PRESENTATION

FOR VALENTINE MHUTE

TOTAL PARENTERAL NUTRITION (TPN)
TPN FORMULATION

• Parenteral nutrition solutions are complex formulations that generally include energy supplied as
dextrose and fat, as well as protein, electrolytes, trace elements, vitamins.
• These components usually needs to be individualised for patients according to their primary diagnosis,
chronic diseases status, and specific goals of parenteral nutrition.
There are two types of TPN Formualtions, which include the following:
a) TPN Formulation without lipid (2-in-1 solution):
Which provides a 24HR supply of all nutrients except fatty acids.
- Calories from amino acids - 20-to-25%
- Calories from dextrose - 75-to-80%

b) TPN Formulation with lipid (3-in-1 solution):

Which provides all of the nutrients needed for a 24-HR period, including fatty acids in the form of
Liposyn.
- Calories from amino acids - 20-to-25%
- Caloroes from lipid -20%
- Calories from dextrose - 55-to-60%
TPN Formulation Continued....

• Regardless of the formula, most TPNs are comprised of the same basic
ingredients:
 Sterile water, which provides hydration
 Dextrose, which supplies the primary source of carbohydrates for
calories and energy.
 Aminosyn ( Amino acids), which provides the builiding blocks for
protein synthesis.
 Lyposyn, which supplies essential fatty acids.
 Electrolytes (Na, K, Mg, PO4, Ca), trace elements or minerals (Zn, Cu,
Cr, Mn, Se,Fe), and vitamins, which provide the body with the nutrients
needed for a myriad of chemical processes (addatives).
STABILITY OF TPN PREPARATIONS

• The stability of TPN formulations principally focuses on the degradation of

nutritional components over time.
• Parenteral Nutrition standard solution remain stable for four months at 2-8℃,
ensuring safe admnistration in preterm infants.
• Some vitamins are chemically unstable, being degraded by UV-light or
oxidised by air and degreded oxalic acid.
Features of Parenteral Nutrition are as follows:
 No changes to the size of the lipid particles and their size of distribution.
 Lack of precipitation of insoluble complexes which may rise from reactions
between admixture components.
 Bioavailability of all components.
 Absence of chemical reactions between components.
Stability of TPN Continued...

• Studies have shown that dextrose, amino acid solutions are

chemically stable for 1-2 months if stored in a refridgerator
and protected from light.
• When amino acids stored atroom temperature. As a result,
the solution will have a colour change to dark brwon colour.
Calcium-Phosphate Compatibility

Factors affect stability

• Addative concentration
• Choice of calcium salt
• Order of mixing
• Amino acid product (brand)
• Amino acid concentration
• Temperature
• Storage time
• Addition of I-cysteine (neonatal)
 REFERENCES

Baker JP, Detsky AS. Nutritional assessment : a comparison of clinical judgement and
objective measurements.N Engl J Med. 1982;306:969–972.
[PubMed] [Google Scholar]
Dudrick SJ, Wilmore DW. Long terra parenteral nutrition with growth, development, and positive
nitrogen balance.Surgery. 1968;64:134–142. [PubMed] [Google Scholar]
Klein S, Simes J, Blackburn GL. Total parenteral nutrition and cancer clinical trials.
Cancer. 1986;58:1378–1386. [PubMed] [Google Scholar]
Long C. Metabolic response to injury and illness : estimation of energy and protein needs from
indirect calorimetry and nitrogen balance. J Parenter Enteral Nutr.
1979;3:452–454. [PubMed] [Google Scholar]
McCarthy MC. Nutritional support in the critically ill surgical patient.
Surg Clin North Am. 1991;71:831–842. [PubMed]
[Google Scholar]