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PubMed1978

Compatibility and stability of electrolytes, vitamins and antibiotics in combination with 8% amino acids solution.

The compatibility and stability of the following additives in an 8% amino acids and 50% dextrose solution intended for total parenteral nutrition were studied: potassium phosphate, calcium gluconate, magnesium sulfate, multiple vitamine mixtures, folic acid, cyanocobalamin, phytonadione, insulin, ampicillin, cephalothin, kanamycin and gentamicin. In addition to physical examination, techniques of ultraviolet spectroscopy, thin-layer chromatography and microbiologic assay were used to delineate compatibility characteristics. The principle compatibility problems are generated by elevated concentrations of calcium and phosphate. The efficacy of ampicillin, cephalothin and kanamycin in the amino acids/dextrose solution, with or without additives, did not appear to be significantly different from control samples prepared in sterile water. It appeared that gentamicin might be significantly more effective in the test solutions than in sterile water, but further investigation is needed to verify this. A comprehensive study of the stability of vitamins in parenteral nutrient solutions must be made before a final judgment can be made.

Amino Acids↗
PubMed1984

Compatibility considerations in parenteral nutrient solutions.

Information on compatibility of nutrients and drugs with parenteral nutrient (PN) solutions is reviewed and evaluated. Precipitation of calcium phosphate when calcium and phosphate salts are added can be affected by pH, amino acid concentration, amino acid product, temperature, sequence of additives, specific salt used, and time since admixture; precipitate formation can occur gradually over 24 hours. Insulin is chemically stable in PN solutions, but adsorption to the infusion system can cause decreased availability. Poor delivery of vitamin A via PN solutions has been reported. The sodium bisulfite content of amino acid injections may cause degradation of thiamine, but studies simulating clinical use are needed. Folic acid stability in PN solutions has been demonstrated, and phytonadione appears to be stable. Drug administration via PN solutions may be advantageous when fluid intake is restricted or peripheral vein access is limited and in home PN therapy. Summarized are results of studies involving heparin, cimetidine hydrochloride, aminophylline, amphotericin B, iron dextran, hydrochloric acid, corticosteroids, narcotics, metoclopramide, digoxin, and fluorouracil. Many antibiotics are probably stable, especially when administered by co-infusion rather than by direct mixture in the PN solution container. When lipids are mixed in the same container with amino acid-dextrose solutions, compatibility and stability of electrolytes, vitamins, and trace elements must be reassessed. Practical research is needed, and availability of additives should be studied in specific patient populations and for specific PN formulations. Valid conclusions are dependent on careful study design.

Adrenal Cortex Hormones↗
PubMed1983

[General characteristics and problems of the galenic aspects of fat emulsions].

The development of a clinically applicable intravenous fat emulsion has a long history. The gain of knowledge about the best lipid and emulsifying system had an intermittent development and led to three generations of distinct fat emulsions. For the evaluation of a fat emulsion it is necessary to compare the results of the same generation only. In the past, many misinterpretations came from mixing the results of different generations. It can be stated that by considering the contraindications, application schedules and basal galenic aspects, only minimal side effects from a parenteral administration of fat emulsions can be seen. Today the most important aspects of parenteral nutrition with fat emulsions are the galenic ones, which are often overlooked. The staining of the liposomes of the fat emulsions with 2% OSO4 make electron microscopic investigations of the liposomes possible after mixing them with carbohydrates, amino acids, electrolytes, vitamins and trace elements. The liposomes of soybean oil emulsions in different "All In One" (AIO) solutions have been under current investigations. The results demonstrated that the liposomes of fresh AIO-solutions carry highly osmiophilic inclusion bodies. Prolonged storage led to further alterations, as change of shape, loss of osmiophility and finally formation of liposomes ghosts. In solutions kept at 4 degrees C those changes developed between the 1st and 2nd month of storage, whereas storage at 22 degrees C was harmless within 48 h only. Therefore, it is recommended that already prepared AIO solutions are kept at 4 degrees C and used as soon as possible.

Carbohydrates↗
PubMedDate not supplied

[Use of biguanide preparations in the treatment of diabetes mellitus].

The blood content of lactic acid was measured in 186 patients with overt diabetes mellitus. The patients had normal or excess body weight and were placed on different treatment methods during decompensation, subcompensation and compensation stages. During diabetes mellitus compensation attained with different treatment methods as well as during treatment including biguanides in the presence of normoglycemia, the mean blood level of lactic acid did not differ significantly from its mean content in normal subjects. Patients with decompensated diabetes mellitus manifested a significant elevation of the mean blood content of lactic acid. There was a definite relationship between the glycemia and high lactic acid level in the blood. Based on an analysis of the reported data and own materials the conclusion is drawn that biguanides should not be used in the treatment of decompensated diabetes mellitus, since this may lead to an increase in blood lactic acid and to the growth of lactic acidosis risk. It is proposed that contraindications to the use of biguanides in diabetes mellitus patients should also include hyperglycemia. Indications to the use of biguanides in diabetes mellitus patients are provided as well as the table of diseases in which biguanides are contraindicated. A list of drugs incompatible with biguanides is also presented. It is recommended that biguanides should not be applied for over 4 to 6 months. It is also recommended that detection of blood lactic acid should be introduced into medical practice on a wider basis, since lactic acidosis cannot be diagnosed without using such a test.

Adolescent↗