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

Andrea Lázaro Cebas1, Siria Pablos Bravo, Pilar Gomis Muñoz

  • 1Hospital 12 de Octubre. andrea.lazaro@salud.madrid.org.

Nutricion Hospitalaria
|October 12, 2018
PubMed

Insights

Parenteral nutrition (PN) solutions with calcium and phosphorus did not form calcium phosphate precipitates within recommended limits. However, calcium-containing micro-precipitates may form, highlighting the importance of filtering PN before administration.

Area of Science:

  • Parenteral nutrition
  • Clinical pharmacy
  • Materials science

Background:

  • Parenteral nutrition (PN) solutions require careful preparation to prevent precipitation.
  • The Spanish SENPE/SEGHNP/SEFH 2008 consensus document provides guidelines for PN preparation to avoid precipitation.
  • Calcium gluconate and sodium glycerophosphate are common components in PN formulations.

Purpose of the Study:

  • To investigate precipitation in parenteral nutrition (PN) solutions containing calcium gluconate and sodium glycerophosphate.
  • To assess precipitation at concentrations within the limits specified by the Spanish SENPE/SEGHNP/SEFH 2008 consensus document.

Main Methods:

  • Prepared seven different PN solutions without lipids, varying amino acid, calcium, and phosphorus concentrations.
  • Stored PN solutions at room temperature (20 hours) and 35 °C (4 hours).
  • Filtered PN solutions through a 0.2 μm filter and examined precipitates using electron microscopy.

Main Results:

  • Precipitates were observed in all tested PN solutions except the control without calcium and phosphorus.
  • Many observed precipitates exceeded 10 μm in size.
  • Post-filtration analysis revealed calcium in the precipitates, but not phosphorus, suggesting non-calcium phosphate precipitation.

Conclusions:

  • Calcium phosphate precipitates were not detected within the specified limits of the consensus document.
  • The formation of calcium-containing micro-precipitates is possible.
  • Filtering parenteral nutrition solutions before administration is crucial to minimize risks.
Abstract

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