• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.12-26
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• 2009

Parenteral nutrition (PN) is effective and relatively safe method providing nutrients to patients with a nonfunctioning or insufficiently functioning gastrointestinal tract via peripheral or central vein. In last several decades, useful steps have been taken in the understanding of nutritional needs, physiological changes and complications of intravenously fed patients. PN includes amino acids, glucose, lipids, electrolytes, vitamins, iron, minerals and trace elements, and must be based on individual circumstances such as patient's age, health status and disease. The purpose of this review is to introduce overall components and recent updates of parenteral nutrition.

• YAKHAK HOEJI
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• v.54 no.4
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• pp.244-251
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• 2010

Standardized parenteral nutrition is required to improve patient's safety, clinical appropriateness and to increase uniformity between institution and institutions. We assessed the consistency with the American society for parenteral and enteral nutrition (A.S.P.E.N.) practice guideline for PN by evaluating current practice process for parenteral nutrition formulation in inpatients pharmacies in Korea. Each question in this survey was based on 2007 A.S.P.E.N. recommendations of standard parenteral nutrition formulation, the American society of health-system pharmacists (ASHP), and the United State Pharmacopoeia (USP) Chapter 797 guideline for compounding parenteral nutritions. All 90 Korean society of hospital pharmacist (KSHP) member directors of pharmacy were requested to respond to the survey in order to compare the survey results to ASHP national survey of pharmacy practice in hospital settings (2002) in compliance with A.S.P.E.N. guideline. We had final response rate of 35.6%. 25 (100%) hospitals complied with this Garb guideline (response rate was 84.4%) which was the highest compliance. Only 17.9% of hospital pharmacies were actively involved in complications monitoring. Monitoring complications and efficacy were least in compliance with the A.S.P.E.N. guideline. 69.0% of Korean pharmacists adjusted medication dosage based on disease state or monitoring laboratory data in compliance with the A.S.P.E.N. guideline. Over 50% of the hospital pharmacies failed to provide and evaluate staff training in aseptic manipulation skills periodically. Korean hospital pharmacies need to comply with the standard practice guideline for compounding sterile preparation in order to provide better quality of parenteral nutrition service for specific patient population.

• Journal of Pharmaceutical Investigation
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• v.21 no.3
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• pp.155-160
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• 1991

Particulate is the foreign insoluble material in injectable solution inadvertently present in a given product. Considerable efforts have been made to avoid or minimize particulate contamination by pharmaceutical manufacturers during the production of parenteral products. Particulate contamination of the parenteral products can occur mainly during the opening (cutting) the container immediately before clinical use. In this study, particulate contamination generated during the opening process of ampoules (conventional type, 1-point and color-break ampoules) was compared with that of a prefilled injectable container (prefilled syringe). The particles were examined under a microscope after filtration of the total fluids in the containers. Particles having wide range of size distribution were found from all the ampoules tested. The contamination from the I-point ampoule and colorbreak ampoule was much less than from the conventional ampoule. Glass particles generated by cutting the glass-made ampoules seemed a principal source of the particulate contamination. The glass-partiaulte contamination could be improved substantially by replacing the ampoule containers with the prefilled syringe. Prefilled syringe, which can be used without any cutting process. did not generate particulates during the use. Therefore, it was concluded that prefilled syringe is most preferable container for the small volume parenteral (SVP) fluids in terms of particulate contamination.

• Journal of Pharmaceutical Investigation
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• v.31 no.3
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• pp.167-172
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• 2001

All-trans retinoic acid (ATRA), vitamin A acid, has been shown to exert anticancer activity in a number of types of cancers, particularly in acute promyelocytic leukaemia (APL). Due to its highly variable bioavailability and induction of its own metabolism after oral treatment, development of parenteral dosage forms are required. However, its poor aqueous solubility and chemical unstability give major drawbacks in parenteral administration. This study was undertaken to investigate a possibility to develop a parenteral formulation of ATRA by employing solid lipid nanoparticle (SLN) as a carrier. By optimizing the production parameters and the composition of SLNs, SLNs with desired mean particle size (<100 nm) as a parenteral dosage form could be produced from trimyristin (as solid lipid), Egg phosphatidylcholine and Tween 80 (as SLN stabilizer). The mean particle size of SLN formulation of ATRA was not changed during storage, suggesting its physical stability. Thermal analysis confirmed that the inner lipid core of SLNs exist at solid state. The mean particle size of ATRA-loaded SLNs was not significantly changed by the lyophilization process. ATRA could be efficiently loaded in SLNs, while maintaining its anticancer activity against HL-60, a well-known APL cell line. Furthermore, by lyophilization, ATRA loaded in SLN could be retained chemically stable during storage. Taken together, our present study demonstrates that physically and chemically stable ATRA formulation adequate for parenteral administration could be obtained by employing SLN technology.

• Proceedings of the PSK Conference
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• 2003.04a
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• pp.295.2-295.2
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• 2003

Lipid nanodispersion (LN) composed of biocompatible lipids and surfactants is an alternative parenteral drug delivery system especially for lipophilic drugs. It has been studied for versatile applications such as oral, parenteral, topical, ocular, vaccine, and peptide drug delivery. The purpose of this study was to produce a novel LN system for intravenous injection using the high pressure homogenization. (omitted)

• Korean Journal of Clinical Pharmacy
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• v.23 no.2
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• pp.167-174
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• 2013

Objective: The study evaluated the impact of pharmacist inventions with the implementation of pharmacistinvolved nutritional support service at neonate intensive care unit in a tertiary teaching hospital. Method: A retrospective and observational study was carried out. The total of 58 infants in neonate intensive care unit was enrolled between January 2011 and October 2012. The pharmacist-involved total parenteral nutritional program was initiated in June of 2012. During the program, pharmacist actively participated in the multidisciplinary round with performing the interventions from reviewing the amount of combined total parenteral nutrition and enteral fluid intakes, the amount of total calories, the glucose infusion rate, and the amounts of proteins per weight in kilogram. The outcome was compared with the results from the control group which reflected the prior period of the program initiation. Result: The number of days of regaining birth weight was significantly shorter (14.5 vs. 19 days, p=0.049) and the percentage of total calorie days with >90 kcal/kg/day was increased significantly (40 vs. 13%, p=0.008) in intervention group compared to the values in control group. In addition, the total mean daily caloric intakes ($84.78{\pm}13.8$ vs. $74.86{\pm}15.36$ kcal/kg/day, p=0.018) was significantly higher in intervention group than those results in control group. There were no significant differences in safety parameters between two groups related to nutritional services of necrotizing enterocolitis, intraventricular hemorrhage, proven sepsis, and also parenteral nutrition-induced hepatotoxicity. Conclusion: Pharmacist-involved total parenteral nutrition managed program was successfully implemented. The outcome showed the improved effectiveness of total parenteral nutrition with pharmacist interventions and no differences in adverse reactions. This could prove the positive effects of pharmacist involvement on nutritional therapy for neonate population.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.2
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• pp.116-122
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• 2013

Purpose: Preterm infants on parenteral nutrition are at a relatively high risk for hypertriglyceridemia because they have immature lipoprotein lipase activity. The purpose of this study was to analyze the clinical factors affecting lipid metabolism in preterm infants receiving parenteral nutrition and to evaluate the influence of intravenous heparin on serum triglycerides to determine the adequate heparin dose to prevent hypertriglyceridemia in preterm infants. Methods: A single-center retrospective review was conducted among preterm infants receiving parenteral nutrition between January 2006 and February 2011. In 75 patients, 110 determinations were performed within 28 days postnatal age. Demographic and clinical data, including laboratory parameters, the dose and the duration of lipid administration, and the amount of intravenous heparin, were analyzed. Results: Serum triglycerides were higher in the small for gestational age (SGA) infants than in the appropriate for gestational age infants ($185.5{\pm}134.9$ mg/dL vs. $126.9{\pm}101.9$ mg/dL, p=0.019). Birth weight, gestational age, and body weight were negatively correlated with serum triglyceride level (r=-0.289, p=0.002; r=-0.208, p=0.029; r=-0.287, p=0.002, respectively). The serum triglyceride level was statistically lower in preterm infants receiving 1 U/mL of heparin than in those receiving 0.5 U/mL heparin or no heparin. Conclusion: Preterm infants receiving parenteral nutrition, particularly SGA and extremely low birth weight infants, tend to have hypertriglyceridemia. Thus, administration of 1 U/mL of heparin rather than 0.5 U/mL or none may be helpful to prevent hypertriglyceridemia in preterm infants.

• Clinical and Experimental Pediatrics
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• v.58 no.11
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• pp.454-458
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• 2015

Compartment syndrome is a rare but devastating condition that can result in permanent neuromuscular or soft tissue injuries. Extravasation injuries, among the iatrogenic causes of compartment syndrome, occur under a wide variety of circumstances in the inpatient setting. Total parenteral nutrition via a peripheral route is an effective alternative for the management of critically ill children who do not obtain adequate nutrition via the oral route. However, there is an inherent risk of extravasation, which can cause compartment syndrome, especially when detected at a later stage. Herein, we report a rare case of compartment syndrome and skin necrosis due to extravasation, requiring emergency fasciotomy and skin graft in a 7-month-old boy who was treated with peripheral parenteral nutrition via a pressurized infusion pump. Although we cannot estimate the exact time at which extravasation occurred, the extent and degree of the wound suggest that the ischemic insult was prolonged, lasting for several hours. Pediatric clinicians and medical teams should carefully examine the site of insertion of the intravenous catheter, especially in patients receiving parenteral nutrition via a peripheral intravenous catheter with a pressurized infusion pump.

• Journal of Pharmaceutical Investigation
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• v.40 no.spc
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• pp.83-95
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• 2010

Over the years, nanoparticle drug delivery systems have demonstrated versatile potentials in biological, medical and pharmaceutical applications. In the pharmaceutical industry nanotechnology research has mainly focused on providing controlled drug release, targeting their delivery to specific organs, and developing parenteral formulations for poorly water soluble drugs to improve their bioavailability. Achievement in polymer industry has generated numerous polymers applicable to designing nanoparticles. From viewpoints of product development, a nanocarrier material should meet requirements for biodegradability, biocompatibility, availability, and regulatory approval crieteria. Albumin is indeed a material that fulfills such requirements. Also, the commercialization of a first albumin-bound paclitaxel nanoparticle product (Abraxane$^{TM}$) has sparked renewed interests in the application of albumin in the development of nanoparticle formulations. This paper reviews the intrinsic properties of albumin, its suitability as a nanocarrier material, and albumin-based parenteral formulation approaches. Particularly discussed in detail are albumin-based particulate injectables such as Abraxane$^{TM}$. Information on key roles of albumin in the nab$^{TM}$ technology and representative manufacturing processes of albumin particulate products are provided. It is likely that albumin-based particulate technology would extend its applications in delivering drugs, polypeptides, proteins, vaccines, nucleic acids, and genes.

• Korean Journal of Community Nutrition
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• v.8 no.4
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• pp.574-583
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• 2003

The purpose of this study was to investigate the anthropometry, biochemical parameters and electrolytes concentrations of the Total Parenteral Nutrition (TPN) patients according to their nutritional status at the time of admission. Thirty-three patients in the Intensive Care Unit at S University Hospital were the subjects of this study. Their nutritional status was classified as At-risk I (Mild PCM, n = 13), At - risk II (Moderate PCM, n = 9) and At-risk III (Marasmus + kwashiorkor + severe PCM, n = 11) . Anthropometeric, biochemical and dietary assessments were performed. The Patients intake of calories (75.02%) and protein (53.15%) was insufficient compare with Korean RDA requirements. The body weight and the Body Mass Index (BMI) in the At-risk III group were significantly lower than in the other groups. The percentage of body weight loss and change of body weight (kg) were significantly higher than in the other groups. The subjects were malnourished as indicated by nutritional related parameters such as serum total protein, albumin, total lymphocyte count (TLC), hemoglobin and hematocrit. Serum total protein, albumin and TLC levels were lower at the time of admission before TPN administration. But after TPN administration, they increased. The electrolyte concentrations did not show any differences following TPN administration. The nutritional status of the patients could be affect by the duration of TPN administration and the number of days of the patients hospitalization. The patients who require nutritional support need the continuous follow-up care and monitoring by a nutritional support team. (Korean J Community Nutrition 8(4) : 574-583, 2003)