Abstract
Metabolic acidosis and metabolic bone disease are frequent complications in patients on parenteral nutrition (PN). A common contributor to these complications could be a daily high renal acid load. This study aims to find a method for predicting the potential total acid load (PTAL) and the pH of the compounded parenteral nutrition mixtures. The pH and titratable acidity (TA) of fifty compounded mixtures were measured. The potential metabolic acid load (PMAL) was calculated by considering the amount of nutrients that are acid producers and consumers. The PTAL of the TPN mixtures was calculated by adding TA to PMAL. Multiple linear regression analyses were used to develop a predictive model for the TA and pH of the compounded mixtures. The predicted TA and pH values of the analyzed mixtures agreed with those measured (Passing-Bablok analysis). The PTAL was >50 mmol/day for 82% of the mixtures, >75 mmol/day for 40% of the mixtures, and >100 mmol/day for 22% of the mixtures. The prediction of the renal acid load in patients on long-term PN could allow more appropriate acid-base balancing. Moreover, predicting the pH of such mixtures could be useful to pharmacists to assess the stability and compatibility of the components in the compounded mixtures.
Highlights
Parenteral nutrition (PN) may be associated with several metabolic complications including metabolic acidosis (MA) and metabolic bone disease (MBD)
A risk of metabolic acidosis associated with parenteral nutrition (PN) in patients without renal dysfunction or bicarbonate loss is clearly correlated with an excessive and acute renal acid load that could be due to the content of both preformed non-volatile acids and non-volatile acids that result from the catabolism of nutrients present in the administered mixture [12]
The preformed non-volatile acids originate from the chlorine, phosphate, or sulfate anions of PN mixture components or from the inorganic acids added to the single solutions of macronutrients and electrolytes to maintain their stability over time or to reach an advantageous pH for the physical-chemical stability of the compounded mixture after their mixing
Summary
Parenteral nutrition (PN) may be associated with several metabolic complications including metabolic acidosis (MA) and metabolic bone disease (MBD). Studies indicate that one of the possible causes of this complication could depend on a chronic, not excessive, renal acid load following daily administration of PN mixtures [7,8]. A persistent and imbalanced daily renal acid load would, represent a common factor among PN patients with overt MBD. It is still being debated, one hypothesis [10] that is sometimes confirmed or contradicted [11] describes that a constant renal acid load triggers the release of alkaline substances from the bone, which are mainly calcium and carbonates. Having the knowledge of the compounded mixture’s pH in advance is important because pH is the leading factor used for predicting the stability and compatibility of the components of such mixtures
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