Effect of the intravenous lipid emulsions on the availability of calcium when using organic phosphate in TPN admixtures.
OBJECTIVE
The addition of high amounts of calcium remains a pharmaceutical concern due to its precipitation with phosphate in total parenteral nutrient (TPN) admixtures, compromising also the stability of the lipid emulsion.


METHODS
Calcium-phosphate solubility was compared when using binary PN solutions versus all-in-one TPN (admixtures with lipid emulsions) in three formulas using organic calcium gluconate and glucose-1-phosphate.


RESULTS
It was found that variation of Ca-P solubility exists between formulation with or without lipid emulsions. Concentrations of Ca decreased after filtrations of all admixtures (from 5% to 30%) and it was more significant in binary solutions. Precipitation has been observed by microscopy at high concentrations of both organic Ca-P after critical conditions of storage (24 h at 37 degrees C plus one day at ambient temperature) for admixtures containing 1% amino acids and 8% glucose with or without lipids compared to admixtures containing 2% or 3.5% amino acids and 14% glucose.


CONCLUSIONS
These data demonstrated that availability of Ca using organic glucose-1-phosphate increased when lipids were present in TPN admixtures, without alteration of the lipid emulsion. Thus, high amounts of Ca (up to 30 mmol/l) and phosphates (up to 40 mmol/l) might be provided safely in parenteral nutrition admixtures.
Chaieb D
Sonia
S
Centre National de Greffe de Moelle Osseuse de Tunis, Jebbary Bab Saadoun, 1006 Tunis, Tunisia. sonia.chaieb@rns.tn
Chaumeil
Jean Claude
JC
Jebnoun
Sami
S
Khrouf
Naima
N
Hedhili
Abderrazek
A
Sfar
Souad
S
D002118:Calcium / Q000737:chemistry*; D011232:Chemical Precipitation; D004355:Drug Stability; D005217:Fat Emulsions, Intravenous / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010289:Parenteral Nutrition, Total; D010316:Particle Size; D010710:Phosphates / Q000737:chemistry*
D005217:Fat Emulsions, Intravenous; D010710:Phosphates; D002118:Calcium