Aaron Jones
1- The manufacturer reports that up to 120 mmol/L Sodium glycerophosphate and 48 mmol/L calcium chloride in one liter PN volume
2- It was reported that PN containing up to 50 mEq/L calcium gluconate and 50 mmol/L Sodium glycerophosphate was compatible. This information allows prescriber to go for higher amounts of calcium and phosphorus especially in neonates. (MacKay M, Anderson C. Physical compatibility of sodium glycerophosphate and calcium gluconate in pediatric parenteral nutrition solutions. April 2, 2014. JPEN J Parenter Enteral Nutr)
3- One unintended consequence of increasing the calcium gluconate in PN, due to the favorable solubility when compounded with Sodium glycerophosphate, is the potential for aluminum toxicity.
4- The FDA guideline recommends not to exceed intake of aluminum above 5 mcg/kg/d.
5- When calcium gluconate injection 10 mL glass ampoules is used in the preparation of parenteral nutrition, the aluminium content of the bag from the ampoule could be up to 220 µg/L. Due to the higher need for calcium and phosphate in neonatal PN, these patients may exceed the recommended limit of Aluminum.
