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[Oxidation of lipids contained in total parental nutrition]
M A Balet Duat1, D Cardona Pera
1Hospital Santa Cruz y San Pablo, Servicio de Farmacia, Barcelona, España.
Insights
Parenteral nutrition (PN) mixtures can oxidize, forming toxic lipoperoxides, especially harmful to newborns and critically ill patients. Current literature lacks a safe peroxide level, necessitating further research into PN oxidation and analysis.
Area of Science:
- Biochemistry
- Clinical Nutrition
- Oxidative Stress
Context:
- Parenteral nutrition (PN) mixtures contain components susceptible to oxidation.
- Oxidation of polyunsaturated lipids generates toxic lipoperoxides.
- Vulnerable populations include neonates and critically-ill patients due to immature or increased oxidative stress.
Purpose:
- To review the toxicity of lipoperoxides.
- To identify factors influencing PN mixture oxidation.
- To evaluate analytical methods for peroxide determination in PN mixtures.
Summary:
- Key oxidation factors include polyunsaturated fatty acid content, bisulphite, vitamin complexes, temperature, bag type, and light exposure.
- Analytical methods include iodine analysis, HPLC, thiobarbituric acid test, and ferrous ion oxidation.
- Methods can quantify total peroxides or specific lipoperoxides.
Impact:
- Highlights the risks associated with oxidized PN, particularly for vulnerable patient groups.
- Underscores the need for standardized analytical methods and safety thresholds for peroxides in PN.
- Informs clinical practice and future research on PN stability and safety.
Abstract:
The components used in parenteral nutrition mixtures are subject to oxidation. The oxidation of polyunsaturated lipids leads to the formation of toxic lipoperoxides. This toxicity is of particular significance in new-born children, because of the lack of maturity of their defensive systems against oxidative processes, and also in critically-ill patients, whose oxidative metabolism is increased. A review of the literature is effected to assess the following: toxicity of lipoperoxides, factors involved in the oxidation of parenteral nutrition mixtures and the analytical methods used to determine the peroxides present in parenteral nutrition mixtures. The factors influencing the oxidation of parenteral nutrition mixtures include: the amount of polyunsaturated fatty acids, the presence of bisulphite, vitamin complexes and their polysorbate content, temperature, type of bag and exposure to light. The analytical methods found for the analysis of peroxides in TPN mixtures are: iodine measurement analysis, high resolution liquid chromatography, the thiobarbituric acid test, and oxidation of the ferrous cation in the presence of xylenol orange. Depending on the method, it is possible to determine total peroxides or only lipoperoxides. The literature reviewed does not establish a threshold level of peroxide concentration below which a parenteral nutrition mixture can be considered safe.