Quantitative Assessment of Trace‐Element Contamination in Parenteral Nutrition Components

Abstract

Background: Trace-element contamination of contemporary parenteral nutrition (PN) components exists in unknown quantities and, in combination with excessive amounts of certain trace elements provided in commercially available adult, pediatric, and neonatal multitrace-element (MTE) products, could result in eventual accumulation and toxicity. This study aims to quantify trace-element contamination in components used for PN compounding to further inform recommendations for MTE product reformulation and individualized trace-element prescribing in PN. Methods: A total of 32 unique components (65 products) available for PN compounding were tested for manganese, chromium, selenium, zinc, and copper contamination, utilizing inductively coupled plasma mass spectrometry. Theoretical adult, pediatric, and neonatal PNs were formulated to assess the impact of macronutrient and micronutrient component doses on PN trace-element contamination. Results: Trace-element contamination was detected in 24 (75%) components tested. Chromium and manganese were common, present in 65.6% and 51.5% of all components, respectively. Eight components did not contain detectable trace-element contamination, most notably sterile water, concentrated dextrose, and lipid emulsion. Manganese contamination in theoretical adult, pediatric, and neonatal PN was 25.18, 9.92, and 1.37 µg, respectively. Chromium contamination was 4.85, 1.5, and 0.28 µg, respectively. Conclusion: Trace-element contamination was prevalent in components used to compound PN. Our findings support reformulation of adult, pediatric, and neonatal manufactured MTE products to eliminate chromium, decrease manganese, and supply full daily physiologic requirements of selenium, zinc, and copper. Future study is needed to assess the additional contamination that could occur through the compounding and storage processes. (JPEN J Parenter Enteral Nutr. 2019;43:970-976) Clinical Relevancy StatementQuantification of trace-element contamination of parenteral nutrition (PN) components, especially manganese and chromium, is critical for the reformulation of From the

Sources of unintentional manganese delivery in neonatal parenteral nutrition

“…We found that magnesium sulfate and calcium gluconate were the major sources, and inorganic phosphate salts were minor ones. In a similarly designed study, Olson et al recently made the same discoveries 16 . Figure 2 compares the results from the current study and Olson et al.…”

“…Comparison of results between current study and Olson et al 16 Cal Gluc, calcium gluconate; Mag Sulf, magnesium sulfate; Sod Phos, sodium phosphate; K Phos, potassium phosphate…”

“…In a similarly designed study, Olson et al recently made the same discoveries. 16 Figure 2 1 and Figure 1). Our calcium gluconate results were twofold to sixfold lower than that of Olson et al, despite testing the same product and manufacturer (Figure 2).…”

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

“…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.…”

“…2. Olson et al 10 Quantitative assessment of trace-element contamination in parenteral nutrition components…”