Total nutrient admixture

A review

Rex Brown, R. A. Quercia, R. Sigman

Research output: Contribution to journalReview article

50 Citations (Scopus)

Abstract

The TNA system of nutritional support has become very popular and offers some unique advantages over the traditional method of administering TPN to hospitalized and home patients. However, these advantages as outlined in this review, must be carefully weighed against potential disadvantages before the TNA system is employed as a nutritional support modality. It should also be noted that the stability of TNA systems is not well established since many stability studies do not provide specific information regarding formulations tested. In addition, many studies do not utilize methods to determine the entire spectrum of particle size and distribution. Droplet size in TNA systems attain a diameter several times larger than the 0.2 to 0.4 μm of manufacturer's lipid emulsions and naturally occurring chylomicrons. Although the administration of the TNA system has not been associated with any acute toxicity, the long-term consequences of infusing droplets larger than 0.4 μm is not definitely known. In addition, the biological implications of using the TNA system need to be elucidated. Subtle differences in the properties of the lipid emulsion can affect the way it is metabolized by the body. Wretlind has mentioned that two apparently similar soybean oil emulsions, Intralipid, and Lipofundin are handled differently by the body. Minor differences in the phospholipid layer of the droplets were postulated as a cause. Certainly the nature of the emulsifying layer of phospholipid on TNA system droplets is modified and therefore may be metabolized differently. The recent report of enhanced growth of microorganisms in TNA systems is also worrisome. Contamination of the extemporaneously compounded TNA systems becomes a major concern. This is particularly important since the preferred method of monitoring sterility (ie, total membrane sampling) is not possible with the TNA system since it requires filtration with a bacterial retention filter. It is clear that emulsion stability and metabolism involves a number of complex chemical and physical interactions. The net effect of adding various dextrose concentrations, different types of amino acids, and the wide range of electrolyte concentrations used in clinical practice to lipid emulsions, is not fully determined. Additional well designed studies appear warranted before widespread use of the TNA system can be recommended.

Original languageEnglish (US)
Pages (from-to)650-658
Number of pages9
JournalJournal of Parenteral and Enteral Nutrition
Volume10
Issue number6
DOIs
StatePublished - Jan 1 1986

Fingerprint

Emulsions
Food
Nutritional Support
Lipids
Phospholipids
Chylomicrons
Soybean Oil
Particle Size
Infertility
Electrolytes
Amino Acids
Glucose
Membranes
Growth

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Total nutrient admixture : A review. / Brown, Rex; Quercia, R. A.; Sigman, R.

In: Journal of Parenteral and Enteral Nutrition, Vol. 10, No. 6, 01.01.1986, p. 650-658.

Research output: Contribution to journalReview article

Brown, Rex ; Quercia, R. A. ; Sigman, R. / Total nutrient admixture : A review. In: Journal of Parenteral and Enteral Nutrition. 1986 ; Vol. 10, No. 6. pp. 650-658.
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