Effect of the Intravenous Lipid Emulsions on the Availability of Calcium when using Organic Phosphate in TPN Admixtures

Abstract

These data demonstrated that availability of Ca using organic glucose-1-phosphate increased when lipids were present in TPN admixtures, without alteration of the lipid emulsion. Thus, high amounts of Ca (up to 30 mmol/l) and phosphates (up to 40 mmol/l) might be provided safely in parenteral nutrition admixtures.

Compatibility of Maximum Inorganic and Organic Calcium and Phosphate Content in Neonatal Parenteral Solutions

“…Furthermore, the use of organic phosphates considerably increases the calcium-phosphate compatibility. It was confirmed that the organic phosphate has superior stability in comparison to dibasic sodium phosphate regardless of pH, temperature, the type of calcium as well as amino acid or glucose concentrations 3,8 .…”

“…Chloride salt contains a higher proportion of calcium available to associate with free phosphate, leading to precipitation due to calcium chloride’s larger dissociation constant in comparison to calcium gluconate 2 . Furthermore, organic calcium salts have a lower degree of dissociation compared to inorganic calcium chloride 3 . These reasons cause that gluconate salt should be the predominant calcium source in compounding PN and it is only recommended in nutrition for preterm infants and children.…”

Compatibility of Maximum Inorganic and Organic Calcium and Phosphate Content in Neonatal Parenteral Solutions

“…The chloride salt contains a higher proportion of calcium available to associate with free phosphate, leading to precipitation due to calcium chloride's larger dissociation constant in comparison to calcium gluconate [2]. Furthermore, organic calcium salts have a lower degree of dissociation compared to inorganic calcium chloride [3]. These reason cause that gluconate salt should be the predominant calcium source in compounding PN and it is only recommended in nutrition for preterm infants and children.…”

“…Furthermore, the use of organic phosphates considerably increases the Ca-P compatibility. It was confirmed that the organic phosphate has superior stability in comparison to dibasic sodium phosphate over a range of pH, temperature, calcium used and amino acid or glucose concentrations [3,8].…”

“…Many authors try to determine the maximum concentrations of calcium and phosphate at various combinations that can be mixed safely, but it cannot be universally determined due to the variety of composition of compounding products [1,2,3,6,9]. Precipitation of calcium phosphate is much more frequent and dangerous in small patients (premature, newborn and children) because the precipitation is more likely to occur at lower volumes and, moreover, is an endothermic reaction (incubators used for neonates increase the likelihood of precipitation).…”