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Oxalogenesis in parenteral nutrition solution components
G F Rockwell1, T Campfield, B C Nelson
1Department of Pediatrics, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA. Gary.Rockwell@BHS.org
Nutrition (Burbank, Los Angeles County, Calif.)
|December 3, 1998
Summary
Oxalate precipitates can form in neonatal total parenteral nutrition (TPN) solutions. Ascorbate addition to TPN with trace metals may increase oxalate formation, posing risks for premature infants.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Clinical Nutrition
Background:
- Oxalate is linked to nephrocalcinosis in premature infants.
- Insoluble oxalate precipitates form in total parenteral nutrition (TPN) intravenous tubing.
- Ascorbate oxidation to oxalate, catalyzed by copper and iron, is a suspected cause.
Purpose of the Study:
- To quantify oxalate formation in individual TPN components.
- To measure oxalate formation when TPN components are combined.
- To simulate clinical conditions for neonatal TPN infusion.
Main Methods:
- Infusion of neonatal TPN solution components at 5 mL/h under simulated clinical conditions.
- Assay of aliquots at intervals for oxalate concentration.
- Capillary electrophoresis used for oxalate quantification.
Main Results:
- Oxalate was detected in one TPN mixture at concentrations up to 8 ppm.
- The addition of ascorbate to an aqueous solution containing trace metals potentially promotes oxalogenesis.
Conclusions:
- Oxalate formation is a concern in neonatal TPN solutions.
- Ascorbate and trace metals in TPN may contribute to oxalate precipitate formation.
- Further investigation is needed to understand and mitigate risks in neonatal intensive care units.