1
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Muacevic A, Adler JR, Fawzy NA, Abbasi S, Othman UI, Ghallab SM, Shehata N. Ultrasound Findings in a Neonate During Anaphylactic Reaction to Total Parenteral Nutrition: A Case Report. Cureus 2023; 15:e33491. [PMID: 36756020 PMCID: PMC9901913 DOI: 10.7759/cureus.33491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
Total parenteral nutrition (TPN) is the intravenous delivery of nutrients and is commonly used in the Neonatal Intensive Care Unit (NICU). Hypersensitivity reactions to parenteral nutrition have seldom been described in the literature. Anaphylaxis is a potentially life-threatening emergency condition that can progress rapidly and involves multiple organ systems. We report a case of anaphylaxis due to TPN in a neonate with observed ultrasound findings during the acute episode never reported in the literature before.
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2
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McMurray JC, Smith KD, Schulz EV. Urticaria in a Term Infant with CHARGE Syndrome. Neoreviews 2023; 24:31-35. [PMID: 36587005 DOI: 10.1542/neo.24-1-e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jeremy C McMurray
- Departments of Pediatrics and Medicine, Division of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, MD
| | - Kristen D Smith
- Departments of Pediatrics and Medicine, Division of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, MD.,Department of Pediatrics, Uniformed Services University, Bethesda, MD
| | - Elizabeth V Schulz
- Departments of Pediatrics and Medicine, Division of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, MD.,Department of Pediatrics, Uniformed Services University, Bethesda, MD
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3
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Shi Y, Song H, Liu J, Lin J, Fang L. Comprehensive Evaluation of Clinical Application of Balanced Compound Amino Acid Injection. Front Nutr 2022; 9:880256. [PMID: 35719164 PMCID: PMC9203120 DOI: 10.3389/fnut.2022.880256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background To provide a reference for hospital drug selection and rational clinical drug selection based on the evaluation of the safety, nutritional quality, and economy of 27 manufacturers of five varieties (18AA, 18AA-I, 18AA-II, 18AA-IV, 18AA-V) of balanced compound amino acids for injection and (18AA-IIoriginal research). Methods The safety of compound amino acids for injection was evaluated by comparing the antioxidant sulfite contents. Based on the amino acid scoring standard mode and the whole egg protein mode as proposed by the Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) in 1973, we compared the formula. The first limiting amino acid content and the comprehensive quality of the total essential amino acid (EAA) contents of the six formulations were studied. The price/content ratio was used to evaluate their economy. Results Similar variety produced by different manufacturers have the same formula and contents of balanced compound amino acids for injection. Safety: 18AA-IIoriginal research and 18AA-II had the lowest sulfite content. Compared with 18AA-IIoriginal research, the sulfite content of 18AA-I, 18AA, 18AA-V, and 18AA-IV were higher (10 times, 16.67 times, 16.67 times, and 33.33 times, respectively). The lower the sulfite content, the safer the product. Nutritional quality: The proportions of amino acids in the five varieties of compound amino acid injection were all suitable. The order of the first limiting amino acids for the formulations was 18AA-IIoriginal research = 18AA-II>18AA >18AA-I = 18AA-IV>18AA-V. The order of the EAA values for the formulations was 18AA-IIoriginal research = 18AA-II>18AA>18AA-I > 18AA-IV > 18AA-V. The overall effectiveness order was 18AA-IIoriginal research = 18AA-II>18AA > 18AA-I>18AA-IV>18AA-V. Economy: Among the 27 manufacturers, 12 manufacturers had a price/content ratio higher than that of 18AA-II original research manufacturers, and 15 manufacturers had a price/content ratio lower than original research manufacturers. Conclusion Through its security, effectiveness, and economy of the comprehensive research, we recommended 18AA-II and 18AA-IIoriginal research with high safety, efficacy, and reasonable price as the first choice. 18AA and 18AA-I with better safety and reasonable price, secondary recommendation. 18AA-IV or 18AA-V with poor safety, efficacy, and economy are not recommended.
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Affiliation(s)
- Yingqin Shi
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
- *Correspondence: Yingqin Shi,
| | - Hai Song
- Department of Science and Education, Tangshan People’s Hospital, Tangshan, China
| | - Jinyan Liu
- Department of Pharmacy, The Second Hospital of Tangshan, Tangshan, China
| | - Jie Lin
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
| | - Lingzhi Fang
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
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4
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Boullata JI, Mirtallo JM, Sacks GS, Salman G, Gura K, Canada T, Maguire A. Parenteral nutrition compatibility and stability: A comprehensive review. JPEN J Parenter Enteral Nutr 2021; 46:273-299. [PMID: 34788478 DOI: 10.1002/jpen.2306] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Several guidance documents support best practices across the stages of the parenteral nutrition (PN)-use process to optimize patient safety. The critical step of PN order verification and review by the pharmacist requires a contextual assessment of the compatibility and stability implications of the ordered PN prescription. This article will provide working definitions, describe PN component characteristics, and present a wide-ranging representation of compatibility and stability concerns that need to be considered prior to preparing a PN admixture. This paper has been approved by the ASPEN Board of Directors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joseph I Boullata
- Pharmacy Specialist in Clinical Nutrition, Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jay M Mirtallo
- Clinical Practice Specialist, American Society for Parenteral and Enteral Nutrition, Professor Emeritus, The Ohio State University, College of Pharmacy, Columbus, OH
| | - Gordon S Sacks
- Senior Director, Medical Affairs for PN Market Unit, Fresenius Kabi USA, LLC, Lake Zurich, IL
| | - Genene Salman
- Assistant Professor of Pharmacy Practice, Marshall B. Ketchum University, College of Pharmacy, Department of Pharmacy Practice, Fullerton, CA
| | - Kathleen Gura
- Manager, Pharmacy Clinical research Program/Clinical Specialist GI/Nutrition, Boston Children's Hospital, Assistant Professor of Pediatrics, Harvard Medical School, Boston, MA
| | - Todd Canada
- Clinical Pharmacy Services Manager & Nutrition Support Team Coordinator, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angela Maguire
- Clinical Pharmacist, BJC HomeCare Infusions, Overland, MO
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- Pharmacy Specialist in Clinical Nutrition, Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA
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5
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Hui MQ, Mi YN, Ma YF, Chen T, Cao YX. Preparation and Evaluation of Lipid Emulsion Containing 13 Vitamins for Injection Without Anaphylactoid Reactions. Int J Nanomedicine 2021; 16:3317-3327. [PMID: 34012261 PMCID: PMC8128444 DOI: 10.2147/ijn.s289596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Multivitamins containing Tween 80 can cause anaphylactoid reactions. The objective of this study was to develop a new lipid emulsion containing 13 fat- and water-soluble vitamins for injection (13V-LE) that were simultaneously dissolved in one bottle and to evaluate the stability of and anaphylactoid reactions to 13V-LE. Methods Particle size, ζ-potential, and polydispersity of 13V-LE were assayed with a Zetasizer Nano ZS. Entrapment efficiency of 13V-LE was determined with HPLC. Behavior, histamine, and blood pressure of beagle dogs were investigated by observation, fluorospectrophotometry, and sphygmomanometry. Results The 13V-LE with the smallest particles and highest entrapment efficiency with stable ζ-potential was composed of soybean oil, glycerin (2.25%, w:v), egg lecithin (1.2%, w:v), and purified water. There was no obvious change in characteristics of the 13V-LE samples in terms of appearance, size distribution, ζ-potential, pH value, or concentration over 6 months. In anaphylactoid reactions tests, when being administered with the multivitamin Infuvite Adult containing Tween 80, six beagles showed grade IV symptoms (P<0.01 vs control), low blood pressure, and high plasma-histamine concentrations (P<0.05 or P<0.01). However, there were no significant differences in behavior, blood pressure, or histamine concentration in the dogs before and after administration in the 13V-LE group. Conclusion The 13V-LE formulation is a suitable intravenous lipid emulsion without anaphylactoid reactions.
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Affiliation(s)
- Min-Quan Hui
- Department of Pharmacology, Health Science Center, Xi'an Jiaotong University, Xi'an, People's Republic of China.,Xi'an Libang Pharmaceutical, Xi'an, People's Republic of China
| | - Yan-Ni Mi
- Department of Pharmacology, Health Science Center, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yu-Fan Ma
- Xi'an Libang Pharmaceutical, Xi'an, People's Republic of China
| | - Tao Chen
- Xi'an Libang Pharmaceutical, Xi'an, People's Republic of China
| | - Yong-Xiao Cao
- Department of Pharmacology, Health Science Center, Xi'an Jiaotong University, Xi'an, People's Republic of China
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6
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Swartz S, Dummann K, Guell C, Lubinsky M, Kozeniecki M. Back pain associated with centrally administered parenteral nutrition. Nutr Clin Pract 2021; 37:199-202. [PMID: 33955609 DOI: 10.1002/ncp.10664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Parenteral nutrition (PN) is well recognized for its ability to provide nutrition to patients without the ability to digest enterally; however, PN must also be seen as a medication with associated adverse drug events similar to any other pharmacological agent that is administered to patients. Here we present a case report of localized lower back pain with central PN infusion. The initial areas of concern were the intravenous lipid emulsion, peripherally inserted central catheter placement, osmolarity of the formula, and the additives. The patient's back pain was ultimately felt to be an adverse reaction to the multivitamin component of the infusion based on an elimination trial of the PN components.
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Affiliation(s)
- Sheila Swartz
- Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kacy Dummann
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Caitlin Guell
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Mark Lubinsky
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Michelle Kozeniecki
- Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA
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7
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Hardy G, Wong T, Morrissey H, Anderson C, Moltu SJ, Poindexter B, Lapillonne A, Ball PA. Parenteral Provision of Micronutrients to Pediatric Patients: An International Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2021; 44 Suppl 2:S5-S23. [PMID: 32767589 DOI: 10.1002/jpen.1990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Micronutrients (vitamins and trace elements) are essential to all nutrition. For children and neonates who are dependent upon nutrition support therapies for growth and development, the prescribed regimen must supply all essential components. This paper aims to facilitate interpretation of existing clinical guidelines into practical approaches for the provision of micronutrients in pediatric parenteral nutrition. METHODS An international, interdisciplinary expert panel was convened to review recent evidence-based guidelines and published literature to develop consensus-based recommendations on practical micronutrient provision in pediatric parenteral nutrition. RESULTS The guidelines and evidence have been interpreted as answers to 10 commonly asked questions around the practical principles for provision and monitoring of micronutrients in pediatric patients. CONCLUSION Micronutrients are an essential part of all parenteral nutrition and should be included in the pediatric nutrition therapy care plan.
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Affiliation(s)
- Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | - Theodoric Wong
- Consultant Pediatric Gastroenterologist, Women's and Children's Hospital, Birmingham, UK
| | - Hana Morrissey
- School of Pharmacy and Pharmaceutical Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Collin Anderson
- Pharmacy, Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Sissel J Moltu
- Department of Neonatology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Brenda Poindexter
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Centre, Cincinnati, Ohio, USA
| | | | - Patrick A Ball
- School of Pharmacy and Pharmaceutical Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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8
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A case of hypersensitivity developing against trace element solution in total parenteral nutrition, proved by skin prick test. Eur J Clin Nutr 2021; 75:1829-1831. [PMID: 33742157 DOI: 10.1038/s41430-021-00892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/31/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
Total parenteral nutrition (TPN) is a commonly used treatment method for patients whose oral intake is insufficient or who cannot use the gastrointestinal system. In the literature hypersensitivity reactions to contents of PN and fats are very rare. But these reactions can be seen in a wide spectrum from minor reactions such as pruritus to life-threating reactions such as anaphylaxis. In this case, a hypersensitivity reaction case will be presented against the trace element product in PN. As far as we know, there are no other cases in the literature that are definitely associated with trace element solution.
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9
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Fetterplace K, Holt D, Udy A, Ridley E. Parenteral nutrition in adults during acute illness: a clinical perspective for clinicians. Intern Med J 2021; 50:403-411. [PMID: 32270615 DOI: 10.1111/imj.14786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 01/01/2023]
Abstract
Parenteral nutrition (PN) is the administration of a nutritional formula by means other than the gastrointestinal (GI) tract. The formula may include carbohydrates, amino acids, lipids, electrolytes and/or micronutrients. The primary indications for PN are intestinal failure (IF) due to an underlying disease or treatment, or if the GI tract is not accessible. The goals of PN should be to ensure adequate nutrition provision to meet patient needs while minimising the risk of complications. PN should be commenced in <48 h in patients who are malnourished or otherwise within 7 days if oral or enteral nutrition is not possible or insufficient. There has been evolution in PN techniques and technology, and the risks associated with PN administration have been reduced. Monitoring clinical, laboratory and metabolic parameters in acute IF is essential to provision of safe nutritional support. When provided to appropriate patients with IF in a timely and considered manner, PN has been shown to be safe, improve nutritional parameters and reduce complications associated with malnutrition. This review aims to provide clinicians a practical guide for the management of PN in adult patients within the acute setting.
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Affiliation(s)
- Kate Fetterplace
- Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Darcy Holt
- Clinical Nutrition and Metabolism Unit and Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma Ridley
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
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10
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Wachnian CJ, Baadjes B, Cheng S, Ramanzin A, Hildebrand KJ. Anaphylaxis to parenteral nutrition in a pediatric oncology patient treated with induction of drug tolerance protocol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:553-554. [PMID: 33096267 DOI: 10.1016/j.jaip.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cielle J Wachnian
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Bjorn Baadjes
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Cheng
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alyssa Ramanzin
- Nutrition Services, BC Children's Hospital, Vancouver, BC, Canada
| | - Kyla J Hildebrand
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
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11
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Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2020; 43 Suppl 1:S5-S23. [PMID: 30812055 DOI: 10.1002/jpen.1525] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krishnan Sriram
- US Department of Veterans Affairs, Regional Tele-ICU System (VISN 23), Hines, Illinois, USA
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Lingtak-Neander Chan
- Department of Pharmacy School of Pharmacy, and Graduate Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Brian Jurewitsch
- Specialized Complex Care Program, St. Michael's Hospital, Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kathleen Logan Coughlin
- Center for Human Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Manzanares
- Department of Critical Care, Faculty of Medicine. Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Rina Mutiara
- Pharmacy Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ricardo Rosenfeld
- Nutrition Support Department, Casa de Saude Sao Jose, Associacao Congregacao de Santa Catarina, Rio de Janeiro, Brazil
| | - Marianna Sioson
- Section of Nutrition, Department of Medicine, The Medical City Hospital, Pasig City, Metro Manila, Philippines
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mette M Berger
- Faculty of Biology and Medicine, Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland
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12
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Mirtallo JM, Ayers P, Boullata J, Gura KM, Plogsted S, Anderson CR, Worthington P, Seres DS, Nicolai E, Alsharhan M, Gutsul L, Mason AE. ASPEN Lipid Injectable Emulsion Safety Recommendations, Part 1: Background and Adult Considerations. Nutr Clin Pract 2020; 35:769-782. [PMID: 32460429 DOI: 10.1002/ncp.10496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/25/2020] [Accepted: 04/11/2020] [Indexed: 12/11/2022] Open
Abstract
Lipid injectable emulsions (ILEs) are complex pharmaceutical formulations used as a source of energy and essential fatty acids in parenteral nutrition. Issues associated with ILE use are distinctly different from oral fat and arise from emulsion stability, dose, and infusion tolerance. Since 1975, soybean oil has been the consistent source oil used in ILE formulations in the US. Partly because of safety concerns with the soybean-based ILE and frequent and long-standing problems with product inventory shortages, new ILE products have become available. Gaps in ILE best practices create a risk for ILE safety errors in prescribing, compounding, and administration of these products. This paper provides information on appropriate indications, dosing, and methods to avoid potential errors with ILE products in the US. This paper (Part 1) will focus on ILE background, information, and recommendations for adult patients, whereas Part 2 of this series will focus on neonatal and pediatric patient-specific information.
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Affiliation(s)
- Jay M Mirtallo
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.,College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Phil Ayers
- Clinical Pharmacy Services, Baptist Medical Center, Department of Pharmacy, Jackson, Mississippi, USA
| | - Joseph Boullata
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen M Gura
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - David S Seres
- Division of Preventive Medicine and Nutrition, Department of Medicine, Institute of Human Nutrition, Columbia University Medical Center, New York, New York, USA
| | - Emily Nicolai
- Nutrition and Food Services, UNC Healthcare Systems, Chapel Hill, North Carolina, USA
| | - Mohammad Alsharhan
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Liliia Gutsul
- Central Admixture Pharmacy Services, Warrendale, Pennsylvania, USA
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13
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Franz N, Pleva M, Nordbeck S. Lipid Emulsion Therapies and Type 1 Hypersensitivity Reactions: Risk Assessment and Management. Nutr Clin Pract 2019; 36:398-405. [PMID: 31769112 DOI: 10.1002/ncp.10443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Over the past decades, awareness and attention given to food allergies has extended further into the realm of pharmacotherapy. Despite the presence of similar ingredients, different intravenous lipid emulsion (ILE)-based medication products have a wide variety of warnings and contraindications for patients with food allergies. Only limited literature is available to guide clinicians in making appropriate medication therapy adjustments to reduce the risk of hypersensitivity reactions in atopic patient populations. Therefore, the authors sought to develop a comprehensive review of potential risk factors or approaches for management of patients with atopic history and need for ILE therapy. Through thorough review of available literature published worldwide, a description of potential contraindications, risk factors, and evaluation methods is presented. Although the current state of knowledge remains relatively poor, this review aims to provide clinicians a better understanding of which risk factors related to the development of hypersensitivity reactions are relevant to lipid emulsion products and how to best manage patients who may be at risk for severe reaction based on their history. Evaluating personal atopic history is essential to the development of an appropriate risk classification system and approaching an individual's therapeutic options. By applying this assessment to local populations, providers should be able to develop an institutional guideline for screening and minimizing risk of substantial hypersensitivity reactions. Finally, a brief review of methods for managing type 1 hypersensitivity reactions is provided in the event that a breakthrough reaction does occur.
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Affiliation(s)
- Nicholas Franz
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Melissa Pleva
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Sarah Nordbeck
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan, USA
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14
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Pang SA, Eintracht S, Schwartz JM, Lobo B, MacNamara E. Hypersensitivity reactions to high osmolality Total Parenteral Nutrition: a case report. Allergy Asthma Clin Immunol 2019; 15:51. [PMID: 31485241 PMCID: PMC6716805 DOI: 10.1186/s13223-019-0364-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background The full range of allergic reactions to Total Parenteral Nutrition (TPN) remains unknown. Additionally, beyond individual allergens, there may be other factors contributing to TPN hypersensitivity reactions. Case presentation We present a case of a patient with negative skin testing to common TPN allergens who had recurrent urticarial reactions to TPN. Her skin reactions resolved once TPN was stopped. Following a literature review, we postulated that the reactions could be due to the high osmolality of her TPN. Consequently, lowering her TPN from 2785 to 1928 mOsm/kg and premedicating with cetirizine resulted in resolution of her urticaria. Conclusions When looking at patients who have hypersensitivity reactions to TPN, one must consider that their reactions may be due to factors other than allergens. More studies are needed to clarify the relationship between high osmolality TPN infusions and non-IgE mediated hypersensitivity reactions.
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Affiliation(s)
- Steph A Pang
- 1Faculty of Medicine, McGill University, 3655 Promenade Sir-William-Osler, Montreal, QC H3G 1Y6 Canada
| | - Shaun Eintracht
- 2Division of Medical Biochemistry, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
| | - Jesse M Schwartz
- 3Division of Allergy and Immunology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
| | - Belinda Lobo
- 4Division of Clinical Nutrition, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
| | - Elizabeth MacNamara
- 2Division of Medical Biochemistry, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
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Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy. Nutrients 2019; 11:nu11081775. [PMID: 31374909 PMCID: PMC6723989 DOI: 10.3390/nu11081775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022] Open
Abstract
Critically ill patients often require life support measures such as mechanical ventilation or haemodialysis. Despite the essential role of nutrition in patients’ recovery, the inappropriate use of medical nutrition therapy can have deleterious effects, as is the case with the use of respiratory, circulatory, or renal support. To increase awareness and to monitor the effects of inappropriate medical nutrition therapy, we propose to introduce the concept of nutritrauma in clinical practice, defined as metabolic adverse events related to the inappropriate administration of medical nutrition therapy or inadequate nutritional monitoring.
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