Pulmonary Deposition of Calcium Phosphate Crystals as a Complication of Home Total Parenteral Nutrition

Abstract

A patient on home total parenteral nutrition (TPN) developed a diffuse granulomatous interstitial pneumonitis secondary to calcium phosphate deposition. Calcium and phosphorus concentrations in the TPN formula were not unusually high, indicating that other factors contributed to calcium phosphate crystallization. The effects of duration of storage of the TPN formulation, solution temperature, pH, and magnesium concentration on calcium phosphate precipitation are discussed.

Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units

“…Physical incompatibilities between IV drugs may lead to precipitation and catheter obstruction, blood-vessel irritation or embolism. Nevertheless, the real clinical consequences of drug precipitation have only been documented for a few drugs and parenteral nutrition [4][5][6][7]. Paediatric drugs are characterised by frequent off-label and unlicensed use [8].…”

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

“…Clinical complications and deaths due to calcium gluconate and potassium phosphate interaction have been reported (5), other reports published in 1996 (6) indicated suspect death resulted from an incompatibility between calcium and phosphate salts associated with the mixing of total parenteral nutrition formulations. Also, the US Food and Drug Administration (FDA) published a Safety Alert report in 1994 (7).…”

Particulate Matter in Injectable Drugs: Evaluation of Risks to Patients

“…Tissot et al [54] detected 14.4 % of nursing errors related to drug incompatibilities in an adult ICU and Gikic et al [55] 3.4 % in a paediatric ICU. Serious consequences have been described due to drug incompatibility, such as obstruction of catheter, therapeutic failure, or the occurrence of embolism [56,57] of fatalities [58,59].…”