Sage Journals: Discover world-class research

Abstract

Background: The solubility of inorganic calcium and phosphate in parenteral solutions can be complicated in pediatrics due to the dosing of calcium and phosphorus at the saturation point. The purpose of this study was to test the solubility of sodium glycerophosphate (NaGP) with calcium gluconate in pediatric parenteral nutrition (PN) solutions. Methods: Five PN solutions were compounded by adding calcium gluconate at 10, 20, 30, 40, and 50 mEq/L and corresponding concentrations of NaGP at 10, 20, 30, 40, and 50 mmol/L. Each of the 5 solutions was compounded using 1.5% and 4% amino acids, cysteines, and lipids. Compatibility was evaluated by visual inspection (precipitation, haze, and color change). Solutions were evaluated microscopically for any microcrystals and measured by a turbidimeter for changes in turbidity. Solutions were further analyzed using United States Pharmacopeia 788 standards. Six hundred seventy-one PN solutions were compounded at various concentrations and evaluated for visual stability. Results: Compatibility testing showed no changes in the PN solution in any of the concentrations tested. Microscopically, no microcrystals were detected. The turbidimeter measurements had changes of ≤0.14 nephelometric turbidity units for all test solutions. There were no visual changes in any of the 671 PN solutions. Conclusion: It is recommended that NaGP replace sodium phosphate in PN solutions. This would eliminate the concern of calcium and phosphorus precipitation and the need of any saturation curves.

Keywords

sodium glycerophosphate parenteral nutrition compatibility

Get full access to this article

View all access options for this article.

References

Eggert

Rusho

MacKay

Chan

. Calcium and phosphorous compatibility in parenteral nutrition solution for neonates. Am J Hosp Pharm. 1982;39:49-53.

Fitzgerald

MacKay

. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing TrophAmine. Am J Hosp Pharm. 1986;43:88-93.

Henry

Jurgens

Sturgeon

. Compatibility of calcium chloride and calcium gluconate with sodium phosphate in a mixed TPN solution. Am J Hosp Pharm. 1980;37:673-674.

MacKay

Fitzgerald

Jackson

. The solubility of calcium and phosphate in two specialty amino acids solutions. JPEN J Parenter Enteral Nutr. 1996;20:63-66.

MacKay

Jackson

Eggert

Fitzgerald

Cash

. Practice-based validation of calcium and phosphorous solubility limits for pediatric parenteral nutrition solutions. Nutr Clin Pract. 2011;26:708-713.

APP/Fresenius Kabi USA. Dear healthcare professional letters (customer letter). http://www.fresenius-kabi.com/. Accessed May 29, 2013.

Phosphate Injectable Availability [package insert]. Lake Zurich, Illinois: Fresenius Kabi; 2013.

Glycophos [package insert]. Halden, Norway: Fresenius Kabi; 2008.

The United States Pharmacopeia, The National Formulary. Vol 1, USP 36:NF 31. Rockville, Maryland: United States Pharmacopeia Convention Inc; 2013.

10.

Chan

Bishop

Kupiec

. Compatibility of ceftobiprole medocaril with selected drugs during simulated y-site administration. Am J Hosp Pharm. 2008;65:1545-1551.

11.

Joy

Silvestri

Franke

. Calcium and phosphorus compatibility in low-osmolarity parenteral nutrition admixtures intended for peripheral vein administration. JPEN J Parenter Enteral Nutr. 2010;34(1):46-54.

12.

Driscoll

Newton

Bistrian

. Potential hazards of precipitation associated with calcium chloride in parenteral nutrition admixtures: response to Migaki et al. JPEN J Parenter Enteral Nutr. 2012;36(5):497-498.

13.

Newton

Driscoll

. Chemistry and safety of phosphorus injections. Am J Health Syst Pharm. 2008;65(18):1761-1766.

14.

Newton

Driscoll

. Calcium and phosphorus compatibility: revisited again. Am J Health Syst Pharm. 2008;65(1):73-80.

15.

Fausel

Newton

Driscoll

Allen

Jr.

Effect of fat emulsion and supersaturation on calcium phosphorus solubility in parenteral nutrient admixtures. Int J Pharm Compd. 1997;1(1):54-59.

16.

Driscoll

Newton

Bistrian

. Precipitation of calcium phosphorus from parenteral nutrient fluids. Am J Hosp Pharm. 1994;51(22):2834-2836.

17.

Department of Health and Human Services. FDA safety alert: hazards of precipitation associated with parenteral nutrition. April 18, 1994. www.fda.gov/safety.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB

Physical Compatibility of Sodium Glycerophosphate and Calcium Gluconate in Pediatric Parenteral Nutrition Solutions

Abstract

Keywords

Get full access to this article

References

Supplementary Material