1
|
Ribeiro Menezes IMN, Nascimento PDA, Peixoto RRA, Oliveira A. Nutritional profile and risk assessment of inorganic elements in enteral and parenteral nutrition formulas. J Trace Elem Med Biol 2024; 84:127442. [PMID: 38554676 DOI: 10.1016/j.jtemb.2024.127442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
The contents of essential (Ca, Fe, K, Na, P, and Zn) and potentially toxic inorganic elements (As, Al, Cd, Cr, Cu, Mn, and Pb) in enteral and parenteral nutrition formulas were evaluated by inductively coupled plasma optical emission spectrometry (ICP OES) and graphite furnace atomic absorption spectrometry (GFAAS). A total of 30 enteral formulas, 23 parenteral solution components, and 3 parenteral solutions were analyzed. The elements Ca and K presented the higher contents (72-2918 mg L-1 and 235-2760 mg L-1) while the lowest concentration levels were found for As and Cd (<0.68 µg L-1 and <0.01-0.62 µg L-1) in the studied samples. The validated analytical methods presented an accuracy of 75-116% and RSD values lower than 9.8%. Calcium gluconate and magnesium sulfate, which are used as raw materials in parenteral solution, are potential sources of Al and Mn contamination. A Hazard Quotient (HQ) >1 was obtained for Al (27 ± 1 µg L-1) in one of the parenteral samples, whereas the established limit is 25 µg L-1. Enteral samples were considered safe for consumption regarding the Al, As, and Cd levels. One healing-specific and pediatric formula contained Pb at levels above 0.25 µg kg-day-1, too high for safe consumption. The enteral formulas (pediatric, diabetes-specific, renal-specific, healing-specific, and standard formula with addition of fiber) presented risks in relation to the consumption of Cr and Mn (>250 µg day-1 and >11 mg day-1). The results indicate the need for strict monitoring, considering that these formulations are often the single patient's food source.
Collapse
Affiliation(s)
| | - Patricia de A Nascimento
- Federal University of Paraná - UFPR, Department of Chemistry, Curitiba, Paraná 81531-980, Brazil
| | - Rafaella R A Peixoto
- Federal Fluminense University - UFF, Department of Analytical Chemistry, Niterói 24220-900, Brazil
| | - Andrea Oliveira
- Federal University of Paraná - UFPR, Department of Chemistry, Curitiba, Paraná 81531-980, Brazil.
| |
Collapse
|
2
|
Peng HX, Chai F, Chen KH, Huang YX, Wei GJ, Yuan H, Pang YF, Luo SH, Wang CF, Chen WC. Reactive Oxygen Species-Mediated Mitophagy and Cell Apoptosis are Involved in the Toxicity of Aluminum Chloride Exposure in GC-2spd. Biol Trace Elem Res 2024; 202:2616-2629. [PMID: 37715092 DOI: 10.1007/s12011-023-03848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
Aluminum chloride is an inorganic polymeric coagulant commonly found in daily life and various materials. Although male reproductive toxicity has been associated with AlCl3 exposure, the underlying mechanism remains unclear. This study aimed to examine the impact of AlCl3 exposure on mitophagy and mitochondrial apoptosis in testicular tissue and mouse spermatocytes. Reactive oxygen species (ROS) and ATP levels were measured in GC-2spd after AlCl3 exposure using a multifunctional enzyme labeler. The changes in mitochondrial membrane potential (MMP) and TUNEL were observed through confocal laser microscopy, and the expression of proteins associated with mitophagy and apoptosis was analyzed using Western blot. Our results demonstrated that AlCl3 exposure disrupted mitophagy and increased apoptosis-related protein expression in testicular tissues. In the in vitro experiments, AlCl3 exposure induced ROS production, suppressed cell viability and ATP production, and caused a decrease in MMP, leading to mitophagy and cell apoptosis in GC-2spd cells. Intervention with N-acetylcysteine (NAC) reduced ROS production and partially restored mitochondrial function, thereby reversing the resulting mitophagy and cell apoptosis. Our findings provide evidence that ROS-mediated mitophagy and cell apoptosis play a crucial role in the toxicity of AlCl3 exposure in GC-2spd. These results contribute to the understanding of male reproductive toxicity caused by AlCl3 exposure and offer a foundation for future research in this area.
Collapse
Affiliation(s)
- Hui- Xin Peng
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Fu Chai
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Ke-Heng Chen
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Yan-Xin Huang
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Guang-Ji Wei
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Huixiong Yuan
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Yan-Fang Pang
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China
| | - Shi-Hua Luo
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
| | - Chun-Fang Wang
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
| | - Wen-Cheng Chen
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
- Graduate School of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
| |
Collapse
|
3
|
Berlana D, López-Hellín J, Pau-Parra A, Ferrer-Costa R. Comparing Aluminum Concentrations in Adult and Pediatric Parenteral Nutrition Solutions: Multichamber-Bag versus Compounded Parenteral Nutrition. Nutrients 2024; 16:1024. [PMID: 38613056 PMCID: PMC11013817 DOI: 10.3390/nu16071024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Aluminum contamination in parenteral nutrition (PN) solutions can lead to neurotoxicity, reduced bone mass, and liver toxicity, especially in pediatric patients. Ingredients commonly used in PN compounding, such as vitamins, trace elements, calcium, and phosphate salts, contain significant amounts of aluminum. This study aimed to compare aluminum concentrations in multichamber-bag (MCB) and compounded PN for adults and pediatrics. A prospective study assessed aluminum concentrations in various types of MCB and compared them with compounded PN formulations with similar compositions. The types of MCB included Lipoflex® (without electrolytes), Omegaflex®, Finomel®, Smofkabiven® (with and without electrolytes), Olimel®, Clinimix®, and Numeta®. Overall, 80 aluminum determinations were included: 36 for MCBs and 44 for compounded PN. MCBs showed significantly lower aluminum concentrations than compounded PN: 11.37 (SD 6.16) vs. 21.45 (8.08) µg/L, respectively. Similar results were observed for adult (n = 40) and pediatric (n = 40) PN formulations (12.97 (7.74) vs. 20.78 (10.28) µg/L, and 9.38 (2.23) vs. 22.01 (5.82) µg/L, respectively). Significant differences were also found between MCBs depending on the manufacturing company. These findings suggest that MCBs PN offer a safer option for reducing aluminum contamination in PN. Harmonizing regulations concerning aluminum concentrations in PN solutions could help mitigate differences between PN formulations.
Collapse
Affiliation(s)
- David Berlana
- Pharmacy Department, Vall d’Hebron Barcelona Campus Hospital, 08035 Barcelona, Spain
- Pharmacology, Toxicology and Therapeutic Chemistry Department, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - Juan López-Hellín
- Biochemistry Department, Vall d’Hebron Barcelona Campus Hospital, 08035 Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Alba Pau-Parra
- Pharmacy Department, Vall d’Hebron Barcelona Campus Hospital, 08035 Barcelona, Spain
| | - Roser Ferrer-Costa
- Biochemistry Department, Vall d’Hebron Barcelona Campus Hospital, 08035 Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| |
Collapse
|
4
|
Aljohar HI, Nawawi RA, Albanyan NS, Aljarboa S, Orfali RS. An Assessment of aluminum contamination in neonatal parenteral nutrition solutions based on measured versus labeled content. Saudi Pharm J 2024; 32:101941. [PMID: 38292404 PMCID: PMC10825339 DOI: 10.1016/j.jsps.2023.101941] [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: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Aluminum can potentially cause toxicity in pediatrics and neonates receiving parenteral nutrition. Some PN solutions and ingredients in Saudi Arabia do not comply with US FDA regulations regarding aluminum exposure. This study aims to determine the aluminum concentration in samples of PN solutions and ingredients used to feed infants in Saudi Arabia. The aluminum in the samples was determined using inductively coupled plasma mass spectrometry. The concentration of metal contaminants in each sample was determined in triplicate. The aluminum content of 38 samples was investigated, 15 of which originated from components included in the prepared PN solutions. Among the 15 samples, the least measurable aluminum content was detected in potassium chloride solutions (0.81 mcg/L). In contrast, the greatest amount of aluminum was detected in potassium phosphate and calcium gluconate (141,64 mcg/L and 462.7 mcg/L), respectively. The results showed that the final PN solution (PNS) product contained more aluminum levels than the content ingredients; in addition, the study found a statistically significant relationship among 18 pediatric patients at KFMC who had intestinal failure and needed long-term parenteral nutrition. Specifically, their high aluminum levels, exceeding the normal range of 0.6 ng/ml, indicate that the current use of PN solutions will likely cause toxicity due to aluminum contamination in additives. Hence, reducing aluminum in PN solutions is imperative to ensure patient safety.
Collapse
Affiliation(s)
- Haya I. Aljohar
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Rania A. Nawawi
- Pharmacy Services Administration, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Nora S. Albanyan
- Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Suliman Aljarboa
- Central Laboratory, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Razan S. Orfali
- Clinical Research Groups Department, Research Centre, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| |
Collapse
|
5
|
Schönenberger KA, Saxer C, Neyer PJ, Huwiler VV, Reber E, Hammerer-Lercher A, Stanga Z, Mühlebach S. Aluminum and other chemical elements in parenteral nutrition components and all-in-one admixtures. Clin Nutr 2023; 42:2475-2483. [PMID: 38411019 DOI: 10.1016/j.clnu.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND & AIMS Parenteral nutrition (PN) can lead to high or even toxic exposure to aluminum (Al). We aimed to quantify concentrations of Al and other chemical elements of all-in-one (AIO) PN admixtures for adults prepared from commercial multichamber bags (Olimel® 5.7%, Omegaflex® special, SmofKabiven®, all with and without electrolytes) and vitamin and trace element additives over a 48-h period. Secondly, we determined the level of Al contamination resulting from admixing and infusion set use. METHODS We used dynamic reaction cell and kinetic energy discrimination inductively coupled plasma mass spectrometry (ICP-MS) to quantify Al, arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), tin (Sn), vanadium (V), and zinc (Zn) in AIO PN admixtures. We extracted samples for analysis via the bag injection ports and infusion sets over a 48-h period after admixing. We compared the measured Al concentrations of AIO PN admixtures with calculated values based on the measured concentrations of individual chamber contents and additives. RESULTS Mean (standard deviation) baseline Al concentrations in AIO PN admixtures ranged from 10.5 (0.5) to 59.3 (11.4) μg/L and decreased slightly over the 48 h (estimate [standard error] -0.09 [0.02] μg/L/hour, p <0.001). Thus, certain products exceeded the widely accepted limit of 25 μg/L. There was no significant difference in Al concentrations between samples extracted via the bag injection ports or infusion sets (p = 0.33), nor between measured and calculated Al concentrations of AIO PN admixtures (p = 0.91). CONCLUSION Because certain commercially available PN admixtures for adults proved to contain excessively high levels of Al in our study, regulations and corresponding quality requirements at the authority level (e.g., Pharmacopoeia and regulatory authorities) are urgently required. Our results showed that the PN handling process (admixing and supplementing additives) or the materials of the infusion set did not lead to additional Al contamination to any extent. Moreover, calculated Al concentrations of AIO PN admixtures derived from individual chamber contents and additives are valid.
Collapse
Affiliation(s)
- Katja A Schönenberger
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
| | - Christoph Saxer
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Peter J Neyer
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Valentina V Huwiler
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland; Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | | | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056 Basel, Switzerland
| |
Collapse
|
6
|
Romanowska H, Bartoszewicz K, Danko M, Wielopolska J, Popińska K, Żydak J, Sibilska M, Borkowska A, Szlagatys-Sidorkiewicz A, Książyk J. Unexpected Serum and Urine Aluminum Concentrations in Pediatric Patients on Home Parenteral Nutrition. Nutrients 2023; 15:3597. [PMID: 37630787 PMCID: PMC10458977 DOI: 10.3390/nu15163597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
The intravenous supply of aluminum (Al) present in parenteral nutrition solutions poses a high risk of the absorption of this element, which can result in metabolic bone disease, anemia, and neurological complications. The aim of this study is to determine the impact of long-term parenteral nutrition (PN) in children on serum Al concentration and its urinary excretion compared to healthy children. We evaluated serum Al concentrations and its urinary excretion in patients enrolled in the Polish home parenteral nutrition (HPN) program between 2004 and 2022. The study group included 83 patients and the control group consisted of 121 healthy children. In children whose PN was started in the neonatal period, we found higher serum Al concentrations and higher urinary Al excretion than in other subjects whose PN was started later. Only 12% of the children on chronic parenteral nutrition had serum Al concentrations of less than 5 μg/L. Healthy children in the control group had higher serum Al concentrations than those in the parenteral nutrition group, which may indicate the influence of one's environment and diet on Al serum levels.
Collapse
Affiliation(s)
- Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Klaudia Bartoszewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Mikołaj Danko
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Wielopolska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland; (K.B.); (J.W.)
| | - Katarzyna Popińska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Joanna Żydak
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Marta Sibilska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| | - Anna Borkowska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, Nowe Ogrody 1-6, 80-803 Gdansk, Poland; (A.B.); (A.S.-S.)
| | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland; (M.D.); (K.P.); (M.S.); (J.K.)
| |
Collapse
|
7
|
Abstract
Prematurity and other complications at birth are nutritional emergencies. Parenteral nutrition is a bridge to enteral nutrition for a few days or months, and sometimes the sole source of nutrition for life. Parenteral nutrition regimens are constructed to provide adequate and balanced energy, macronutrients, and micronutrients to support growth and prevent deficiencies. Neonatal parenteral nutrition regimens are complicated by periodic shortages of essential products, compatibility challenges, and contaminants. Newborns benefit from serial growth assessments, monitoring of biochemical status, nutrition-focused physical examinations, and management by a multidisciplinary team to ensure adequacy of parenteral nutrition and promote best outcomes.
Collapse
Affiliation(s)
- Sharon Groh-Wargo
- Nutrition and Pediatrics, Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, C.G72, Cleveland, OH 44109-1998, USA
| | - Stephanie Merlino Barr
- Neonatal Dietitian, Department of Pediatrics, MetroHealth Medical Center, 2500 MetroHealth Drive, C.G72, Cleveland, OH 44109-1998, USA.
| |
Collapse
|
8
|
Sauberan J, Mercier M, Katheria A. Sources of unintentional manganese delivery in neonatal parenteral nutrition. JPEN J Parenter Enteral Nutr 2021; 46:1283-1289. [PMID: 34919287 DOI: 10.1002/jpen.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Manganese (Mn) neurotoxicity is a concern in neonates receiving parenteral nutrition (PN). Prior studies have identified Mn contamination of PN ingredients as a source of daily Mn exposure from PN. This study was conducted to determine which neonatal PN ingredients are sources of this unintentional Mn delivery. METHODS Mn concentration was measured in different lot numbers of individual PN ingredients using inductively coupled plasma mass spectrometry (ICP-MS). PN admixtures were then prepared using standard doses of the tested individual ingredients and admixture Mn concentration was measured. RESULTS Magnesium sulfate and calcium gluconate are the major contributors to hidden unintentional Mn exposure in neonatal PN. Maximum measured Mn concentrations in these two ingredients were 443 and 46.8 mcg/L, respectively. Sodium and potassium phosphate were the next highest at 40 and 24 mcg/L, respectively. Other ingredients contained a trivial or no measurable quantity of Mn. PN admixture Mn content was 16-30% higher than predicted values based on individual ingredient Mn content. If infused at 150 mL/kg/day, a standard neonatal PN admixture with no added Mn is capable of unintentionally delivering up to 0.9 mcg/kg/day of Mn. CONCLUSION Neonatal PN without any added Mn provides close to the ASPEN recommended 1 mcg/kg/day dosage of Mn. This supports the potential utility of a Mn-omission approach to trace element provision in neonatal PN. Further studies are needed to test such an approach, and to evaluate the clinical significance of unintended Mn delivery in neonates receiving PN. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jason Sauberan
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, 92123, USA
| | | | - Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, 92123, USA
| |
Collapse
|
9
|
Legrand P, Desdion A, Boccadifuoco G, Dufaÿ Wojcicki A, Worsley A, Boudy V, Dufay SG. Development of an HPLC/UV method for the evaluation of extractables and leachables in plastic: Application to a plastic-packaged calcium gluconate glucoheptonate solution. J Pharm Biomed Anal 2018; 155:298-305. [DOI: 10.1016/j.jpba.2018.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
|
10
|
Huston RK, Christensen JM, Alsharhani SM, Mohamed SM, Heisel CF. Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions without Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology. Nutrients 2018; 10:E208. [PMID: 29443921 PMCID: PMC5852784 DOI: 10.3390/nu10020208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022] Open
Abstract
There are no compatibility studies for neonatal parenteral nutrition solutions without cysteine containing calcium chloride or calcium gluconate using light obscuration as recommended by the United States Pharmacopeia (USP). The purpose of this study was to do compatibility testing for solutions containing calcium chloride and calcium gluconate without cysteine. Solutions of TrophAmine and Premasol (2.5% amino acids), containing calcium chloride or calcium gluconate were compounded without cysteine. Solutions were analyzed for particle counts using light obscuration. Maximum concentrations tested were 15 mmol/L of calcium and 12.5 mmol/L of phosphate. If the average particle count of three replicates exceeded USP guidelines, the solution was determined to be incompatible. This study found that 12.5 and 10 mmol/L of calcium and phosphate, respectively, are compatible in neonatal parenteral nutrition solutions compounded with 2.5% amino acids of either TrophAmine or Premasol. There did not appear to be significant differences in compatibility for solutions containing TrophAmine or Premasol when solutions were compounded with either CaCl₂ or CaGlu-Pl. This study presents data in order to evaluate options for adding calcium and phosphate to neonatal parenteral nutrition solutions during shortages of calcium and cysteine.
Collapse
Affiliation(s)
- Robert K Huston
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR 97227, USA.
| | - J Mark Christensen
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Sultan M Alsharhani
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Sumeia M Mohamed
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA.
| | - Carl F Heisel
- Neonatal Pharmacy, Randall Children's Hospital at Legacy Emanuel, Portland, OR 97227, USA.
| |
Collapse
|
11
|
Limketkai BN, Choe M, Patel S, Shah ND, Medici V. Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0217-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|