Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions with Added Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology

Huston, Robert K.; Christensen, J. Mark; Alshahrani, Sultan M.; Mohamed, Sumeia M.; Heisel, Carl F.; Stout, Kim N.

doi:10.1002/jpen.1434

Cited by 6 publications

(15 citation statements)

References 24 publications

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“…An additional 2 papers were voted as important by a majority of the authors which allowed for a total of 6 papers to be identified for further evaluation. [7][8][9][10][11][12] An additional 9 articles comprising organizational guidelines, consensus, recommendation, and position papers included separately as important papers to our practice. [13][14][15][16][17][18][19][20][21] Of these 15 finalist articles, 6 were published in Journal of Parenteral and Enteral Nutrition, 6 in Clinical Nutrition, 2 in Journal of Trauma and Acute Care Surgery, and 1 in Nutrition in Clinical Practice.…”

Section: Resultsmentioning

confidence: 99%

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Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

et al. 2020

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Purpose The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2019 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 111 articles were identified; 6 from the primary literature were voted by the group to be of high importance. An additional 9 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

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Section: Resultsmentioning

confidence: 99%

“…3. Huston et al 8 Calcium chloride and calcium gluconate in neonatal parenteral nutrition solutions with added cysteine: Compatibility studies using laser light obscuration methodology…”

Section: First Author Titlementioning

confidence: 99%

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

et al. 2020

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“…Several studies have reported that the presence of cysteine in PN solution improves the compatibility of calcium phosphate. 27,28 Since cysteine is not used in our hospital, we did not include it in the current study.…”

Section: Discussionmentioning

confidence: 99%

Use of sodium glycerophosphate in neonatal parenteral nutrition solutions to increase calcium and phosphate compatibility for preterm infants

Wang

Hsieh

Liu

et al. 2020

Pediatrics & Neonatology

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Background: Preterm infants require higher calcium and phosphate intake than term infants to facilitate adequate bone growth, but this is rarely met in parenteral nutrition (PN) solution because of the limited solubility of calcium and phosphate. This study aimed to evaluate the solubility of organic phosphate with calcium gluconate in neonatal PN solutions, simulating its clinical use. Methods: PN solutions were composed of calcium gluconate at 50 mEq/L and sodium glycerophosphate (NaGP) at 25 mmol/L. Another component included 1% or 4% amino acid and 10% or 20% dextrose. For comparison, PN solution composed of potassium phosphate was also evaluated. Each solution was evaluated using the following methods: visual inspection, light obscuration particle count test, and pH measurement. To simulate the clinical condition, the solution was tested after compounding, after being stored at 25 C for 24 h, and after being stored at 2 C-8 C for 2 or 9 days and subsequently at 25 C for 24 h. Results: There was no visual deposition in PN solution using NaGP in any of the concentrations and under any stored condition. The solution fulfilled the criteria of physical compatibility as < 25 particles/mL measuring !10 mm in diameter and <3 particles/mL measuring !25 mm in diameter. On the contrary, visual deposition was evidently noted in PN solution using potassium phosphate after its formulation, and the particle count significantly exceeded the range of physical compatibility. Pediatrics and Neonatology (2020) 61, 331e337 Conclusion: NaGP and calcium gluconate have significantly good compatibility in PN solution. The use of NaGP in neonatal PN prevents calcium and phosphorus precipitation, hence increasing their supply to preterm infants in meeting their growth requirement.

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“…Methods for processing and evaluating PN solutions as well as performing particle counts visually, microscopically, and using LO following USP 788 methods have been described previously. 8 Additives that were included in the PN solutions are shown in Table 1. Multivitamins were not added because of the intermittent shortages of availability.…”

Section: Methodsmentioning

confidence: 99%

High particle counts in neonatal parenteral nutrition solutions with added cysteine: Relationship to crystal formation and effect of filtration on cysteine content

Huston¹,

Christensen

Mohamed

et al. 2021

J Parenter Enteral Nutr

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Background: Parenteral nutrition(PN) solutions containing calcium gluconate and cysteine have elevated particle counts when analyzed using laser light obscuration (LO) as recommended by the United States Pharmacopeia. It is unclear whether increased particle formation in these solutions results in decreased availability of cysteine to neonatal patients due to filtration. Objective:The purpose of this study was to measure cysteine concentrations in neonatal PN solutions before and after filtration as well as analyze precipitates on filters.Methods: Solutions of PN containing amino acids with and without cysteine that were compounded with calcium chloride or calcium gluconate plus potassium phosphate were analyzed using LO. Concentrations of cysteine were measured before and after filtration. The effect on particle formation of magnesium sulfate (MgSO 4 ) and D70 was also evaluated.Results: Multiple additives including the specific calcium or D70 additive, cysteine, and MgSO 4 influenced particle formation of particles detected using LO. There was no significant decrease in cysteine concentration because of filtering and there was no difference in the amount of calcium on filters of various solutions after filtration regardless of LO particle counts. Scanning electron micrographic (SEM) analysis found no significant differences in crystal composition. Light microscopic and SEM examination did not show evidence of high particle counts on filters. Conclusion:The increased particle counts detected in neonatal PN solutions containing cysteine added at the time of compounding does not appear to result in increased precipitate or crystal formation. It is not associated witha decrease in cysteine delivery to patients.

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Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions with Added Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology

Abstract: This study found that neonatal PN solutions containing CaGlu with added cysteine have significantly higher particle counts, exceeding USP guidelines for compatibility, than those containing CaCl .

Cited by 6 publications

References 24 publications

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

Use of sodium glycerophosphate in neonatal parenteral nutrition solutions to increase calcium and phosphate compatibility for preterm infants

High particle counts in neonatal parenteral nutrition solutions with added cysteine: Relationship to crystal formation and effect of filtration on cysteine content

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