Parenteral Nutrition Formulations Flashcards
What is the smallest pore size filter that is recommended for total nutrient admixture (TNA)?
1.2 micron
According to recommendations by ASPEN parenteral nutrition safety consensus and the National Advisory Group on Standards and Practice Guidelines for parenteral formulations, the amount of dextrose used in preparation of a PN formulation is required to appear on the label as:
Grams per day (eg, dextrose 250 gm/day)
What is the most commonly used carbohydrate energy substrate in PN?
Dextrose
Amount of kcal per gram from dextrose?
3.4 kcal/gm
What concentrations is dextrose available in?
2.5-70%
Why are higher dextrose concentrations (>10%) generally reserved for central venous administration?
Because of their propensity to cause thrombophlebitis in peripheral veins
Amount of kcal per gm in glycerol (glycerin)?
4.3 kcal/gm
What is the nitrogen content of amino acid products?
Varies, but for nitrogen balance calculations, amino acid products are generally assumed to be 16% nitrogen
6.25 gm amino acid = 1 gm nitrogen
What are the most frequently used amino acid concentrations used in PN compounding?
8.5%, 10%, and 15%
What concentrations are amino acids available in?
3.5-20%
What is the theory behind modified amino acid formulations marketed for use in renal failure that are composed primarily of essential amino acids?
Theory that nonessential amino acids can be physiologically recycled from urea, whereas essential amino acids must be provided from the diet
Do essential amino acid formulations offer a significant advantage in renal failure?
No
What are the 2 ILE formulations available in the US?
Intralipid and Smoflipid
The 2 ILE formulations available in the US are composed solely of what kind of triglycerides?
Long-chain triglycerides
What are the available concentrations of commercial ILE formulations?
20% and 30%
What is the kcal content of 20% ILE concentrated formula?
2 kcal/ml
What is the kcal content of 30% ILE concentration formula?
2.9-3 kcal/ml, depending on the manufacturer
Are 10% ILE formulations available for PN?
No, currently marketed only in premixed products and products with a lipid emulsion such as Propofol.
What effect does the high phospholipid:triglyceride ratio of 10% ILE have?
Increases the presence of free phospholipids, which interfere with lipoprotein lipase activity, thereby decreasing the lipid clearance rate
Is ILE 30% formula available for direct IV administration?
No. ILE 30% formulation is approved only for the compounding of a 3-in-1 admixture (ie, TNA)
What are the major component fatty acids in the 100% soybean based ILE?
Linoleic acid, oleic acid, palmitic acid, alpha-linolenic acid, stearic acid
Do ILE products using a 50:50 mix of soybean oil and safflower oil contain more or less omega-3 fatty acids than ILE using 100% soybean oil?
Less. Safflower oil contains only a trace of alpha-linoleic acid. Contain half as much omega-3 fatty acid (alpha-linolenic acid) as 100% soybean oil ILE
What led to the development of alternative ILE formulations made from various oil sources?
Concern about the high content of proinflammatory omega-6 polyunsaturated fatty acids (PUFA) in traditional ILE
Describe the general composition of Smoflipid and the percent concentration that is available?
Smof refers to the types of oils in it: soybean oil (30%), medium-chain triglycerides (30%), olive oil (25%), and fish oil (15%). Available as a 20% solution