[Precipitation limits in pediatric parenteral nutritions with organic sources of calcium and phosphate].

Abstract:

OBJECTIVE:to determine if precipitation processes occur in parenteral nutrition solutions (PNs) with calcium gluconate and sodium glycerophosphate in the precipitation threshold limits of the Spanish SENPE/SEGHNP/SEFH 2008 consensus document of PN preparation. METHODS:seven PNs with different composition were prepared in triplicate: five 100 ml PNs with different concentrations of amino acids, calcium and phosphorus similar to consensus document maximum concentrations for precipitation, and two control PNs: one without calcium and phosphorus and other with high calcium and phosphorus content and low concentration of amino acids. All PNs did not contain lipids to allow correct detection of precipitates. The no lipid PNs were stored at room temperature for 20 hours, and at 35 °C for four hours. Subsequently, they filtered through a 0.2 μm filter, which was observed by electron microscopy. Because a large amount of not expected precipitates was observed, complementary studies were carried out. RESULTS:precipitates were observed in all PNs except in the control solution without calcium and phosphorus; many of them were greater than 10 μm. However, according to our studies, these crystals were produced after filtration and calcium was found in their composition, but not phosphorus. Particles from the preparation of parenteral nutrition were also observed. CONCLUSIONS:in our study we did not find calcium phosphate precipitates in the limits included in the consensus document SENPE/SEGHNP/ SEFH. However, it is possible that micro precipitates with calcium are formed. It is important to filter PNs prior to their administration. :OBJETIVO: conocer si hay precipitación en nutriciones parenterales (NP) con gluconato cálcico y glicerofosfato sódico en las cantidades límites del documento de consenso español de preparación de nutrición parenteral SENPE/SEGHNP/SEFH 2008. MÉTODOS: se prepararon por triplicado siete NP: cinco de 100 ml con concentraciones de aminoácidos, calcio y fósforo similares a las concentracionesmáximas de precipitación del documento consenso SENPE/SEGHNP/SEFH y dos controles, uno sin calcio y fósforo y otro con alto contenido de calcio y fósforo y baja concentración de aminoácidos. Las NP no contenían lípidos. Las NP se almacenaron 20 horas a temperatura ambiente y cuatro horas a 35 °C, y se filtraron con un filtro de 0,2 micras. Estos filtros se transportaron y observaron parcialmente por microscopía electrónica. Los cristales observados se analizaron por espectrometría por dispersión de rayos X a 1.000 aumentos. Al observarse gran cantidad de precipitados, que no se correspondían a los estudios publicados, se realizaron estudios complementarios para conocer su origen. RESULTADOS: en todos los casos, a excepción del control sin calcio y fósforo, se observaron precipitados. Sin embargo, estos cristales, según nuestros estudios, se produjeron después de la filtración y en su composición está el calcio, pero no el fósforo. También se observaron partículas provenientes de la preparación de nutrición parenteral. CONCLUSIONES: en nuestro estudio no encontramos precipitados de fosfato cálcico en los límites recogidos en el documento consenso SENPE/SEGHNP/SEFH. Sin embargo, es posible que se formen microprecipitados con calcio en su composición. Es importante fi ltrar las NP previamente a su administración.

journal_name

Nutr Hosp

journal_title

Nutricion hospitalaria

authors

Lázaro Cebas A,Pablos Bravo S,Gomis Muñoz P,Orbaneja MÁ,Spiers S,Shinn M,Ferrari Piquero JM

doi

10.20960/nh.1861

subject

Has Abstract

pub_date

2018-10-05 00:00:00

pages

1009-1016

issue

5

eissn

0212-1611

issn

1699-5198

journal_volume

35

pub_type

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