Quantitative analysis of insulin in total parenteral nutrition bag in Taiwan

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Abstract

Regular insulin can reduce hyperglycemia when directly added to total parenteral nutrition (TPN) solutions. Insulin is not routinely added to all TPN solutions. For patients who require insulin prior to the initiation of TPN supplement, one-third to one-half of the usual total daily dose can be added to the TPN bag as regular human insulin. However, an incorrect dose or an interaction between insulin and the TPN bag material may affect blood sugar control in clinical practice. Therefore, it is important to quantitatively determine the final dose of insulin in the TPN bag. High performance liquid chromatography is a very powerful technique for determining the purity of proteins. The goal of this study was to use high-performance liquid chromatography to perform quantitative analysis of insulin in a TPN bag. The analysis was performed under different light conditions (UV, fluorescent, and darkness) and different temperatures (25°C and 2–8°C). The results show that adsorption of insulin on an ethylene vinyl acetate TPN bag is significantly higher than that on glass. Based on the results, it is evident that regular insulin should be administered separately from TPN to reduce cost and eliminate wasteful disposal of TPN solutions.

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Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition.

Grant Napier, Cathy Zaccaria, P Thomas Fletcher … (2005)

Hyperglycemia is associated with poor clinical outcomes and mortality in myocardial infarction, stroke, and general hospital patients. However, there are few data regarding the effect of hyperglycemia on outcomes in patients receiving total parenteral nutrition (TPN), a therapy that predisposes patients to hyperglycemia. The aim of this study was to determine whether elevated blood glucose levels are associated with adverse outcomes in patients receiving TPN. A retrospective analysis was undertaken from the medical records of 111 patients (122 treatment episodes) receiving TPN. All patients had blood drawn daily for the measurement of blood glucose levels. Outcome measures were assessed as a function of mean daily blood glucose levels while receiving TPN. Increased blood glucose levels were associated with an increased risk of cardiac complications (odds ratio 1.61, 95% CI 1.09-2.37, P = 0.02), infection (1.4, 1.08-1.82, P = 0.01), systemic sepsis (1.36, 1.00-1.86, P = 0.05), acute renal failure (1.47, 1.00-2.17, P = 0.05), and death (1.77, 1.23-2.52, P < 0.01). When the data were examined by quartiles of blood glucose levels, the mortality of subjects in the highest quartile was 10.9 times (95% CI 2.0-60.5, P < 0.01) that of subjects in the lowest quartile, and the risk of developing any complication was 4.3 times higher (1.4-13.1, P < 0.01). These effects were independent of age, sex, or prior diabetes status. Hyperglycemia is a predictor of poor outcomes in patients receiving TPN. The confirmation of a relation between blood glucose levels and adverse outcomes provides support for tight glycemic control in these patients.

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Long-term total parenteral nutrition with growth, development, and positive nitrogen balance.

William Rhoads, D Wilmore, S. Dudrick … (1968)

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Is Open Access

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

Gabriel Olveira, María José Requena Tapia, María Ocón Bretón … (2013)

OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels 180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.

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Author and article information

Journal

Journal ID (nlm-ta): J Food Drug Anal

Journal ID (iso-abbrev): J Food Drug Anal

Title: Journal of Food and Drug Analysis

Publisher: Taiwan Food and Drug Administration

ISSN (Print): 1021-9498

ISSN (Electronic): 2224-6614

Publication date (Electronic, collection): 2016

Publication date (Electronic, pub): 16 October 2015

Volume: 24

Issue: 1

Pages: 214-219

Affiliations

[a ]Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

[b ]Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

[c ]School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan

Author notes

[* ]Corresponding authors. Department of Pharmacy, Kaohsiung Medical University Hospital, Number 100, Shihcyuan 1st Road, Sanmin District, Kaohsiung City 80708, Taiwan. E-mail addresses: 880032@ 123456gmail.com (H.-L. Tsao), jk2975525@ 123456hotmail.com (C.-Y. Chen).

[1]

Kuo-Hua Yu and Shun-Jin Lin contributed equally to this study.

Article

Publisher ID: jfda-24-01-214

DOI: 10.1016/j.jfda.2015.08.003

PMC ID: 9345436

PubMed ID: 28911406

SO-VID: c8e9255e-cb0e-47b0-b4ad-0c9f4b08db59

License:

This is an open access article under the CC-BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 23 May 2015

Date revision received : 08 July 2015

Date accepted : 14 August 2015

Funding

Funded by: Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Award ID: 93-ND-040

Funded by: Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Award ID: KMUH103-3R69

This study was supported by a grant from the Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (93-ND-040) and by Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (KMUH103-3R69).

Quantitative analysis of insulin in total parenteral nutrition bag in Taiwan

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Most cited references 26

Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition.

Long-term total parenteral nutrition with growth, development, and positive nitrogen balance.

Parenteral Nutrition–Associated Hyperglycemia in Non–Critically Ill Inpatients Increases the Risk of In-Hospital Mortality (Multicenter Study)

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