Effect of Intralipid, amino acids, container, temperature, and duration of storage on vitamin stability in total parenteral nutrition admixtures.

This study was designed to determine the stability of certain vitamins added to total parenteral nutrition (TPN) admixtures with or without Intralipid iv fat emulsion and with each of four amino acid solutions stored in either glass bottles or plastic bags at either ambient room (25 degrees C) or refrigerator (5 degrees C) temperature for a 48-hr period. Riboflavin and folacin were not affected by the experimental conditions. The presence of Intralipid resulted in higher levels of vitamin E due to Intralipid's inherent vitamin E content; no other experimental conditions affected vitamin E. Thiamin levels decreased in admixtures containing the amino acid solution C and stored at 25 degrees C. Vitamin A levels were lower in admixtures stored in plastic but were maintained in admixtures containing Intralipid and stored in glass bottles at either temperature. Vitamin C levels were maintained in admixtures stored at 5 degrees C for all experimental conditions. The greatest vitamin C losses occurred in admixtures containing amino acid solutions C or D stored in plastic bags, or containing D stored in glass bottles at 25 degrees C.

Effect of phototherapy light, sodium bisulfite, and pH on vitamin stability in total parenteral nutrition admixtures.

The three sections of this study extend previous research into losses of vitamins A, C, E, thiamin, riboflavin, and folic acid from total parenteral nutrition (TPN) admixtures. First, phototherapy light on TPN admixtures containing one of four amino acid solutions was studied. Experimental conditions included presence or absence of Intralipid iv fat emulsion, plastic bag or glass bottle storage container, and storage time of up to 48 hrs. The second phase studied stability of the same vitamins (except vitamin E) for 48 hrs in admixtures containing the amino acid solution which has no bisulfite, in glass bottles; with or without Intralipid; and with added sodium bisulfite (final concentrations of 0, 1, 2, 3, 4, 5 and 10 mEq/liter). Third, vitamin C and thiamin levels were measured in admixtures containing the amino acid solution with no bisulfite, without Intralipid, stored in glass bottles with various bisulfite concentrations (0, 1, 2, or 3 mEq/liter) and three pH levels (5.5, 6.5, and 6.75 pH). Exposure of TPN admixtures to phototherapy light caused losses of vitamins A, C, and riboflavin. Intralipid inclusion significantly reduced losses of vitamin A and riboflavin, but did not appear to affect vitamin C levels. The smallest vitamin C losses were noted in admixtures containing amino acid solutions A or B. Phototherapy light did not affect thiamin levels. Bisulfite had no affect on vitamin C, riboflavin, or folic acid levels. Vitamin A levels were maintained with bisulfite concentrations less than 3 mEq/liter. At 3 mEq/liter bisulfite, admixtures with Intralipid showed 50% loss of vitamin A.(ABSTRACT TRUNCATED AT 250 WORDS)

Parenteral infusion with an admixture of amino acids, dextrose, and fat emulsion solution: compatibility and clinical safety.

Fat emulsions are increasingly utilized as intravenous calorie sources in patients requiring total parenteral nutrition. In the United States, they are traditionally administered separate from the dextrose/amino acid solution because of concern regarding physical stability and clinical safety when fat emulsions are administered, having been mixed with the dextrose solution. The separate infusion entails multiple manipulations of the infusion system with increased risk of contamination and sepsis and increased cost in maintaining two infusion lines. This prospective sequential two-phase clinical study evaluated solution compatibility and clinical safety of an admixture of fat emulsion (Intralipid 20%), dextrose, amino acids (Veinamine 8%), electrolytes, vitamins, and trace minerals. Continuous infusion of this solution in 25 adult patients from 2 to 35 days did not result in any adverse clinical reactions or abnormal laboratory parameters. Gross, visual examination and in vitro analysis of the admixture solutions revealed no physical instability or changes in fatty acid composition in admixture solutions stored at 4 degrees C for up to 6 weeks.

Peripheral vein infusion of dextrose/amino acid solutions +/- 20% fat emulsion.

The purpose of this study was to evaluate the incidence of phlebitis occurring during peripheral infusion of nutrient solutions with and without 20% fat emulsions. Eighty patients were randomly assigned to one of four groups: (1) dextrose/amino acids-630 mOsmol/liter; (2) dextrose/amino acids/fat emulsion-706 mOsmol/liter; (3) dextrose/amino acids-882 mOsmol/liter and; (4) dextrose/amino acids/fat emulsion-983 mOsmol/liter. The peripheral infusion site was examined daily and the number of changes in infusion sites were recorded and the degree of phlebitis encountered was graded. The four groups were similar in the mean number of iv site changes per patient and per day. The average grade of phlebitis was similar (0.23-0.27 events/day) among the four groups. Infiltration occurred more frequently with butterfly needle while phlebitis occurred more frequently with plastic angiocatheters. Patients appeared to tolerate peripheral infusion with high osmolar solutions just as well as lower osmolar solutions. Concurrent infusion with a 20% fat emulsion did not alter the number of iv site changes or the incidence or degree of phlebitis reported and thus, did not appear to have a protective effect on the vein when infused with dextrose/amino acid solutions.

Early history of parenteral nutrition.

A historical review is presented of a number of aspects of early animal experiments and clinical trials dealing with the i.v. infusion of whole blood and milk; the nutritional use of i.v. erythrocytes, plasma proteins, protein hydrolysates, amino acids, and glucose; and development and use of i.v. fat emulsions. A brief description of the experience with the nutritional use of i.v. ethyl alcohol is also presented. The important studies beginning in the 1960's by Dudrick, Rhoads, Vars, and Wilmore are described elsewhere by them.

Hematopoietic studies in vitamin A deficiency.

Recent studies of experimental vitamin A deficiency in man led the authors to conclude that anemia may result from lack of vitamin A. A review of numerous nutrition surveys in underdeveloped countries enhanced the suspicion that deficiency of vitamin A does contribute to the prevalence of anemia. Preliminary studies of vitamin A-deficient rats confirmed previous observations that anemia may result from lack of this vitamin. The livers of these animals had very low concentrations of vitamin A but normal or increased concentrations of iron. The finding of anemia is in contrast with other reports that vitamin A deficiency may cause elevated values for hemoglobin and hematocrit. The authors suggest that loss of taste and smell as a result of deficiency may account for refusal of experimental animals to eat and drink enough to prevent inanitation and dehydration. The resulting hemoconcentration may mask the true hematological picture, which is one of anemia.

Effects of a glucose meal on human pulmonary function at 1600-m and 4300-m altitudes.

The effects of a high-glucose meal on pulmonary function were observed in seven healthy males at medium (1,600 m) and high (4,300 m) altitude. Thirty minutes after the ingestion of 410 kcal (109.9 g cerelose) of glucose, peak serum glucose values were noted with a subsequent decrease over 3 h to below fasting levels at both elevations. At the same time, triglyceride levels continued to decline from 104.2 to 83.3 mg at 1,600 m and 103.7 to 80.5 mg/100 ml at 4,300 m, with differences being significant after 2 h. Both V-E and V-T increased in response to translocation to altitude; however, only V-T increased by 10.9% and 13.3% at 0.5 h for 1,600 m and 4,300 m, respectively. The V-o-2 increased during glucose elevation at 4300 m, while P-A-O2 remained essentially unchanged except for differences associated with translocation to altitude. A 13.9% increase was noted in D-L-CO followign glucose ingestion at 4,300 m along with a decreased triglyceride levels. The elevated D-L-CO values suggest an increase in gas exchange at the alveolar-capillary (A-c) level following the ingestion of a glucose meal for individuals transported to high altitude.

Ascorbate sulfate: a urinary metabolite of ascorbic acid in man.

Ascorbate-3-sulfate is a significant metabolite of ascorbic acid excreted in human urine. The characteristics of this compound were determined in experiments in which labeling with carbon-14 and tritium was used coupled with cochromatography with synthetic ascorbate-3-sulfate (both labeled and not labeled with sulfur-35) in a variety of solvent and absorbent systems.