Compatibility of Calcium Chloride and Calcium Gluconate with Sodium Phosphate in a Mixed TPN Solution

Henry, RS; Rw, Jurgens; Rj, Sturgeon; Athanikar, Narayan K.; Welco, A; Leuven, M Van

doi:10.1093/ajhp/37.5.673

Cited by 36 publications

(54 citation statements)

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“…3 Although CaGlu has been consistently found to have significantly higher levels of Al contamination compared with CaCl, [4][5][6] CaGlu has been used in neonatal PN solutions by many centers to provide increased Ca intake instead of solutions containing CaCl. Currently, the FDA recommends limiting the Al intake from contamination of PN for preterm infants to ≤0.19 µmol/ kg/d (≤5 µg/kg/d).…”

Section: Infantsmentioning

confidence: 99%

Neonatal Parenteral Nutrition Containing Calcium Chloride and Sodium Phosphate

Huston¹,

McCulley

Markell

et al. 2012

ICAN: Infant, Child, & Adolescent Nutrition

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Objective. The authors' objectives were to determine mineral as well as Al intakes for ≤1000 g birth weight (ELBW) infants supported with parenteral nutrition (PN) solutions containing calcium chloride (CaCl) and sodium phosphate (NaPhos). Study design. This study was a prospective cohort study of 32 ELBW infants. Nutrient and Al intakes were recorded based on actual fluid intakes and concentrations of nutrients and Al in PN solutions. Growth velocities and peak alkaline phosphatase (AP) levels during the hospital stay were recorded. Result. Mean (±standard deviation) weight, length, and head circumference gains and AP were 13.7 ± 1.8 g/kg/d, 1.0 ± 0.2 cm/wk, 0.7 ± 0.1 cm/wk, and 636 ± 227 U/L, respectively. Al intake was 0.27 ± 0.07 µmol/kg/d (7.2 ± 1.8 µg/ kg/d) in infants receiving PN with low Al content. This study documented average parenteral Ca and P intakes of 1.15 to 1.20 and 1.19 to 1.29 mmol/ kg/d, (46-48 and 37-40 mg/kg/d), respectively, with PN fluid intakes of 90 to 100 mL/kg/d. Conclusion. AP and growth in ELBW infants receiving PN solutions containing CaCl are comparable to those reported in the literature for ELBW infants. Ca and P intakes approaching those reported for preterm infants receiving PN containing calcium gluconate can be provided with PN solutions containing CaCl. Fluid restriction is a significant factor limiting mineral intakes. Al intake can be limited to near FDA recommended intakes in PN solutions containing CaCl.

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Section: Infantsmentioning

confidence: 99%

Neonatal Parenteral Nutrition Containing Calcium Chloride and Sodium Phosphate

Huston¹,

McCulley

Markell

et al. 2012

ICAN: Infant, Child, & Adolescent Nutrition

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“…9 We believe that this study overcomes these objections. Magnesium was included in all formulations over a range of concentrations; solutions were tested at 320C after 24 hours, which is a higher temperature than quoted in most published series, and which exceeds the environmental temperature of the average neonatal unit.…”

Section: Discussionmentioning

confidence: 78%

Calcium and phosphorus solubility in neonatal intravenous feeding solutions.

MacMahon

Mayne

Blair

et al. 1990

Archives of Disease in Childhood

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The limited solubility of calcium and phosphorus in standard parenteral nutrition formulations has restricted the ability to provide sufficient minerals to preterm infants to prevent substrate deficient metabolic bone disease. We determined the solubility limits of calcium and phosphorus in a total of 160 formulations under carefully controlied conditions. By increasing the concentrations of dextrose, amino acids, and by using Addiphos instead of 8-7% dipotassium hydrogen phosphate as the phosphorus source, higher concentrations of both calcium and phosphorus were held in solution. This should permit the delivery of increased concentrations of these minerals at rates which approximate fetal accretion.Metabolic bone disease is common in sick preterm infants.' The cause is multifactorial; inadequate calcium and phosphorus intake is a major factor.2 The in utero accretion rate of calcium and phosphorus approximates 2 5-3-0 and 2-0-2 5 mmol/kg/day respectively in the third trimester.3 ' During intravenous alimentation, the intake of these minerals is frequently restricted to about I 0 mmol/kg/day5 as it is not possible to deliver adequate amounts intravenously without exceeding their solubility limits. The solutions were prepared based on the assumption that a neonate on parenteral nutrition would receive in the order of 150 ml/kg/day (130 mg/kg/day test solution and 20 ml/kg/day of intravenous fat solution). The composition/kg/ day of the test solutions was: sodium 3-9 mmol (3-0 mmol/100 ml), potassium 2-6 mmol (2-0 mmol/100 ml), trace elements as Ped-El (KabiVitrum) 4 ml (3-1 ml/100 ml), water soluble vitamins as Solivito N (KabiVitrum) 0-65 ml (0 5 ml/100 ml), magnesium in the amino acid and trace element preparations, 0-14-0-12 mmol (0-1-0 16 mmol/100 ml), and sodium heparin at 1 U/ml. Calcium and phosphorus were added in molar ratio of 1-2:1-0. The amount of these minerals and the amino acid and trace element solutions were included in all calculations. Additional phosphorus was supplied as either 8-7% dipotassium hydrogen phosphate or Addiphos, which is a proprietary preparation. This contains monobasic potassium phosphate 170-1 mg, sodium phosphate 133-5 mg, potassium hydroxide 14-0 mg, sorbitol 1 0 mg, and water for injection 1 ml. In total there is 15 mmol potassium, 15 mmol sodium, and 20 mmol phosphate in 10 ml.During preparation of the solutions the environmental air was passed through a 0-3 micron filter. Volumes were measured to the nearest 0-01 ml and the solution was shaken and thoroughly mixed before the next constituent was added. The 200 ml minibags were placed in an incubator at 32°C and examined for the presence of precipitation by a single observer at 24 and 48 hours under polarised light. The upper limit of solubility was defined by the maximum concentration of calcium and phosphorus that could be added to any solution without precipitation occurring by 24 hours. The effect on the solubility limits of these solutions of omitting sodium heparin, of adding extra magnesium (equivalent to ...

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“…Calcium gluconate in glass vials is the additive most responsible for the excessive Al exposure of neonatal patients to Al from PN [1,6,19]. Concerns with regard to the use of CaCl 2 in PN are based upon a single study from 1980 that showed increased ionization of calcium in solutions of water (not in PN solutions) for CaCl 2 (90%) compared to calcium gluconate (70-75%) [20]. In the same paper the authors published compatibility curves for both CaCl 2 and CaGlu in adult PN solutions and, although less calcium can be added for a given concentration of phosphate when using CaCl 2 , the authors did not recommend against using CaCl 2 in PN.…”

Section: Discussionmentioning

confidence: 99%