Admixture of a Multivitamin Preparation to Parenteral Nutrition: The Major Contributor to In Vitro Generation of Peroxides

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Abstract
Background. Peroxides have been reported to contaminate lipid emulsions and amino acid solutions used in total parenteral nutrition (TPN). This is particularly disturbing in newborn infants who are prone to several diseases related to immature defense mechanisms against oxidative challenges. It is not clear whether the antioxidants in multivitamins help protect parenteral nutrients against the hazards of oxidation. Objective. To evaluate the role of a multivitamin preparation (MVI) on the actual peroxide load received by patients on TPN. Methodology. The generation of peroxides in parenteral nutrition was tested first using test solutions. We compared the relative contribution of commercially available amino acid solutions, a lipid emulsion, and MVI on the level of peroxides in clinically relevant TPN solutions. Second, we measured the level of peroxides actually infused at the bedside. In both circumstances, the effects of time and light exposure were isolated. The level of peroxides was determined by a colorimetric technique and expressed as μm equivalents tert-butyl hydroperoxide (μm = TBH). Results. Even when protected from light, the addition of MVI produced a 10-fold increase in peroxides (mean ± SEM, n = 3, 19 ± 4 to 189 ± 8 μm = TBH at 4 h) in the fat-free TPN solution and a fourfold increase (64 ± 6 to 244 ± 8 μm = TBH at 4 h) in the lipid-containing TPN solution. A dose–response relationship was found between the concentration of MVI and peroxide levels. The effect of light was the strongest in the presence of multivitamins. The amino acid solutions had a relative inhibitory effect on the generation of peroxides by MVI, which varied (from 54 ± 1% to 72 ± 1%) all according to the amino acid blend. In parenterally fed premature infants, protecting the intravenous set from light decreased the load of infused peroxides (146 ± 15 vs 215 ± 24 μm= TBH). Conclusions. The lipid emulsion had a significant but minor additive effect compared with the multivitamin preparation, which was the major contributor to the generation of peroxides. Protection from photooxidation is not sufficient to prevent peroxidation of TPN solutions. Contrary to what one would expect, increasing the concentration of MVI will lead to a greater generation of peroxides, suggesting that the essential antioxidants in MVI do not have antiperoxide properties. amino acids, antioxidants, detergents, lipids, newborn infants, oxidation, parenteral nutrition.