Stability of Fat-Soluble Vitamins A (Retinol Palmitate),E (Tocopherol Acetate),and K1 (Phylloquinone) in Total Parenteral Nutrition at Home

Abstract

Our purpose was to extend previous studies of the stability of vitamins A (retinol palmitate), E (tocopherol acetate), and K₁ (phylloquinone) to total parenteral nutrition at-home (TPNH) admixtures. First, stability over 20 days was tested. Experimental conditions included presence or absence of lipids, presence or absence of trace elements, and storage in a glass bottle or in a single or multi-layer plastic bag (ethylene vinyl acetate, polyvinyl chloride, Stedim 5, and Stedim 6). The 20-day storage studies were conducted at 4°C or at ambient air temperature. The second part of the study consisted of exposing to natural light TPNH admixtures with or without lipids, but with trace elements, in the same containers (except polyvinyl chloride). Finally, a clinical situation of TPNH was simulated with a TPNH admixture prepared 11 days before the test in a Stedim 6 plastic bag and stored at 4°C in total darkness. For vitamins A, E, and K₁, we observed good stability for 20 days; the final concentrations ranged from 75% to 100% of initial concentrations whatever the conditions studied. It appears that there is no significant difference of action between all containers and that the presence or absence of lipids and trace elements in admixtures stored at 4°C or ambient temperature makes no difference. With exposure to sunlight, vitamin losses were 100% at 3 hours for vitamin A and 50% for vitamin K ₁; vitamin E concentrations were unchanged after 12 hours of experiment. The presence of lipids or type of container did not appear to enhance protection from direct sunlight. Finally, we showed that, under standardized conditions of preparation, storage, and administration of TPNH such as those used in the pharmaceutical department of Debrousse Hospital, the amounts of vitamins A, E, and K₁ that were administered to patients adequately corresponded to the amounts of vitamins prescribed and added to TPN admixtures. (Journal of Parenteral and Enteral Nutrition 17:56-60, 1993)