A.S.P.E.N. Position Paper: Recommendations for Changes in Commercially Available Parenteral Multivitamin and Multi–Trace Element Products

• Published in: Nutrition in clinical practice 2012-08, Vol.27 (4), p.440-491
• Main Authors: Vanek, Vincent W., Borum, Peggy, Buchman, Alan, Fessler, Theresa A., Howard, Lyn, Jeejeebhoy, Khursheed, Kochevar, Marty, Shenkin, Alan, Valentine, Christina J.
• Format: Article
• Language: English
• Subjects: Avitaminosis - drug therapy; Carnitine - administration & dosage; Choline - administration & dosage; Dietary Supplements; Dietetics - standards; Guidelines as Topic; Humans; Nursing; Nutritional Requirements; Parenteral Nutrition - standards; Parenteral Nutrition Solutions - standards; Trace Elements - administration & dosage; Trace Elements - deficiency; United States; United States Food and Drug Administration; Vitamins - administration & dosage
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1177/0884533612446706

The parenteral multivitamin preparations that are commercially available in the United States (U.S.) meet the requirements for most patients who receive parenteral nutrition (PN). However, a separate parenteral vitamin D preparation (cholecalciferol or ergocalciferol) should be made available for treatment of patients with vitamin D deficiency unresponsive to oral vitamin D supplementation. Carnitine is commercially available and should be routinely added to neonatal PN formulations. Choline should also be routinely added to adult and pediatric PN formulations; however, a commercially available parenteral product needs to be developed. The parenteral multi–trace element (TE) preparations that are commercially available in the U.S. require significant modifications. Single-entity trace element products can be used to meet individual patient needs when the multiple-element products are inappropriate (see Summary/A.S.P.E.N. Recommendations section for details of these proposed modifications).