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[Patri]

Pues con esto en otro tema del foro ya me estoy dando vueltas a la cabeza. Busco por internet y lo único que hay son trabajos médicos donde no dicen nada de este tipo de cosas. Me pasaré por farmacia del hospital a ver qué me cuentan (aunque si ponen en la bolsa que se proteja será por algo). Si no podríamos indagar entre todos y quizá publicar un artículo si hallamos resultados

[Lilita]

Effects of light-exposed parenteral nutrition on hepatic function and lidocaine metabolism: a study using isolated rat liver perfusion.

        * Zaman N,
        * Tam YK,
        * Jewell LD,
        * Coutts RT.

    Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.

    Effects of light-exposed parenteral solutions on hepatic function and lidocaine metabolism were studied. Male rats (190-220 g) were randomly assigned to one of the three isocaloric treatment groups: parenteral nutrition (PN) (+L) group (n = 6), animals received a solution of 24.2% dextrose and 5.2% amino acids with light exposure; PN(-L) group (n = 5), animals received the same solution without light exposure; and CF group, chow-fed animals (n = 6) that received rat chow and water. Average energy intake in these animals was approximately 33 kcal/100 g/d. Lidocaine metabolism was studied in livers isolated from animals 7 d after treatment. Liver morphology indicated that five livers from PN(+L) animals developed steatosis. The lidocaine metabolism rate was the slowest in PN(+L) animals; this is marked by changes in the steady state levels (% dose) of lidocaine [PN(+L), 47.9 +/- 17.6; PN(-L), 25.9 +/- 2.1; versus CF, 11.3 +/- 5.3; p < 0.05]. The extraction ratio and intrinsic clearance values were reduced by 41 and 86% in PN(+L) group and 16 and 70% in PN(-L) group, respectively, when compared with CF (p < 0.05). Metabolite to drug ratios indicated that N-dealkylation, ring-hydroxylation, and aryl methyl hydroxylation of lidocaine were severely impaired, particularly in the PN(+L) animals. The extents of reduction in metabolic pathways were in the ranges 79-95% in the PN(+L) group and 44-90% in the PN(-L) (p < 0.05). These findings suggest that parenteral nutrition infusion induces steatosis and reduces the rate of lidocaine metabolism and exposure of parenteral nutrition solutions to light exacerbates this change.

    PMID: 8827778 [PubMed - indexed for MEDLINE]

Increased urinary peroxides in newborn infants receiving parenteral nutrition exposed to light.

        * Laborie S,
        * Lavoie JC,
        * Chessex P.

    Department of Pediatrics and Research Center Hospital Ste-Justine, University of Montreal, Montreal, Quebec, Canada.

    OBJECTIVES: To determine whether peroxide loads infused with total parenteral nutrition (TPN) are fully quenched by premature infants. STUDY DESIGN: After baseline urine peroxide levels were established, the effect of various parenteral regimens was correlated with urinary peroxide levels in 64 newborn infants </=32 weeks' gestation. This correlation was achieved with the properties of light and of various parenteral nutrient admixtures on the generation of peroxides. Peroxides were measured by the ferrous oxidation of xylenol orange. RESULTS: The level of urinary peroxides measured for infants given a fat-free TPN regimen unprotected from light (74.5 +/- 15.3 micromol/L) was similar to levels found in infants given a lipid-containing regimen (88.1 +/- 10.3 micromol/L). When photoprotected, the fat-free alimentation was associated with peroxide levels (28.8 +/- 2.8 micromol/L) similar to those measured before TPN (27.6 +/- 4.1 micromol/L). CONCLUSIONS: Because urine peroxide levels are changed by various nutritional procedures, antioxidant systems of premature infants are unable to fully quench the oxidant load associated with TPN.

    PMID: 10802495 [PubMed - indexed for MEDLINE]

Losses of vitamin A and E in parenteral nutrition suitable for premature infants
C Haas1,b, O Genzel-Boroviczény2,b and B Koletzko1,a

1Division of Metabolic Disorders and Nutrition, University of Munich, Munich, Germany

2Division of Neonatology, Department of Pediatrics, University of Munich, Munich, Germany

Correspondence to: B Koletzko, Department of Pediatrics, Head, Div. Metabolic Disorders and Nutrition, Dr. von Hauner Children's Hospital, University of Munich, Lindwurmstr. 4, D-80337 München, Germany. E-mail: bkoletz@helios.med.uni-muenchen.de

aGuarantor: B Koletzko.

bContributors: C Haas, O. Genzel-Boroviczény.
Abstract

Objective: To assess the bioavailability of vitamins A and E administered parenterally with either water-soluble or lipid-soluble preparations.

Study design: A water soluble preparation (MVI PediatricÒ) administered with a glucose-amino acid solution and a lipid soluble preparation (Vitalipid N InfantÒ) infused with a lipid emulsion were subjected to phototherapy light, different flow rates, light protection, different tubing materials and tubing sizes, and concentrations in the effluents were determined.

Results: Recovery of retinol in glucose-amino acid solution was poor under all conditions (16-30% without; 21-42% with light protection tubing) and increased to 61% with polyethylene and to 44% with polyurethane tubings. Polyurethane tubings with reduced volume improved retinol delivery to 56%. Retinylpalmitate (Vitalipid) losses were low, with recovery of 86 and 77% with and without light protection, respectively. Recoveries of alpha-tocopherylacetate in GLUC-AA were 103-107% without and 94-102% with light protection and of alpha-tocopherol in LIPID 89% without and 85% with light protection.

Conclusions: Parenteral vitamin A delivery is improved by the infusion of retinylpalmitate with lipids. Light protecting tubings provide only a marginal benefit with artificial light and none with phototherapy light. Polyethylene and polyvinylchloride tubings adsorb less retinol than polyurethane tubings. Small tubing diameters resulting in higher flow rates enhance retinol delivery.

European Journal of Clinical Nutrition (2002) 56, 906-912. doi:10.1038/sj.ejcn.1601417

Limiting light-induced lipid peroxidation and vitamin loss in infant parenteral nutrition by adding multivitamin preparations to Intralipid

    * KM Silvers11Free Radical Research Group Christchurch School of Medicine, New Zealand
    * KB Sluis11Free Radical Research Group Christchurch School of Medicine, New Zealand
    * BA Darlow22Department of Pathology, Department of Paediatrics Christchurch School of Medicine, New Zealand
    * F McGill22Department of Pathology, Department of Paediatrics Christchurch School of Medicine, New Zealand
    * R Stocker33Biochemistry Group The Heart Research Institute, Sydney, Australia
    * CC Winterbourn11Free Radical Research Group Christchurch School of Medicine, New Zealand

    *
      1Free Radical Research Group Christchurch School of Medicine, New Zealand 2Department of Pathology, Department of Paediatrics Christchurch School of Medicine, New Zealand 3Biochemistry Group The Heart Research Institute, Sydney, Australia

CC Winterbourn, Department of Pathology, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand (Tel. +64 3 364 0564, fax. +64 3 364 183, e-mail. christine.winter-bourn@chmeds.ac.nz)
Abstract

Parenteral lipids are susceptible to light-induced peroxidation, particularly under phototherapy. Ascorbic acid is protective. The aim of this study was to investigate whether dark delivery tubing and/or coadministration of multivitamin preparations could prevent peroxidation of Intralipid without undue vitamin loss. In experiments carried out on the benchtop, lipid peroxidation occurred in ambient light and was more extensive under phototherapy. Dark tubing decreased peroxide formation, but only by about 65%. In simulated clinical conditions in which solutions were pumped through standard clear or dark minibore plastic tubing, Intralipid accumulated lipid peroxides as measured by the FOX assay (280 μM) or as triglyceride hydroperoxides (52 μM). Multivitamin preparations (MVIP or Soluvit/Vitlipid) inhibited peroxide formation almost completely, and were fully protective when used with dark tubing. There was loss of riboflavin (65% from Soluvit and 35% from MVIP) in clear tubing but this was decreased to 18% and 11%, respectively, in dark tubing. Ascorbate loss was 20% (MVIP) and 50% (Soluvit) and only slightly less in dark tubing. Ascorbate loss was also seen in the absence of Intralipid and is due to riboflavin-induced photo-oxidation.

Conclusion: Multivitamin preparations protect Intralipid against light-induced formation of lipid hydroperoxides, and administering multivitamins with Intralipid via dark delivery tubing provides a practical way of preventing peroxidation of the lipid while limiting vitamin loss. This procedure should be considered for routine use as well as with phototherapy.

Photoprotection of solutions of parenteral nutrition decreases the infused load as well as the urinary excretion of peroxides in premature infants.

        * Chessex P,
        * Laborie S,
        * Lavoie JC,
        * Rouleau T.

    Department of Pediatrics, Perinatal Service and Research Center, H pital Ste-Justine University of Montreal, Quebec, Canada.

    Light exposure and multivitamins are contributing factors to the generation of peroxides in solutions of parenteral nutrition. This article verifies if peroxides infused with parenteral nutrition are of biological significance in neonates. The mechanisms responsible for the generation of peroxides in total parenteral nutrition solutions are reviewed. The consequences of infused peroxides on an index of oxidant stress and on levels of a central antioxidant are evaluated in an animal model. The effect of photoprotection of parenteral nutrition on a biological marker of redox imbalance is evaluated in the urine of premature infants. Parenteral multivitamins produce a drop in glutathione and an oxidant stress similar to peroxides in the lungs of newborn guinea pigs. Infused peroxides elicited an increased urinary peroxide excretion in infants receiving parenteral nutrition exposed to light. Photoprotection reduced levels of infused and excreted peroxides. The results suggest that peroxides infused with total parenteral nutrition are not fully quenched by premature infants.

    PMID: 11339665 [PubMed - indexed for MEDLINE]

[Amoxi]

En el hospital la bolsa venía protegida por una fina película plástica q protege de los UVA, ¿ya no las envían así?
Los lípidos q vienen aparte no había q protegerlos.
Muy buena esa bibliografía, Lil 

[sira]

sí que vienen en una bolsa, aunque no es opaca

[Lilita]

Bueno... esto no tiene nada q ver con la fotosensibilidad de la NP pero puede servir...

Adjunto Tipos y indicaciones de NP

[Patri]

Joer lil, si es que donde hay calidad...
Gracias

[Lilita]

Pues tampoco tiene q ver con la fotosensibilidad... pero es interesante...

Momento óptimo para el reemplazo del set de administración intravenosa

[akineton]

las parenterales se protegen de la luz para evitar en el enracimiento de los lipidos causados por la luz solar.

[BEAUTY]

Un articulo sobre recomendaciones para la nutricion parenteral



un articulo sobre la estabilidad de medicamentos termolabiles a temperatura ambiente

[Patri]

las parenterales se protegen de la luz para evitar en el enracimiento de los lipidos causados por la luz solar.

Pero a los neonatos se les pasan los lípidos por separado, vienen en una jeringa de medicación de 50, ahí creo que ni ponen que se proteja y para los inyectores de jeringa no sé si hay opacos (tampoco jeringas opacas).

[PantaManzanito!!]

las parenterales se protegen de la luz para evitar en el enracimiento de los lipidos causados por la luz solar.

Pero a los neonatos se les pasan los lípidos por separado, vienen en una jeringa de medicación de 50, ahí creo que ni ponen que se proteja y para los inyectores de jeringa no sé si hay opacos (tampoco jeringas opacas).

Jeringas opacas las he visto en UCIP del Materno de Malaga....y las usaban para farmacos como el seguril. La ostia!! que me siento importante de poder participar en este tipo de temas!! jajajaj

[BEAUTY]

Los farmacos que vienen en ampollas que no son trasparentes, es decir, esas que son de color marron, es porque tienen que ser protegidos de la luz, y el seguril es uno de ellos.

[Amoxi]

He encontrado esto sobre NPT en recién nacidos:

http://bvs.sld.cu/revistas/enf/vol22_4_06/enf03406.htm

[Amoxi]

las parenterales se protegen de la luz para evitar en el enracimiento de los lipidos causados por la luz solar.

Pues yo pensaba q era para proteger las vitaminas 

[Patri]

Gracias amoxi. Ahora surge otra duda... ¿lo de fotosensible a varias horas de exposición, de cuántas horas estamos hablando?. En todo caso, hablando de horas no haría falta sistema opaco, el equipo es largo pero una gota no tardaría mucho en llegar abajo, aunque supongo que sí vendría bien tapar la bolsa para no acumular horas de exposición.

[Amoxi]

Bueno... esto no tiene nada q ver con la fotosensibilidad de la NP pero puede servir...

Adjunto Tipos y indicaciones de NP

Es curioso lo del yodo, no se me había ocurrido 
Patri, supongo q dependerá de la composición de la nutrición.
A ver si alguien nos lo sabe aclarar.

[akineton]

Pues seguramente como dices amoxi tambien sera por determinadas vitaminas q sean fotosensibles. En cuanto a lo de la fotosensibilidad, nosotros en mi unidad cambiamos las parenterales cada 24 horas y al igual que el sistema de perfusion que lo ponemos opaco.

[Patri]

Pues de composición si es total llevará de todo (en distintas cantidades). Lo de las ampollas tintadas me lo dijeron este verano, ni lo sabía, pero no está mal tener tablas de fotosensibilidad o estabilidad ambiental de medicamentos. Por ejemplo el nolotil lo ponemos tal cual pero si ya es en bomba y con un suero a bajo ritmo...

[Amoxi]

Se desvía un pelín del tema del post, pero si hablamos de medicamentos, el servicio de Farmacia de los hospitales suele tener una guía.
Éste es un ejemplo de un Servicio de salud:

http://216.239.59.104/search?q=cache:0V3fB4oGjEsJ:www.scsalud.es/publicaciones/descargar.php%3FId%3D4%26Id2%3D8+medicacion+fotosensible&hl=es&ct=clnk&cd=1&gl=es