Parenteral Nutrition

Barnett, M.I.; Cosslett, A.G.; Duffield, John R.; Evans, D. A.; Hall, Simon B.; Williams, Dean T.

doi:10.2165/00002018-199000051-00016

Cited by 34 publications

(9 citation statements)

References 5 publications

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Section: Introductionmentioning

confidence: 99%

“…Total parenteral nutrition mixture (TPN) is a multicomponent drug consisting of over 50 ingredients mixed within one container, which involves some risk of interaction between the components, auxiliary substances and packaging [10,11]. TPN is expected to be physicochemically and microbiologically stable in addition to meeting all requirements for parenteral drugs during preparation, storage and administration [11,12,13]. Other important considerations include defining the shelf-life of TPN and the possibility of adding drugs (e.g., vitamins and trace elements), whose stability may be affected by the presence and concentrations of TPN components (amino acids, glucose, lipid and electrolytes) as well as storage conditions, e.g., temperature and light exposure [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Physicochemical Compatibility and Stability of Linezolid with Parenteral Nutrition

et al. 2019

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Patients referred to intensive care units (ICU) require special care due to their life-threatening condition, diseases and, frequently, malnutrition. Critically ill patients manifest a range of typical physiological changes caused by predominantly catabolic reactions in the body. It is necessary to provide the patients with proper nutrition, for example by administering total parenteral nutrition (TPN). The addition of linezolid to TPN mixtures for patients treated for linezolid-sensitive infections may reduce the extent of vascular access handling, resulting in a diminished risk of unwanted catheter-related infections. The compatibility and stability studies were conducted of linezolid in parenteral nutrition mixtures of basic, high- and low-electrolytic, high- and low-energetic and immunomodulatory composition. Mixtures containing linezolid were stored at 4–6 °C and 25 °C with light protection and at 25 °C without light protection for 168 h. In order to evaluate changes in the concentration of linezolid a previously validated reversed-phase HPLC method with UV detection was used. It was found that linezolid was stable at 4–6 °C in the whole course of the study whereas at 25 °C it proved stable over a period of 24 h required for administration of parenteral nutrition mixtures. The TPN mixtures demonstrated compatibility with linezolid and suitable stability, which were not affected by time or storage conditions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physicochemical Compatibility and Stability of Linezolid with Parenteral Nutrition

et al. 2019

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“…3.5–6.5 23 ) is described to be a result of glucose decomposition into levulinic and formic acids at temperatures in the autoclave. 24 Since the glucose content is the only difference between the two buffered electrolyte solutions, this is the probable cause of the more acidic product pH in the glucose‐containing product. For midazolam, the acidic pH of the glucose‐containing product was beneficial.…”

Section: Discussionmentioning

confidence: 99%

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Nilsson

Nguyen

Nezvalová-Henriksen

et al. 2022

Pediatric Anesthesia

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Background: In the local pediatric intensive care unit, precipitation was observed in the intravenous catheter upon co-administration of four drugs together with the buffered electrolyte solution (Plasma-Lyte 148, Baxter). Co-infusion of incompatible combinations represents a safety concern. Aims:To reproduce the clinical case of precipitation. To further explore and understand the risk of precipitation, different combinations of the components as well as the corresponding electrolyte solution with 5% glucose (Plasma-Lyte 148 with 5% glucose) should be investigated. Methods: Physical compatibility of fentanyl, ketamine, midazolam, and potassium chloride was tested in combination with the buffered electrolyte solutions. The concentrations and infusion rates representative of children 10-40 kg were used to estimate mixing ratios. Analyses detecting visual particles (Tyndall beam) and sub-visual particles (light obscuration technology) were undertaken. Measured turbidity and pH in mixed samples were compared with unmixed controls.Results: Both midazolam and ketamine showed formation of visual and sub-visual particles upon mixing with Plasma-Lyte 148, respectively. Particle formation was confirmed by increased turbidity and a distinct Tyndall effect. pH in mixed samples mirrored the pH of the buffered electrolyte, suggesting that the solubility limits of midazolam, and in some ratios also ketamine, were exceeded. Midazolam also precipitated in combination with the glucose-containing product that held a lower pH, more favorable for keeping midazolam dissolved.Conclusions: Replication of the case revealed that both midazolam and ketamine contributed to the precipitation. Midazolam and ketamine were both evaluated as incompatible with the buffered electrolyte solution and midazolam also with the buffered electrolyte-glucose solution and should not be co-administered in the same i.v.catheter line. Fentanyl and potassium chloride were interpreted as compatible with both buffered electrolytes.

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“…Instabilities and physico-chemical incompatibilities often occur due to the many components of AIO admixtures (lipid emulsion, amino acids, glucose, trace elements, vitamins) [44], [45], [46]. New formulations, created in emulsion systems with lipophilic drugs, show clinically relevant differences in pharmacokinetics or changes in bioavailability of the substrates as compared to the original product [47].…”

Section: Drugsmentioning

confidence: 99%

Practical handling of AIO admixtures – Guidelines on Parenteral Nutrition, Chapter 10

Mühlebach

Franken²,

Stanga³

2009

GMS German Medical Science; 7:Doc18; ISSN 1612-3174

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Parenteral Nutrition

Cited by 34 publications

References 5 publications

Physicochemical Compatibility and Stability of Linezolid with Parenteral Nutrition

Physicochemical Compatibility and Stability of Linezolid with Parenteral Nutrition

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Practical handling of AIO admixtures – Guidelines on Parenteral Nutrition, Chapter 10

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