Background and aim: Lipid peroxidation in parenteral nutrition mixtures is still a challenge. We aimed to evaluate the effect of two different amino acid solutions used in different clinical situations on lipid peroxidation of three different lipid emulsions (Intralipid, ClinOleic, and SMOFlipid) in all-in-one admixtures during 24 h of simulated infusion. The selected amino acid solutions included one used in stable patients and one used in renal insufficiency (Aminomel10E and Nephrotect, respectively).
Methods: Eighteen all-in-one admixtures were prepared. The simulated infusion with light protection was conducted straight after the preparation for 24 h at room temperature. The lipid peroxidation process was evaluated in all-in-one admixtures and the original lipid emulsion by determining the malondialdehyde levels (high-performance liquid chromatography) and conjugated dienes and trienes (ultraviolet-visible spectrophotometry).
Results: Malondialdehyde in the original packaging was lower in SMOFlipid (9 µM) compared with Intralipid (27 µM, P = 0.0003) and ClinOleic (25 µM, P = 0.0001). During simulated infusion, ClinOleic showed a significantly lower rate of lipid peroxidation (26% decrease in aldehyde levels) in comparison with Intralipid and SMOFlipid (up to 39% and 31% increase in aldehyde levels, respectively) when the admixture was based on Aminomel10E. In admixtures based on Nephrotect, ClinOleic, and SMOFlipid showed better oxidative stability in comparison with Intralipid. Admixtures based on Nephrotect and Intralipid had higher levels of primary lipid peroxidation products than those based on ClinOleic (P = 0.030) or SMOFlipid (P = 0.071, not significant).
Conclusions: Amino acid solutions influence the rate of lipid peroxidation. The observation should be confirmed in larger studies with different amino acid solutions.
Keywords: amino acid solution; lipid emulsions; lipid peroxidation; parenteral nutrition.
© 2023 American Society for Parenteral and Enteral Nutrition.