655 ACHIEVEMENT OF HIGH CA AND P CONCENTRATIONS IN PARENTERAL NUTRITION SOLUTIONS FOR NEONATES

Abstract

Supply of nutrients approximating intrauterine accretion rates is a goal for total parenteral nutrition. In prematures it has been difficult to achieve high levels of Ca and P in parenteral nutrition solutions because of incompatibility of these minerals. We determined the amounts of these ions held in stable solution in Dextrose 5 or 10% and Amino acid 1.25% or 2.5% solution containing Zn, Cu, Mg, multivitamins, folic acid, Vit. K and Vit. B12. The appearance of the solutions was noted immediately and after 24 and 48 hrs at 4°C. When 10% Ca gluconate (9.4mgCa/ml) was added first to the base solution followed by K phosphate (P 93 mg/ml) precipitates occurred on addition of 1-2 drops of K phosphate. When P was diluted and then added, larger amounts of Ca and P were held in stable solution. However when the order of addition was reversed, i.e., P added first followed by Ca, optimal amounts of Ca and P were held in stable solution. The solubility of Ca and P in D 10% AA 2.5% was greater than in D 5% AA 1.25%, and at least 25% more P could be added. With D 5% AA 1.25% no precipitates were observed at 4°C in 48 hrs at Ca 150 mg/dl with P ≤50 mgm/dl; at Ca 100 mg/dl with P ≤75mgm/dl, at Ca 50 mgm/dl with P ≤ 100 mgm/dl. With D 10% AA 2.5% no precipitates occurred at 4°C in 48 hours at Ca 150 mg/dl with P ≤100 mgm/dl; at Ca 100mgm/dl with P 100 ≤mgm/dl; at Ca 50 mgm/dl with P ≤125 mgm/dl. Thus, when the order of addition of P and Ca in D-AA solutions is optimal it is possible to achieve high levels of these minerals exceeding that needed to approximate intrauterine requirements.