Trace Element Contamination of Total Parenteral Nutrition. 1. Contribution of Component Solutions

Pluhator-Murton, Michelle M.; Fedorak, Richard N.; Audette, Robert J.; Marriage, Barbara J.; Yatscoff, Randall W.; Gramlich, Leah

doi:10.1177/0148607199023004222

Cited by 88 publications

(94 citation statements)

References 15 publications

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“…The boron content of GCW as determined by us (28 lM/L) is in line with the physiologic boron plasma levels of <30 lM/L [9]. A study from the United States found 80 lM/L of TPN [10]. Berner et al reported widely varying boron contents in various parenteral fluids; the estimated concentration in a typical TPN intake was 6 lM/L [11].…”

Section: Minor Elements (Lm/l)supporting

confidence: 76%

Green coconut water for intravenous use: Trace and minor element content

Petroianu

Kosanović

Shehatta

et al. 2004

J Trace Elements Exper Med

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Green coconut water (GCW; liquid endosperm) is sterile and has been used in the past in remote locations and/or during armed conflicts as a short-term intravenous hydration fluid. It is also conceivable to use GCW for total parenteral nutrition (TPN) under similar circumstances. Patients on TPN need elemental supplementation. Although data on the major elements (calcium, magnesium, potassium, sodium, and phosphorus) found in GCW are abundant, very limited information concerning trace and minor element content in GCW is available. The purpose of this study was to determine trace and minor element content in GCW. Major elements were arbitrarily defined as those with a GCW concentration in the mM range, as opposed to minor ones in the lM range and trace elements in the nM range. The values determined show the great variability typical for samples of plant origin. Under TPN conditions, GCW (1,000 mL/day) would be able to provide adequate supplementation of manganese (12 ± 5 lmol/L) and possibly zinc (6 ± 1 lmol/L) but not chromium (not detected, i.e., less than 9 nM/L) and copper (105 ± 100 nM/L). With respect to elements usually considered nonessential or even toxic, GCW compares favorably with commonly used TPN solutions, most notably for aluminium content (740 ± 360 nM/L) and cadmium (7 ± 4 nM/L). The levels of lead (150 ± 67 nmol/L) and barium (600 ± 300 nmol/L) were similar to those typically found in commercial TPN solutions. Those of strontium (8 ± 4 lmol/L) are higher but unlikely to be harmful. In conclusion, although GCW is not completely equivalent to high-tech (and high-cost) TPN solutions with trace element supplements, it still may provide sufficient support of at least some of the trace elements if used as a substitute. The GCW investigated by us is, at least, not toxic. However, our results for several trace elements are much lower than values previously reported in the literature, especially in coconuts from ''polluted'' areas. GCW from polluted soil might be easily toxic if used intravenously.

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Section: Minor Elements (Lm/l)supporting

confidence: 76%

Green coconut water for intravenous use: Trace and minor element content

Petroianu

Kosanović

Shehatta

et al. 2004

J Trace Elements Exper Med

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“…[89][90][91][92][93][94][95][96] Amounts of contamination can vary between manufacturers and from lot to lot within a manufacturer's product. 92,94,96 At least a dozen minerals (from arsenic to zinc) have been identified as contaminants.…”

Section: Questionmentioning

confidence: 99%

“…97,98 The trace elements chromium and zinc are the most frequently measured as contaminants in a number of PN components. 90,91,95,[99][100][101][102] This may necessitate the use of individual rather than fixeddose multi-trace element products to allow dosing flexibility for patient PN regimens when contaminants are of concern. Further research is recommended on micronutrient contamination of PN.…”

Section: Questionmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

253

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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“…Manganese contaminants in PN can be as high as 0.31 mg/L, with dextrose and electrolyte solutions contributing as much as 0.038 mg/L. 6,10,[30][31][32] Home PN patients have had elevated serum manganese concentrations after more than 10 years of eliminating manganese from their PN. 33 Because manganese is mostly excreted in the bile, manganese accumulation occurs in patients with cholestasis.…”

Section: Manganesementioning

confidence: 99%