["All in one" parenteral nutrition: is it that safe?]

The use of "all in one" admixtures is supported by an extensive number of studies and by many years of experience. However, we detected stability problems in some mixtures whose stability was previously reported. We made modifications in one of these mixtures [composed of 1.000 ml Freamine 8.5%, 100 ml 10% dextrose, 500 ml water, 500 ml Intralipid 20%, 75 ml electrolyte solution (Na 75 mEq, K 60 mEq, Ca 15 mEg, Mg 15 mEq, Cl 90 mEq, acetate 75 mEq)] in order to see how the different components affect the emulsion stability. All the admixtures were visually inspected after storage during 24 hour at room temperature. It was observed that admixtures with low glucose concentration, high electrolyte levels and high volume were less stable than admixtures containing high glucose, low electrolyte and low volume. Amino acid concentration did not increased the stability as expected. MCT/LCT emulsions were more stable than LCT emulsions. More studies are needed to explain the stability problems of these TPN solutions.