A patient on home total parenteral nutrition (TPN) developed a diffuse granulomatous interstitial pneumonitis secondary to calcium phosphate deposition. Calcium and phosphorus concentrations in the TPN formula were not unusually high, indicating that other factors contributed to calcium phosphate crystallization. The effects of duration of storage of the TPN formulation, solution temperature, pH, and magnesium concentration on calcium phosphate precipitation are discussed. (Journal of Parenteral and Enteral Nutrition13:209-213, 1989)
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References
1.
Pomerance HH , Ruder RE: Crystal formation: a new complication of total parenteral nutrition. Pediatrics52:864-866, 1973
2.
Knight PJ, Buchanan S., Clatworthy HW: Calcium and phosphate requirements of preterm infants who require prolonged hyperalimentation. JAMA243:1244-1246, 1980
3.
Robinson LA, Wright BT: Central venous catheter occlusion caused by body-heat-mediated calcium phosphate precipitation. Am J Hosp Pharm39:120-121, 1982
4.
Stennett DJ, Gevwick WH, Egging PK et al: Precipitate analysis from an indwelling total parenteral nutrition catheterJPEN12:88-92, 1988
5.
Athanikar N. , Boyer B., Deamer R., et al: Visual compatibility of 30 additives with a parenteral nutrient solution. Am J Hosp Pharm36:511-513, 1979
6.
Kaminski MV, Harris DF, Collins CF, et al: Electrolyte compatability in a synthetic amino acid hyperalimentation solution. Am J Hosp Pharm31:244-6, 1974
7.
Niemiec PW, Vanderveen TW: Compatibility considerations in parenteral nutrient solutions. Am J Hosp Pharm41:893-911. 1984
8.
Van Den Berg L.Soliman FS: Composition and pH changes during freezing of solutions containing calcium and magnesium phosphate. Cryobiology6:10-14, 1969
9.
Boulet M., Marier J.: Precipitation of calcium phosphates from solutions at near physiological concentrations . Arch Biochem Biophys93:157-165, 1961
10.
Schuetz DH, King JC: Compatibility and stability of electrolytes, vitamins and antibiotics in combination with 8% amino acid solution. Am J Hosp Pharm35:33-34, 1978
11.
Henry RS, Jurgens RW Jr, Sturgeon RJ, et al: Compatibility of calcium chloride and calcium gluconate with sodium phosphate in a mixed TPN solution. Am J Hosp Pharm37:673-674, 1980
12.
Sturgeon RJ , Athanikar NK, Henry RS, et al: Titratable acidity of crystalline amino acid admixtures. Am J Hosp Pharm. 37:388-390, 1980
13.
Turco S., King R.: Sterile Dosage Forms, Philadelphia, Lea and Febiger, 1979, p 276
14.
Kobayashi NH , King JC: Compatibility of common additives in protein hydrolysate/dextrose solution. Am J Hosp Pharm34:589-594, 1977
15.
Poole R., Rupp C, Kerner J: Calcium and phosphorus in neonatal parenteral nutrition solutions. JPEN7:358-360, 1983
16.
Chan J., Malekzadeh M., Hurley J.: pH and titratable acidity of amino acid mixtures used in hyperalimentation . JAMA220:1119-1120, 1972
17.
Eggert LD, Rusho WJ, MacKay MW, et al: Calcium and phosphorus compatibility in parenteral nutrition solutions for neonates. Am J Hosp Pharm39:49-53, 1982
18.
Boulet M., Marier J., Rose D.: Effect of magnesium on formation of calcium phosphate precipitates . Arch Biochem Biophys96:629-636, 1962