A review of stability issues associated with vitamins in parenteral nutrition

Abstract

Background & aims: There has been a move to increased emphasis on delivering parenteral nutrition to patients at home, which may improve patient care and reduce costs. However, safe provision of home, and indeed any, parenteral nutrition necessitates consideration of the physical and chemical stability of the parenteral nutrition and its components.Methods: Medline and Embase were used to search for all English-language publications on vitamin stability. Identified publications were then analysed and summarised in the following review.Results: Vitamins are one of the least stable components in PN and there are three main ways in which they have been shown to degrade: photodegradation, oxidation and through storage material interaction.Previous research on vitamins has demonstrated that significant losses can occur in the bag, which could have clinical consequences, particularly for long-term users of parenteral nutrition. These losses are most dramatic for vitamin C, which is rapidly degraded by oxygen, and vitamin A, which is rapidly degraded in the presence of sunlight.Conclusions: There are a number of stability issues associated with vitamins in parenteral nutrition and further investigation is needed to assure their stability and compatibility with other parenteral nutrition constituents.

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications

“…The contributing factors to peroxidation of lipid emulsions are exposure to oxygen within the bag, photo-degradation, and an increasing ambient temperature, the type of container used, trace elements in the formulation and the content of alphatocopherol within the bag [84,99]. Peroxidation can therefore be minimised by the use of multi-layer bags, which reduce the amount of oxygen in the bag, a formulation with sufficient amounts of anti-oxidant alpha-tocopherol, which acts as free radical scavenger and anti-oxidant ascorbic acid [83,100] (LOE 3).…”

“…Vitamins are prone to stability issues due to photo-degradation, oxidation and interactions with PN bags and administration sets [100]. Ascorbic acid is very susceptible to oxidation.…”

“…This effect is seen when the bags are exposed to daylight but also artificial ambient light on the ward. Lipid opacity is not sufficient to prevent photo-degradation therefore the bags and administration sets both need to be light protective [100] (LOE 3).…”

Nanomedicine: a new paradigm to overcome drug incompatibilities

“…calcium, phosphate and magnesium salts) all affect the stability of vitamins. [30][31][32] Oxidation of ascorbic acid, a water-soluble vitamin, is the most common and important reaction that has been widely investigated, and the role of some bivalent ions as catalysts, especially copper, has been established. [33,34] Allwood showed that vitamin A is more susceptible to photodegradation when exposed to wavelengths less than 400 nm, with maximum degradation occurring between 330 and 350 nm.…”

Nanoemulsions for food fortification with lipophilic vitamins: Production challenges, stability, and bioavailability

“…All‐trans retinols and β‐carotene have the highest vitamin activities among the known retinoid and carotenoids which may undergo oxidation and isomerization reactions in the presence of oxygen, light and heat . Either sunlight or artificial light (e.g., white light bulbs in houses) may cause photodegradation of vitamin A, which play role in chemical stability of the vitamin in food formulations during storage or consumption . Isomerization of retinols induced by heat may lead to the formation of cis isomers which show very low vitamin activity .…”