TPN Nutrient Shortages?

Posted by SF8N at Jul 12, 2011 10:40 AM |

July 12, 2011

TPN Nutrient Shortages?

Joe Krenitsky, MS, RD

Currently we still do not have intravenous calcium or magnesium sulfate, with only limited amounts of magnesium chloride available to add to PN solutions, and now we just found out that we have a minimal amount of the multiple trace element solution and no IV selenium.  We are planning on adding the multi-trace element additive only on Monday and Thursday to spare what we have and we will add 5 mg zinc/day to the PN.  Chromium gets into the solutions via contamination and the multi-trace additive provides an excess of manganese and copper, so we don’t plan to add extra of those for patients on short-term PN.  However, those patients that stay on PN for a protracted period will likely require additional copper and chromium.

You have to ask why after 40 years of PN use with minimal and rare shortages do we suddenly have so many problems obtaining adequate parenteral nutrients?  I have to say that I was glad to see ASPEN taking a proactive position regarding parenteral nutrient shortages and that they have sent a query and request to the FDA.  This ASPEN page has links to the ASHP and FDA websites regarding the shortages:

http://www.nutritioncare.org/Index.aspx?id=6068

With the recent encouragement to embrace pre-made PN solutions I really wonder if the companies are obtaining sufficient ingredients for those pre-made solutions, and if so, how?

 

“The power of accurate observation is frequently called cynicism by those who don't have it.”
- George Bernard Shaw

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