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Data Mining-Based Stability and Prescription Analysis of Neonatal Parenteral Nutrition Solution. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5744656. [PMID: 34900196 PMCID: PMC8654557 DOI: 10.1155/2021/5744656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/31/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
In order to evaluate the stability of neonatal parenteral nutrition solution, in this paper, the prescription of neonatal parenteral nutrition solution was investigated and analyzed. The formula of neonatal parenteral nutrition solution used, particularly the one utilized in this study, is commonly used in clinical practice. All the neonatal parenteral nutrition solution required for the test was prepared on the purification workbench in a sterile environment. The time points of stability of parenteral nutrient solution were 0, 12, and 24 hours, respectively, and three parallel samples were taken at each time point. Likewise, to investigate the stability of two kinds of fat milk injection in parenteral nutrition solution of neonates and provide a reference for subsequent experiments and to investigate the influence of electrolyte, amino acid, temperature, pH value, mixing sequence, and the final concentration of glucose on the stability of neonatal parenteral nutrition solution, the stability indexes of neonatal parenteral nutrition liquid mainly include appearance, pH, insoluble particles, fat milk particle size, and particle size distribution. Neonatal parenteral nutrition solution prescriptions from the First Affiliated Hospital of Jinan University, specifically from January to June 2019, were collected and statistically processed. The experimental data were processed by SPSS 19.0 software and data mining technology. The results were expressed as mean ± standard deviation and statistically processed by ANOVA. P < 0.05 was considered statistically significant. The results showed that the stability of neonatal parenteral nutrient solution was influenced by many factors. The formula of neonatal parenteral nutrition solution is generally reasonable, but there are unreasonable phenomena which are needed to be improved further if feasible.
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Forchielli ML, Bonoli A, Stancari A, Bruno LL, Piro F, Piazza G, Albertini C, Pession A, Puggioli C, Bersani G. Do carnitine and extra trace elements change stability of paediatric parenteral nutrition admixtures? Clin Nutr 2018; 38:2369-2374. [PMID: 30442387 DOI: 10.1016/j.clnu.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION High concentrations of trace elements (TE), in particular zinc and selenium, along with carnitine, are often added to parenteral admixtures in paediatric patients on long-term Parenteral Nutrition (PN). We aim to evaluate whether lipid droplet diameters of these admixtures maintain the recommended range of 0.4-1.0 μm. MATERIALS AND METHODS Stability studies were carried out on six parenteral admixtures with carnitine, trace elements and electrolytes added in different amounts. Each admixture was formulated with five different lipid emulsions with or without fish oil. Analyses were performed at time 0 (t = 0) and 24, 48, 72, 96 (t = 96) hours after compounding. Droplet diameters were determined by Light Scattering-Reverse Fourier Optics Technique. Samples, stored at 4 °C, were triple tested for a total of 450 analyses. Regression analyses were performed using panel-data techniques. RESULTS During the 4 days, lipid droplet diameters were in the expected range of 0.4-1.0 μm regardless of trace element and carnitine amounts in all admixtures apart from those containing fish-oil based emulsions and calcium concentrations equal to 4.5 mmol/L. In these latter admixtures, 12% of droplet diameters were larger than 1.0 μm and 2% exceeded 5.0 μm immediately after compounding. CONCLUSION Carnitine and high concentrations of trace elements do not affect PN admixtures stability and can be safely infused in long-term home-PN paediatric patients and prematures. Only high calcium concentrations in compresence with fish oil based lipid emulsions seem to change PN stability.
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Affiliation(s)
- M L Forchielli
- Paediatrics, S.Orsola-Malpighi Medical School, Bologna, Italy.
| | - A Bonoli
- Civil, Environmental and Materials Engineering Department, University of Bologna, Italy
| | - A Stancari
- Pharmacy Service, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - L L Bruno
- Pharmacy Service, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - F Piro
- Pharmacy Service, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - G Piazza
- Pharmacy Service, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - C Albertini
- Paediatrics, S.Orsola-Malpighi Medical School, Bologna, Italy
| | - A Pession
- Paediatrics, S.Orsola-Malpighi Medical School, Bologna, Italy
| | - C Puggioli
- Pharmacy Service, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - G Bersani
- Consulting Pharmacist, Bologna, Italy
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Stability and assessment of amino acids in parenteral nutrition solutions. J Pharm Biomed Anal 2018; 147:125-139. [DOI: 10.1016/j.jpba.2017.07.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
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Uccello-Barretta G, Balzano F, Aiello F, Falugiani N, Desideri I. Stability of hydrophilic vitamins mixtures in the presence of electrolytes and trace elements for parenteral nutrition: a nuclear magnetic resonance spectroscopy investigation. J Pharm Biomed Anal 2014; 107:7-10. [PMID: 25560848 DOI: 10.1016/j.jpba.2014.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022]
Abstract
In total parenteral nutrition (TPN), especially in the case of preterm infants, simultaneous administration of vitamins and trace elements is still a problematic issue: guidelines put in evidence the lack of specific documentation. In this work NMR spectroscopy was applied to the study of vitamins (pyridoxine hydrochloride, thiamine nitrate, riboflavin-5'-phosphate and nicotinamide) stability in presence of salts and trace elements. Vitamins in D2O were first analyzed by (1)H NMR spectroscopy in absence of salts and trace elements; changes in chemical shifts or in diffusion coefficients, measured by NMR DOSY technique, were analyzed. The effects of salts and trace elements on single vitamins and on their admixtures were then investigated by performing quantitative analyses during 48h. Selected vitamins are subject to intermolecular interactions. No degradative effects were observed in presence of salts and trace elements. Only riboflavin-5'-phosphate is subject to precipitation in presence of divalent cations; however, at low concentration and in presence of other vitamins this effect was not observed. Solutions analyzed, in the condition of this study, are stable for at least 48h and vitamins and trace elements can be administered together in TPN.
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Affiliation(s)
- Gloria Uccello-Barretta
- Dipartimento di Chimica e Chimica Industriale, Università degli Studi di Pisa, via G. Moruzzi 3, 56124 Pisa, Italy.
| | - Federica Balzano
- Dipartimento di Chimica e Chimica Industriale, Università degli Studi di Pisa, via G. Moruzzi 3, 56124 Pisa, Italy
| | - Federica Aiello
- Dipartimento di Chimica e Chimica Industriale, Università degli Studi di Pisa, via G. Moruzzi 3, 56124 Pisa, Italy
| | - Niccolò Falugiani
- Dipartimento di Chimica e Chimica Industriale, Università degli Studi di Pisa, via G. Moruzzi 3, 56124 Pisa, Italy
| | - Ielizza Desideri
- U.O. Farmaceutica - Gestione del farmaco, Azienda Ospedaliero Universitaria Pisana, via Roma 67, 56126 Pisa, Italy
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Forchielli ML, Bonoli A, Preite I, Stancari A, Maselli S, Guarguaglini AM, Mignini I, Masi M, Puggioli C, Bersani G. Parenteral nutrition admixtures for pediatric patients compounded with highly refined fish oil-based emulsion: assessment of physicochemical stability. Clin Nutr 2014; 33:1127-31. [PMID: 24411491 DOI: 10.1016/j.clnu.2013.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/21/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
Abstract
Fish oil-based emulsion is increasingly used in pediatric patients receiving Parenteral Nutrition (PN). However, its unique use in children on long-term PN is nutritionally debatable as some patients are better off with a mixture of long-chain (LCT) or long-chain + medium-chain (LCT + MCT) triglycerides along with Fish Oil (FO). Lipid emulsions are safely infused when particle diameter ranges between 0.4 and 1.0 micron (like chylomicra), according to European guidelines. No data exist on Fish Oil stability when added to other PN components typically present in pediatric formulations such as other lipids or micronutrients. Our goal is to evaluate the stability of a highly refined FO-emulsion in PN admixtures containing LCT or LCT + MCT triglycerides and different calcium content. Stability studies were carried out on six PN admixtures having two levels of calcium concentration compounded with olive oil LCT + FO, LCT + MCT + FO emulsion and pure FO alone, respectively. The analyses were performed immediately at time 0 (t = 0) and 24, 48, 72, 96 (t = 96) hours after compounding. Particle diameters were determined by Light Scattering-Reverse Fourier Optics Technique by means of a Laser Granulometer. Every sample was stored at 4 °C and triple tested. Statistical significance was verified by f-test. In all admixtures, physicochemical stability did not change between t = 0 and t = 96 and particle diameters were in the expected range of 0.4-1.0 micron provided calcium concentration remained below 4.5 mmol/L. When calcium exceeded that level, 12% of particle diameters was larger than 1.0 micron and 2% exceeded 5.0 micron immediately after compounding. In particular, admixtures compounded with olive oil LCT + FO emulsion or FO emulsion alone showed lower particle diameters compared to admixture with olive/soybean LCT alone, probably due to a different steric encumbrance of oleic acid and omega-3 fatty acid. In the PN admixtures tested, containing FO-emulsion alone or in combination with olive LCT or LCT + MCT, the fat emulsion appears to be stable and safe for infusion when calcium concentration is maintained below 4.5 mmol/L. If calcium level exceeds 4.5 mmol/L, as often required in premature patients, it is advisable to infuse FO emulsion alone through a second intravenous line.
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Affiliation(s)
- M L Forchielli
- Paediatrics, S. Orsola-Malpighi Medical School, Bologna, Italy.
| | - A Bonoli
- Civil, Environmental and Materials Engineering Department, University of Bologna, Italy
| | - I Preite
- Civil, Environmental and Materials Engineering Department, University of Bologna, Italy
| | - A Stancari
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
| | - S Maselli
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
| | - A M Guarguaglini
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
| | - I Mignini
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
| | - M Masi
- Paediatrics, S. Orsola-Malpighi Medical School, Bologna, Italy
| | - C Puggioli
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
| | - G Bersani
- Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy
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Pharmaceutical point of view on parenteral nutrition. ScientificWorldJournal 2013; 2013:415310. [PMID: 24453847 PMCID: PMC3885274 DOI: 10.1155/2013/415310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/06/2013] [Indexed: 11/17/2022] Open
Abstract
Parenteral nutrition--a form of administering nutrients, electrolytes, trace elements, vitamins, and water--is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them.
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Lobo BW, da Veiga VF, Cabral LM, Michel RC, Volpato NM, de Sousa VP. Influence of the relative composition of trace elements and vitamins in physicochemical stability of total parenteral nutrition formulations for neonatal use. Nutr J 2012; 11:26. [PMID: 22510447 PMCID: PMC3411489 DOI: 10.1186/1475-2891-11-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/17/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate the influence of the relative composition of trace elements and vitamins in physicochemical stability of neonatal parenteral nutrition. MATERIAL AND METHODS Three formulations for neonatal administration were selected; the main variable was the presence of trace elements and vitamins. The analyses where carried out immediately after preparation and at 24 h, 48 h, 72 h and 7 days after preparation. Three methods were selected to determine globule size: light obscuration, dynamic light scattering and optical microscopy. Complementary evaluation including visual inspection, determination of pH and osmolarity, peroxide levels and measurements of zeta potential were also performed. RESULTS There was an observable alteration in color and phase separation in the PN stored at 25°C and 40°C. Neither globule size pattern, nor any other physicochemical characteristic evaluated appeared to be considerably altered in any of the analyzed formulations even after 7 days of storage at 5°C. Globule size in all the PN studied was consistent with the established limit, below 500 nm by DLS measurement, and PFAT5 was below 0.05% under all storage temperatures. CONCLUSION Concomitant presence of trace elements and vitamins in the same neonatal formulation did not alter the evaluated aspects of stability.
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Affiliation(s)
- Bianca W Lobo
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Venício F da Veiga
- Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Lúcio M Cabral
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
| | - Ricardo C Michel
- Instituto de Macromoléculas Professora Eloisa Mano, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21945-970, Brasil
| | - Nádia M Volpato
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90610-000, Brasil
| | - Valéria P de Sousa
- Departamento de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brasil
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Ribeiro DO, Pinto DC, Lima LMTR, Volpato NM, Cabral LM, de Sousa VP. Chemical stability study of vitamins thiamine, riboflavin, pyridoxine and ascorbic acid in parenteral nutrition for neonatal use. Nutr J 2011; 10:47. [PMID: 21569609 PMCID: PMC3115844 DOI: 10.1186/1475-2891-10-47] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/14/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this work was to study the vitamins B1, B2, B6 and C stability in a pediatric formulation containing high amounts of calcium in the presence of organic phosphate, amino acids, glucose, sodium chloride, magnesium sulfate, pediatric vitamins and trace elements under different conditions using developed and validated analytical methods. METHODS The study was carried out during 72 h with formulations packaged in recommended storage temperature (4°C) and 25°C, with and without photoprotection. RESULTS The results showed that the methodologies used for assessing the chemical stability of vitamins B1, B2, B6 and C in the formulation were selective, linear, precise and accurate. The vitamins could be considered stable in the formulation during the three days of study if stored at 4°C. When stored at 25°C vitamin C presented instability after 48 h. CONCLUSION The pediatric formulation containing high amount of calcium in the presence of organic phosphate, amino acids, glucose, sodium chloride, magnesium sulphate, pediatric vitamins and trace elements packaged in bag-type trilaminate presented a shelf life of the 72 h, when maintained under refrigeration, between 2°C and 8°C. This shelf life was measured considering the vitamins studied. Further studies are needed including all the vitamins present in this formulation.
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Affiliation(s)
- Daniela O Ribeiro
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Daniela C Pinto
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Luis Mauricio TR Lima
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Nádia M Volpato
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90610-000, Brazil
| | - Lúcio M Cabral
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Valéria P de Sousa
- Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
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Davydova N, Stippler E, Jin P, Giancaspro G. Development and validation of a dissolution test method for vitamin A in dietary supplement tablets. J Pharm Biomed Anal 2010; 53:295-301. [PMID: 20427140 DOI: 10.1016/j.jpba.2010.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/25/2010] [Accepted: 03/26/2010] [Indexed: 11/18/2022]
Abstract
A dissolution test method and an analytical procedure by HPLC were developed and validated for evaluation of the dissolution behavior of dietary supplements tablets containing vitamin A in the forms of retinyl acetate or retinyl palmitate. Seven different commercially available products containing retinyl acetate or retinyl palmitate were selected for this study. A dissolution medium containing 1% (w/v) Octoxynol 9 (Triton X-100) and 1% (w/v) (+)-sodium alpha-ascorbate in 0.05 M phosphate buffer, pH 6.8, was found suitable to ensure sink conditions and chemical stability for both retinyl acetate and retinyl palmitate. Two rotation speeds, 50 and 75 rpm, were evaluated with USP Apparatus 2 and 900 ml dissolution medium. Dissolution profiles were generated over 120 min. Dissolution samples were analyzed with a reversed-phase HPLC method with UV detection at 325 nm. Each product was also assayed for vitamin A content according to USP 32-NF 27. The results from 45 min to the last time point of the dissolution tests performed at 75 rpm were consistent with the Assay results. The dissolution test described here could be proposed as a pharmacopeial standard to assess the performance of tablet formulations containing vitamin A as retinyl esters.
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Affiliation(s)
- Natalia Davydova
- US Pharmacopeia, 12601 Twinbrook Parkway, Rockville, MD 20852-1790, USA.
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Skouroliakou M, Matthaiou C, Chiou A, Panagiotakos D, Gounaris A, Nunn T, Andrikopoulos N. Physicochemical Stability of Parenteral Nutrition Supplied as All-in-One for Neonates. JPEN J Parenter Enteral Nutr 2008; 32:201-9. [DOI: 10.1177/0148607108314768] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Skouroliakou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Chrysoula Matthaiou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Antonia Chiou
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Demosthenes Panagiotakos
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Antonis Gounaris
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Tony Nunn
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
| | - Nikolaos Andrikopoulos
- From Harokopio University, IASO Maternity Hospital, Athens, Greece; Harokopio University, Athens, Greece; Neonatal Unit, Medical School, University of Thessalia, Thessalia, Greece; and Royal Liverpool Children's NHS Trust, Liverpool, UK
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Stability investigation of total parenteral nutrition admixture prepared in a hospital pharmacy. VOJNOSANIT PREGL 2008; 65:286-90. [DOI: 10.2298/vsp0804286m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. In the cases when nutrition of patients can not be orally nor enterally performed, parenteral nutrition is a method of the therapy that provides more successful and rapid recovery. In that way, hospitalization can be significantly shorter, healing costs reduced and mortality minimized. Total parenteral nutrition (TPN) admixtures are the most complex systems which contain amino acids, carbohydrates, lipid emulsion, macroelectrolytes (Na+, K+, Ca2+, Mg2+, Cl-, SO42-, PO43-), oligoelements, hydro- and liposoluble vitamines, heparin, insulin and water. Concerning the mentioned complexity, special attention should be payed to physicochemical and microbiological stability of a mixture, because of interactions among components, that can be very hard to analyze. The aim of this study was to investigate the problem of stability of TPN admixtures prepared in a hospital pharmacy. Methods. Admixture TPN was aseptically prepared in laminar air - flow environment on the basis of the specified order in supplementing components and additives to basic solutions. Solutions were kept in sterile multicompartment ethylene-vinyl-acetate bags. After preparation and slow homogenization, TPN admixtures were submitted to physicochemical and microbiological stability analyses in various period of time. The assessment of physical stability of TPN admixture was done on the basis of visual inspection, determination of pH value and measuring of particle size. The investigation of sterility and pyrogenic test were performed according to Ph. Yug. V regulations. Results. Physico-chemical and microbiological analyses were applied and no significant changes in visual sense, pH value and droplet size stability of the TPN admixture were observed during the period of 60 hours. The lipid droplets were smaller in size than 5 ?m, that is the most common pharmacopoeia requirement. Conclusion. The results of our study confirmed that a TPN admixture prepared in a hospital pharmacy can be stored without stability loss for at least 60 hours.
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Gellis C, Sautou-Miranda V, Jarrige JF, Grand-Boyer A, Bleyzac N, Chopineau J. Methylprednisolone sodium succinate in pediatric parenteral nutrition: influence of vehicle injection. Clin Nutr 2004; 23:515-25. [PMID: 15297087 DOI: 10.1016/j.clnu.2003.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Accepted: 09/16/2003] [Indexed: 11/19/2022]
Abstract
Many drugs can be administered in parenteral nutrient mixtures, but no work on the delivery of corticoids by such means is reported. We studied the influence of pediatric parenteral nutrient mixtures on the kinetic parameters of the corticoid methylprednisolone injected in an intravenous bolus in rabbits as its sodium succinate ester. Four groups of six male New Zealand rabbits were used. After extraction, the plasma drug concentrations were measured by high performance liquid chromatography. The distribution volume of the ester and the clearance rates of the two entities (ester and methylprednisolone) were lowered in the presence of a lipid emulsion. The description of these pharmacokinetic parameters provides a basis for a preclinical study of 24h administration of methylprednisolone in a parenteral nutrient mixture.
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Affiliation(s)
- Christophe Gellis
- Clinical and Biotecnological Pharmacy Laboratory, Faculté de Médecine-Pharmacie, 28, place Henri-Dunant, 63003 Clermont-Ferrand cédex, France
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Lee MD, Yoon JE, Kim SI, Kim IC. Stability of total nutrient admixtures in reference to ambient temperatures. Nutrition 2003; 19:886-90. [PMID: 14559326 DOI: 10.1016/s0899-9007(03)00173-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the stability of emulsions under different temperatures simulating clinical conditions of storage and exposure during infusion, five total nutrient admixture formulas in this institution were analyzed: adult, patients with hepatic failure, infants, stressed patients, and patients with renal failure. METHODS Each mixture was allocated in a sterile 100-mL glass bottle, which was prefilled and refilled with nitrogen gas. Bottles were stored at 4 degrees C for 0 d, 3 d, and 7 d and then exposed to three different temperatures: usual room temperature (18 degrees C to 25 degrees C), high (>28 degrees C) in a water bath, or storage (4 degrees C) for 24 and 48 h. The gross inspection of the emulsions and parallel measurements of pH, particle sizes, divalent ions, peroxide levels, and microbial cultures were performed. RESULTS Every lot was stable near 18 degrees C, but 8 of 10 lots stored for 7 d (25 degrees C and >28 degrees C) and 15 of 20 lots stored for 3 and 7 d (25 degrees C and >28 degrees C) showed coalescence. The overall coalescence incidences by storage, exposure, and heat were statistically significant (P < 0.005). CONCLUSION For the safety of total nutrient admixtures, special attention is required to keep the ambient temperature below 28 degrees C and completely exclude air from the container.
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Affiliation(s)
- Myung Duk Lee
- Nutritional Support Service, Department of Surgery, Kangnam St. Mary's Hospital, Seoul, South Korea.
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Pironi L, Guidetti M, Zolezzi C, Fasano MC, Paganelli F, Merli C, Bersani G, Pizzoferrato A, Miglioli M. Peroxidation potential of lipid emulsions after compounding in all-in-one solutions. Nutrition 2003; 19:784-8. [PMID: 12921890 DOI: 10.1016/s0899-9007(03)00099-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the peroxidation potential of fat emulsions in all-in-one solutions (AIOs). METHODS Three 20% emulsions were compared: soybean oil (SO; 60% polyunsaturated fatty acids [PUFAs], alpha-tocopherol:PUFAs = 0.44), soybean plus medium-chain triacylglycerol (SO-MCT; 31% PUFAs, alpha-tocopherol:PUFAs = 0.35), and olive oil (OO; 21% PUFAs, alpha-tocopherol:PUFAs = 1.42). For each emulsion, six AIO solutions were prepared by adding 250 mL of emulsion to a lipid-free solution. Lipid peroxide (LPX) and malondialdehyde (MDA) concentrations were evaluated in fat emulsions, lipid-free solutions, and AIOs immediately (T0) and 24 h (T24) after lipid addition. Statistical analysis was done with analysis of variance. RESULTS Fat emulsion LPX in SO-MCT was lower than that in SO (P = 0.015) and OO (P = 0.024); LPX in SO was greater than that in OO (P = 0.013); MDA in SO was greater than that in SO-MCT (P = 0.001) and OO (P = 0.013); and MDA in SO-MCT was greater than that in OO (P = 0.001). In comparison with MDA at AIO-T0, MDA at AIO-T24 increased in SO (P = 0.005) and SO-MCT (P < 0.001) and decreased in OO (P = 0.003); at AIO-T24, LPX was greater in SO, but not significantly. CONCLUSIONS In AIO bags, LPX occurred within 24 h after the addition of the lipid emulsion and seemed to be directly related to the PUFA content and inversely related to the alpha-tocopherol:PUFA ratio of the emulsion.
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Affiliation(s)
- Loris Pironi
- Departement of Internal Medicine and Gastroenterology, Bologna, Italy
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