Calcium/Phosphate Solubility Curves for Premasol and Trophamine Pediatric Parenteral Nutrition Formulations.

OBJECTIVES: Calcium and phosphate incompatibility in parenteral nutrition formulations remains a critical concern for patient safety. This study examined calcium phosphate solubility for 2-in-1 admixtures prepared using 2 commercially available pediatric amino acid solutions (Premasol, Baxter Healthcare Corp; or Trophamine, B. Braun Medical Inc), applying identical test methods, storage conditions, and acceptance criteria. METHODS: Parenteral 2-in-1 admixtures included amino acid; dextrose; static concentrations of sodium, potassium, and magnesium, and varying concentrations of calcium (0-60 mEq/L), phosphate (15-50 mmol/L), and cysteine. Three replicate samples were stored for 48 hours at 40°C ± 2°C and then visually inspected for particulate matter, evaluated for subvisible particulate matter, when particulate matter was noted, microscopic examination was performed to confirm the presence of calcium phosphate crystals. Pass criteria were: all replicates free of visible particulate matter related to calcium phosphate crystals and particle counts below US Pharmacopeia <788> limits. RESULTS: Premasol and Trophamine generated identical calcium phosphate curves for 2% amino acid formulations containing 20% dextrose with/without cysteine, and similar curves for the 1% or 3% amino acid formulations containing 10% or 20% dextrose with/without cysteine. Calcium phosphate particles were identified in failed samples by scanning electron microscopy/energy dispersive X-ray spectroscopy. Calcium phosphate solubility was higher in formulations containing cysteine 40 mg/g amino acid vs. cysteine 20 mg/g amino acid and in cysteine 20 mg/g amino acid vs. no cysteine. CONCLUSIONS: Admixtures made with 1%, 2%, or 3% Premasol or Trophamine have essentially equivalent calcium phosphate solubility curves when tested with identical methods, storage conditions, and acceptance criteria.

Identification and Quantification of Intravenous Therapy Drugs Using Normal Raman Spectroscopy and Electrochemical Surface-Enhanced Raman Spectroscopy.

Errors in intravenous (IV) drug therapies can cause human harm and even death. There are limited label-free methods that can sensitively monitor the identity and quantity of the drug being administered. Normal Raman spectroscopy (NRS) provides a modestly sensitive, label-free, and completely noninvasive means of IV drug sensing. In the case that the analyte cannot be detected within its clinical range with Raman, a label-free surface-enhanced Raman spectroscopy (SERS) approach can be implemented to detect the analyte of interest. In this work, we demonstrate two individual cases where we use NRS and electrochemical SERS (EC-SERS) to detect IV therapy analytes within their clinically relevant ranges. We implement NRS to detect gentamicin, a commonly IV-administered antibiotic and EC-SERS to detect dobutamine, a drug commonly administered after heart surgery. In particular, dobutamine detection with EC-SERS was found to have a limit of detection 4 orders of magnitude below its clinical range, highlighting the excellent sensitivity of SERS. We also demonstrate the use of hand-held Raman instrumentation for NRS and EC-SERS, showing that Raman is a highly sensitive technique that is readily applicable in a clinical setting.