title: Calcium chloride and sodium phosphate in neonatal parenteral nutrition containing TrophAmine: precipitation studies and aluminum content.
abstract: OBJECTIVE
  The objectives were to determine concentrations of calcium chloride (CaCl) and sodium phosphate (NaPhos) that can be safely added to TrophAmine-based parenteral nutrition (PN) and to measure aluminum (Al) concentrations in PN solutions containing CaCl and NaPhos vs those containing calcium gluconate (CaGlu) and potassium phosphate (KPhos).
  
  
  METHODS
  In study A, PN solutions containing varying amounts of TrophAmine, CaCl, and NaPhos were compounded and then evaluated visually for precipitation. In study B, Al concentrations were measured in PN solutions containing CaCl and NaPhos (S1), CaGlu and NaPhos (S2), or CaGlu and KPhos (S3).
  
  
  RESULTS
  Study A showed that a maximum phosphorus concentration of 15 mmol/L could be added to a solution containing 12.5 mmol/L of calcium without evidence of precipitation when the amino acid (AA) concentration reached ≥3 g/dL (3%). In study B, the mean (range) Al concentrations were S1 = 2.2 (1.9-2.4), S2 = 8.5 (7.8-9.3), and S3 = 11.7 (10.8-12.2) µmol/L (means of 6.0, 22.9, and 31.5 micrograms/dL, respectively).
  
  
  CONCLUSIONS
  The data can provide a guide for compounding neonatal PN solutions containing TrophAmine, CaCl, and NaPhos. More studies are needed to determine the long-term effects of substituting CaCl for CaGlu in PN solutions for neonates. Substituting CaCl and NaPhos for CaGlu and KPhos significantly decreases Al concentrations in PN and potential Al exposure of neonatal patients.
authors.affiliation: Providence St Vincent Medical Center, Portland, Oregon 97225, USA. Evelyn.Migaki@providence.org
authors.forename: Evelyn A
authors.initials: EA
authors.lastname: Migaki
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Melhart
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Dewar
authors.forename: Robert K
authors.initials: RK
authors.lastname: Huston
mesh_terms: D000535:Aluminum / Q000009:adverse effects / Q000032:analysis*; D000596:Amino Acids / Q000494:pharmacology*; D002122:Calcium Chloride / Q000032:analysis*; D002125:Calcium Gluconate; D004573:Electrolytes / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D007231:Infant, Newborn; D057947:Parenteral Nutrition Solutions / Q000494:pharmacology*; D010289:Parenteral Nutrition, Total / Q000379:methods*; D010710:Phosphates / Q000032:analysis*; D010758:Phosphorus / Q000032:analysis; D017680:Potassium Compounds; D012995:Solubility; D012996:Solutions / Q000494:pharmacology
chemical_list: D000596:Amino Acids; D004573:Electrolytes; D057947:Parenteral Nutrition Solutions; D010710:Phosphates; D017680:Potassium Compounds; D012996:Solutions; C545824:amino-acid, glucose, and electrolyte solution; D010758:Phosphorus; C013216:potassium phosphate; D000535:Aluminum; D005947:Glucose; D002122:Calcium Chloride; C018279:sodium phosphate; D002125:Calcium Gluconate