions. The aim of the study was to estimate the amount of DEHP to which children receiving home TPN are exposed for months and years.
  
  
  METHODS
  1000 mL of TPN, identical in constitution and amount to the home TPN of 1 of our patients, were perfused through 5 different connecting tube systems and collected in hexane-rinsed glass bottles. The concentration of DEHP in the TPN was analyzed before and after perfusion.
  
  
  RESULTS
  Before perfusion of the lines, the solution had a DEHP concentration of 0.05 to 0.69 microg/mL (baseline value). After perfusion of the lines, the load of DEHP in the solution varied between 1.41 and 2.07 microg/mL. This TPN was established for children weighing 20 kg. The daily dosage is between 71 and 104 microg x kg(-1) x day(-1). TPN is administered at home for many months and years. The monthly charge of DEHP is between 42.3 and 62.1 mg. Children weighing 20 kg therefore receive a dosage between 2.1 and 3.1 mg x kg(-1) x month(-1).
  
  
  CONCLUSIONS
  Diethylhexylphthalate and its metabolite monoethylhexylphthalate have been demonstrated to be carcinogenic, embryotoxic, hepatotoxic, pneumotoxic, and cardiotoxic and are known to disrupt endocrine pathways and liver detoxifying capacity in animals. They are suspected of having multiple effects in humans as well. The doses presented above should therefore be avoided in children receiving home TPN by the use of tubing systems that are completely free of DEHP. Such systems are available.
authors.affiliation: University Clinic of Pediatric Surgery, University of Marburg, Marburg, Germany. loff@med.uni-marburg.de
authors.forename: Steffan
authors.initials: S
authors.lastname: Loff
authors.forename: Torsten
authors.initials: T
authors.lastname: Hannmann
authors.forename: Ulrike
authors.initials: U
authors.lastname: Subotic
authors.forename: Franziska-Maria
authors.initials: FM
authors.lastname: Reinecke
authors.forename: Hartmut
authors.initials: H
authors.lastname: Wischmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Brade
mesh_terms: D002648:Child; D004051:Diethylhexyl Phthalate / Q000009:adverse effects / Q000737:chemistry / Q000302:isolation & purification*; D004340:Drug Contamination; D005217:Fat Emulsions, Intravenous / Q000032:analysis*; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous / Q000009:adverse effects; D016562:Parenteral Nutrition, Home Total / Q000295:instrumentation*; D010968:Plasticizers / Q000009:adverse effects / Q000737:chemistry / Q000302:isolation & purification*; D011143:Polyvinyl Chloride / Q000009:adverse effects / Q000737:chemistry; D013997:Time Factors
chemical_list: D005217:Fat Emulsions, Intravenous; D010968:Plasticizers; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate