scholarly journals Compatibility of Maximum Inorganic and Organic Calcium and Phosphate Content in Neonatal Parenteral Solutions

Author(s):  
Dorota Watrobska-Swietlikowska

The aim of the study was to determine the maximum safe concentration of calcium and phosphate in neonatal parenteral nutrition (PN) solutions when various combinations of inorganic and organic salts are applied. Twelve PN solutions for neonatal use were aseptically prepared. Increasing concentration of inorganic and organic calcium and phosphate were added to the standard formulas. Each admixture was separately tested according to following conditions; after mixing, 37°C for 24 h, and maximum safe combination of calcium and phosphate were stored at 4°C for 30 days and followed by 24 h at 37°C. Visual inspections against a black and white contrast background, microscopic observation of undiluted PN solutions as well as the membrane filter after filtration of the PN solution, pH evaluation, and spectrophotometry at 600 nm were examined in triplicate. Safe maximum concentration of organic and inorganic calcium and phosphate was proposed individually for each composition of parenteral nutrition solutions. Surprisingly organic calcium with organic phosphate showed precipitation but over the therapeutic range. The protective effect of amino acid was observed and higher concentrations of calcium and phosphate were free of precipitation.

2019 ◽  
Author(s):  
Srinivas Bolisetty ◽  
David Osborn ◽  
Tim Schindler ◽  
John Sinn ◽  
Girish Deshpande ◽  
...  

Abstract The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid and ClinOleic preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusions: Formulations and guidelines to standardise parenteral nutrition practice across the Australasian region have the potential to improve nutrition and clinical outcomes of neonates. Standardisation can also result in cost savings, quality improvement and error minimisation in PN prescribing and ordering.


2020 ◽  
Author(s):  
Srinivas Bolisetty ◽  
David Osborn ◽  
Tim Schindler ◽  
John Sinn ◽  
Girish Deshpande ◽  
...  

Abstract Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusions: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.


2020 ◽  
Author(s):  
Srinivas Bolisetty ◽  
David Osborn ◽  
Tim Schindler ◽  
John Sinn ◽  
Girish Deshpande ◽  
...  

Abstract Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. Conclusions: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.


1971 ◽  
Vol 121 (2) ◽  
pp. 249-256 ◽  
Author(s):  
Patricia A. Meitner ◽  
Beatrice Kassell

Several minor pepsinogens, present in extracts of bovine fundic mucosa obtained from the fourth stomach or abomasum, were separated from the main pepsinogen by chromatography on hydroxyapatite at pH7.3. The major pepsinogen and two of these minor pepsinogens were studied in detail. All three zymogens have N-terminal Ser-Val-, C-terminal -Val-Ala and not more than 1mol of glucose/mol of protein; no significant differences in amino acid composition were found. The pepsinogens differ in their organic phosphate content, which accounts for their chromatographic separation. By activation at 0°C and pH2, a corresponding series of pepsins is formed. These enzymes were separated by hydroxyapatite chromatography at pH5.7. All the pepsins have N-terminal valine, C-terminal alanine and are free from carbohydrate. Again the only difference detected among them is in their organic phosphate content. The pepsins of high phosphate content are converted by an acid phosphatase in vitro into pepsins of low phosphate content.


2018 ◽  
Vol 10 (12) ◽  
pp. 4578 ◽  
Author(s):  
Yingjie Zhu ◽  
Xiaoli Du ◽  
Can Gao ◽  
Zhenya Yu

Inorganic and organic phosphate adsorption by iron–manganese (Fe–Mn) plaques extracted from reed roots was investigated. Scanning electron microscopy indicated the roots had rough surfaces and fine particles attached. X-ray photoelectron spectra indicated that Fe and Mn in the Fe–Mn plaques were mainly in the +III and +IV oxidation states, respectively. The contact time, initial phosphate concentration, and temperature effects on inorganic and organic phosphate adsorption were investigated by performing batch tests. Pseudo-second-order model described inorganic and organic phosphate adsorption, indicating the chemisorption was the dominant adsorption process. Langmuir and Freundlich isotherm models were fitted to the equilibrium data, and the Langmuir model fitted best. The maximum inorganic and organic phosphate adsorption capacities at 298 K were 7.69 and 3.66 mg/g, respectively. The inorganic and organic phosphate adsorption processes were spontaneous and exothermic. The inorganic phosphate adsorption capacity was higher than the organic phosphate adsorption capacity, and the presence of organic phosphate did not negatively affect adsorption at inorganic to organic phosphate molar ratios between 1:1 and 3:1. Fourier-transform infrared spectra before and after adsorption showed abundant functional groups on Fe–Mn plaques and that phosphate was probably adsorbed via replacement of hydroxyl groups and inner-sphere surface complexation.


Author(s):  
David A Osborn ◽  
Tim Schindler ◽  
Lisa J Jones ◽  
John KH Sinn ◽  
Srinivas Bolisetty

ChemInform ◽  
1987 ◽  
Vol 18 (4) ◽  
Author(s):  
M. IITSUKA ◽  
T. KATO ◽  
K. KIKUGAWA

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