Abstract
IntroductionWe have previously reported results of precipitation studies for neonatal parenteral nutrition solutions containing calcium chloride and sodium phosphate using visual methods to determine compatibility. The purpose of this study was to do further testing of compatibility for solutions containing calcium chloride using more sensitive methods.MethodsSolutions of Trophamine (Braun Medical Inc, Irvine, CA) and Premasol (Baxter Pharmaceuticals, Deerfield, IL) were compounded with calcium chloride and potassium phosphate. Controls contained no calcium or phosphate. After incubation at 37° for 24 hours solutions without visual precipitation were analyzed to determine mean particle size using dynamic light scattering from a laser light source.ResultsParticle sizes were similar for control solutions and those without visual precipitation and a mean particle size <1000 nm. Compatible solutions were defined as those with added calcium and phosphate with no visual evidence of precipitation and mean particle size <1000 nm. In solutions containing 2.5–3% amino acids and 10 mmol/L of calcium chloride the maximum amount of potassium phosphate that was compatible was 7.5 mmol/L.ConclusionMaximum amounts of phosphate that could be added to parenteral nutrition solutions containing Trophamine and calcium chloride were about 7.5–10 mmol/L less for a given concentration of calcium based upon laser methodology compared to visual techniques to determine compatibility. There were minor differences in compatibility when adding calcium chloride and potassium phosphate to Premasol versus Trophamine.
Highlights
We have previously reported results of precipitation studies for neonatal parenteral nutrition solutions containing calcium chloride and sodium phosphate using visual methods to determine compatibility
Calcium gluconate (CaGlu) has been consistently identified as the calcium (Ca) additive with the highest level of Al contamination in parenteral nutrition (PN) [6,7,8] while PN solutions made with CaCl2 and sodium phosphate (NaPhos) contain significantly less Al compared to those made with CaGlu and potassium phosphate (KPhos) [1,9]
The mean particle size as measured by the microscope for both study groups was lower than the particle size for controls but particle counts were not significantly different
Summary
We have previously reported results of precipitation studies for neonatal parenteral nutrition solutions containing calcium chloride and sodium phosphate using visual methods to determine compatibility. Calcium gluconate (CaGlu) is commonly used in parenteral nutrition (PN) solutions due to decreased dissociation of calcium cations into solution, thereby decreasing the risk of forming precipitates with phosphate, compared to calcium chloride (CaCl2) [4]. CaGlu has been consistently identified as the calcium (Ca) additive with the highest level of Al contamination in PN [6,7,8] while PN solutions made with CaCl2 and sodium phosphate (NaPhos) contain significantly less Al compared to those made with CaGlu and potassium phosphate (KPhos) [1,9]. Calcium chloride is the only calcium additive available in North America that, when added to neonatal PN solutions, limits inadvertent administration of Al to levels near the FDA recommendation
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