title: Calcium Chloride in Neonatal Parenteral Nutrition Solutions with and without Added Cysteine: Compatibility Studies Using Laser and Micro-Flow Imaging Methodology.
abstract: BACKGROUND
  Previous studies of compatibility of calcium chloride (CaCl2) and phosphates have not included particle counts in the range specified by the United States Pharmacopeia. Micro-flow imaging techniques have been shown to be comparable to light obscuration when determining particle count and size in pharmaceutical solutions.
  
  
  OBJECTIVE
  The purpose of this study was to do compatibility testing for parenteral nutrition (PN) solutions containing CaCl2 using dynamic light scattering and micro-flow imaging techniques.
  
  
  METHODS
  Solutions containing TrophAmine (Braun Medical Inc, Irvine, CA), CaCl2, and sodium phosphate (NaPhos) were compounded with and without cysteine. All solutions contained standard additives to neonatal PN solutions including dextrose, trace metals, and electrolytes. Control solutions contained no calcium or phosphate. Solutions were analyzed for particle size and particle count. Means of Z-average particle size and particle counts of controls were determined. Study solutions were compared to controls and United States Pharmacopeia (USP) Chapter 788 guidelines. The maximum amount of Phos that was compatible in solutions that contained at least 10 mmol/L of Ca in 2.5% amino acids (AA) was determined. Compatibility of these solutions was verified by performing analyses of 5 repeats of these solutions. Microscopic analyses of the repeats were also performed.
  
  
  RESULTS
  Amounts of CaCl2 and NaPhos that were compatible in solutions containing 1.5%, 2%, 2.5%, and 3% AA were determined. The maximum amount of NaPhos that could be added to TrophAmine solutions of > = 2.5% AA containing at least 10 mmol/L of CaCl2 was 7.5 mmol/L. Adding 50 mg/dL of cysteine increased the amount of NaPhos that could be added to solutions containing 10 mmol/L of CaCl2 to 10 mmol/L.
  
  
  CONCLUSIONS
  Calcium chloride can be added to neonatal PN solutions containing NaPhos in concentrations that can potentially provide an intravenous intake of adequate amounts of calcium and phosphorus.
authors: Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, United States of America.
authors: Robert K
authors: RK
authors: Huston
authors: Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America.
authors: J Mark
authors: JM
authors: Christensen
authors: Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America.
authors: Sultan M
authors: SM
authors: Alshahrani
authors: Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR, United States of America.
authors: Sumeia M
authors: SM
authors: Mohamed
authors: Neonatal Pharmacy, Providence St. Vincent Medical Center, Portland, OR, United States of America.
authors: Sara M
authors: SM
authors: Clark
authors: School of Chemical, Biological, & Environmental Engineering, Oregon State University, Corvallis, OR, United States of America.
authors: Jeffrey A
authors: JA
authors: Nason
authors: Medical Data Research Center, Providence Health and Services, Portland, OR, United States of America.
authors: Ying Xing
authors: YX
authors: Wu
mesh_terms: D000596:Amino Acids / Q000737:chemistry; D002122:Calcium Chloride / Q000032:analysis*; D011232:Chemical Precipitation; D003545:Cysteine / Q000008:administration & dosage*; D000067493:Dynamic Light Scattering / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010288:Parenteral Nutrition / Q000379:methods; D057947:Parenteral Nutrition Solutions / Q000032:analysis*; D010316:Particle Size; D010710:Phosphates / Q000032:analysis*
chemical_list: D000596:Amino Acids; D057947:Parenteral Nutrition Solutions; D010710:Phosphates; D003545:Cysteine; D002122:Calcium Chloride; C018279:sodium phosphate