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Trissel'sTM Ca/P Check

Influence of pH

The pH of the parenteral nutrition admixture plays a pivotal role in determining the compatibility of the calcium and phosphate in the admixture. Lower pH admixtures tend to permit much more calcium and phosphate in solution than those with higher pH values. Even seemingly small changes in pH can play a substantial role in precipitation occurrence. As a consequence, the addition of cysteine HCl injection (or other acidifying agent) to admixtures will lower the pH and increase the amounts of calcium and phosphate that remain compatible in the admixture. Similarly, addition of neutral or alkaline drugs or components (including fat emulsions) may increase the pH and result in calcium phosphate precipitation.

In the accompanying graph, the calcium and phosphate compatibility was substantially reduced in an admixture containing 1% FreAmine III and 10% dextrose (FreAmine III Formula 1) when the pH was adjusted from the natural pH of 6.6 up to neutrality at pH 7.0 using sodium hydroxide.

Adapted from:
Eggert LD, Rusho WJ, MacKay MW, et al. Calcium and phosphorus compatibility in parenteral nutrition solutions for neonates. Am J Hosp Pharm. 1982; 39:49-53.

influence4

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