title: Maximizing calcium and phosphate content in neonatal parenteral nutrition solutions using organic calcium and phosphate salts.
abstract: BACKGROUND
  The provision of high amounts of calcium and phosphate in parenteral nutrition (PN) solution for neonates is important for bone mass accretion. Because of the risk of calcium phosphate precipitation, a well-documented incompatibility for inorganic salts, the concentrations of these electrolytes in PN are generally limited to 5 mmol/L. The aim of this study was to assess the risk of precipitation of calcium phosphate when organic calcium and phosphate salts are used instead of inorganic salts.
  
  
  METHODS
  Precipitation curves were determined for inorganic and organic calcium and phosphate salts in a PN solution favorable to precipitation (low concentration of amino acids and glucose) using visual inspection and particle counts.
  
  
  RESULTS
  The use of organic phosphate salt was associated with a decreased risk of precipitation of calcium phosphate. No precipitation occurred up to a concentration of 50 mmol/L of calcium and phosphate. In contrast, organic calcium salt only slightly decreased the risk of precipitation.
  
  
  CONCLUSIONS
  Up to 50 mmol/L of organic calcium and phosphate salts can be safely mixed in PN, even in unstable conditions, making it possible to follow the current European recommendations for requirements in neonates.
authors.affiliation: Pharmacy, Geneva University Hospitals, Geneva, Switzerland. lucie.bouchoud@hcuge.ch
authors.forename: Lucie
authors.initials: L
authors.lastname: Bouchoud
authors.forename: Caroline
authors.initials: C
authors.lastname: Fonzo-Christe
authors.forename: Farshid
authors.initials: F
authors.lastname: Sadeghipour
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
mesh_terms: D002118:Calcium / Q000737:chemistry*; D002130:Calcium Phosphates / Q000737:chemistry*; D011232:Chemical Precipitation; D006801:Humans; D007231:Infant, Newborn; D009930:Organic Chemicals / Q000737:chemistry*; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D012306:Risk; D012492:Salts / Q000737:chemistry*; D012995:Solubility
chemical_list: D002130:Calcium Phosphates; D009930:Organic Chemicals; D057947:Parenteral Nutrition Solutions; D012492:Salts; D002118:Calcium