Stability of total parenteral nutrition supplied as ‘all-in-one’ for children with chemotherapy-linked hyperhydration

Abstract

The maximal allowable concentrations of calcium and phosphate in total parenteral nutrition mixtures for children from one compartment were investigated. Children treated with both chemotherapy and total parenteral nutrition are supplied with high amounts of electrolytes (besides normal nutritive needs) in a restricted volume. Such nutritive mixtures are suspected of precipitation and disintegration of the lipid emulsion by (polyvalent) electrolytes, such as calcium and phosphate. Calcium (range 1.5–150 mmol/l total parenteral nutrition) and phosphate (range 21–300 mmol/l) were added to a test total parenteral nutrition mixture. After storage (24 and 48 h) at both 22°C and 37°C the mixtures were observed by microscopy for the presence of precipitates. The stability of the fat emulsion was visually assessed and the particle size distribution was measured by flow cytometry. The examined total parenteral nutrition mixtures (pH 5.4–5.7) were stable during 48 h at 37°C if the calcium concentration is below 16 mmol/l, the phosphate concentration is below 52 mmol/l and the product of both concentrations is below 250 mmol²/l².