Ca and Phos Content in Neonatal PN

JPEN J Parenter Enteral Nutr. 2010 Sep-Oct;34(5):542-5.

Maximizing calcium and phosphate content in neonatal parenteral nutrition solutions using organic calcium and phosphate salts.

Bouchoud L, Fonzo-Christe C, Sadeghipour F, Bonnabry P.

Pharmacy, Geneva University Hospitals, Geneva, Switzerland. lucie.bouchoud@hcuge.ch

Abstract

BACKGROUND: The provision of high amounts of calcium and phosphate in parenteral nutrition (PN) solution for neonates is important for bone mass accretion. Because of the risk of calcium phosphate precipitation, a well-documented incompatibility for inorganic salts, the concentrations of these electrolytes in PN are generally limited to 5 mmol/L. The aim of this study was to assess the risk of precipitation of calcium phosphate when organic calcium and phosphate salts are used instead of inorganic salts.

METHODS: Precipitation curves were determined for inorganic and organic calcium and phosphate salts in a PN solution favorable to precipitation (low concentration of amino acids and glucose) using visual inspection and particle counts.

RESULTS: The use of organic phosphate salt was associated with a decreased risk of precipitation of calcium phosphate. No precipitation occurred up to a concentration of 50 mmol/L of calcium and phosphate. In contrast, organic calcium salt only slightly decreased the risk of precipitation.

CONCLUSION: Up to 50 mmol/L of organic calcium and phosphate salts can be safely mixed in PN, even in unstable conditions, making it possible to follow the current European recommendations for requirements in neonates.