Precipitation limits in pediatric parenteral nutritions with organic sources of calcium and phosphate

• Published in: Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral Vol. 35; no. 5; pp. 1009 - 1016
• Main Authors: Lázaro Cebas, Andrea, Pablos Bravo, Siria, Gomis Muñoz, Pilar, Orbaneja, Miguel Ángel, Spiers, Samantha, Shinn, Martyn, Ferrari Piquero, José Miguel
• Format: Journal Article
• Language: Spanish
• Published: Spain 05.10.2018
• Subjects: Amino Acids - analysis; Calcium - chemistry; Consensus; Crystallization; Filtration; Organic Chemicals - chemistry; Parenteral Nutrition; Parenteral Nutrition Solutions - chemistry; Phosphates - chemistry
• ISSN: 1699-5198
• DOI: 10.20960/nh.1861

to determine if precipitation processes occur in parenteral nutrition solutions (PNs) with calcium gluconate and sodium glycerophosphate in the precipitation threshold limits of the Spanish SENPE/SEGHNP/SEFH 2008 consensus document of PN preparation. seven PNs with different composition were prepared in triplicate: five 100 ml PNs with different concentrations of amino acids, calcium and phosphorus similar to consensus document maximum concentrations for precipitation, and two control PNs: one without calcium and phosphorus and other with high calcium and phosphorus content and low concentration of amino acids. All PNs did not contain lipids to allow correct detection of precipitates. The no lipid PNs were stored at room temperature for 20 hours, and at 35 °C for four hours. Subsequently, they filtered through a 0.2 μm filter, which was observed by electron microscopy. Because a large amount of not expected precipitates was observed, complementary studies were carried out. precipitates were observed in all PNs except in the control solution without calcium and phosphorus; many of them were greater than 10 μm. However, according to our studies, these crystals were produced after filtration and calcium was found in their composition, but not phosphorus. Particles from the preparation of parenteral nutrition were also observed. in our study we did not find calcium phosphate precipitates in the limits included in the consensus document SENPE/SEGHNP/ SEFH. However, it is possible that micro precipitates with calcium are formed. It is important to filter PNs prior to their administration.