Poster Topical Area: Vitamins and Minerals

Location: Hall D

Poster Board Number: 490

P26-029 - Calcium Chloride and Calcium Gluconate in Neonatal Parenteral Nutrition Solutions with Cysteine: Compatibility Studies Using Laser Light Obscuration Methodology

Sunday, Jun 10
8:00 AM – 6:00 PM

Background: Neonatal parenteral nutrition (PN) solutions containing calcium gluconate (CaGlu) and cysteine have elevated particle counts when analyzed using light obscuration (LO) as recommended by the United States Pharmacopeia (USP) (Parikh et al, Am J Health-Syst Pharm, 2005). There are no compatibility studies for solutions compounded with cysteine and containing calcium chloride (CaCl2) using LO.

Objective: The purpose of this study was to do compatibility testing for neonatal PN solutions containing CaCl2 and CaGlu with cysteine.


Methods:
Solutions of Premasol (2.5% amino acids), containing either CaCl2 or CaGlu and potassium phosphate (KPhos) were compounded with cysteine (50 and 100 mg/dL). Solutions were analyzed for particle counts using LO. Maximum concentrations tested were 20 mmol/L of Ca and 15 mmol/L of KPhos. Three solutions containing CaCl2 (144 total solutions) and two containing CaGlu (96 total solutions) and the same concentration of additives were compounded. If the average particle count of replicates exceeded USP guidelines the solution was incompatible.


Results:
All solutions containing CaGlu had particle counts that exceeded USP guidelines for particle counts >= 10 microns (range = 86-580 particles/mL). For CaCl2 90 of 144 solutions were compatible (range of particle counts for all solutions = 3-121 particles/mL). Maximum compatible concentrations of CaCl2 and KPhos were 15 mmol/L and 12.5 mmol/L, respectively, for solutions containing both 50 and 100 mg/dL of cysteine.


Conclusion:
This study found that neonatal PN solutions with cysteine containing CaGlu have significantly higher particle counts than those containing CaCl2. We speculate that an interaction between cysteine and gluconate leads to particle formation and elevated particle counts.




Funding Source: Funding for the study was provided by a grant from Northwest Newborn Specialists PC.

Robert K. Huston is an employee of Northwest Newborn Specialists, PC. Northwest Newborn Specialists, PC played no role in the design, conduct, analysis, interpretation, or reporting of this study. The views, conclusions, and opinions expressed are solely those of the authors and do not represent those of Northwest Newborn Specialists, PC. Otherwise the authors declare no conflicts of interest.

CoAuthors: J. Mark Christensen – Oregon State University, Corvallis, OR, USA; Sultan Alshahrani – Oregon State University, Corvallis, OR, USA; Sumeia Mohamed – Oregon State University, Corvallis, OR, USA; Carl Heisel – Randall Children’s Hospital at Legacy Emanuel, Portland, OR, USA

Robert K. Huston

Neonatologist
Randall Children's Hospital at Legacy Emanuel
Portland, Oregon