ParenteralNutrition: The Role of the Pharmacist in the Era ... · 2005 Parenteral Nutrition: The Role of the Pharmacist in the Era of 3-chamber Bags Stefan Mühlebach, Prof. Dr. Swissmedic,

ESPEN Congress Brussels 2005

bull Parenteral NutritionThe Role of the Pharmacist in the Era of 3-chamber Bags

bull Stefan Muumlhlebach

20052005

ParenteralParenteral NutritionNutritionThe Role of the Pharmacist in the Era of The Role of the Pharmacist in the Era of

33--chamber Bagschamber Bags

Stefan Muumlhlebach Prof DrSwissmedic Berne (Switzerland)

Stefanmuehlebachswissmedicch

20052005

The Swiss Capital BerneThe Swiss Capital BerneView from View from SwissSwissmedicmedic to the to the AlpesAlpes

20052005

The Berner Oberlandafter the heavy rainfalls last week

(Fluids can harm)

20052005

ContentContentbull Parenteral Nutrition Characteristicsbull NST Pharmacistrsquos Rolebull Delivery Systems and their limitsbull Pharmacistrsquos Role in PN Safetybull Conclusions

20052005

ParenteralParenteral Nutrition (PN)Nutrition (PN)

(Total)(Total)

ParenteralParenteralNutritionNutrition

(Partial)(Partial)

GastrointestinalFailure

GastrointestinalDysfunction

ImpairedEnteral Absorption

Digestion

Assimilation

20052005

PN Characteristics (1)PN Characteristics (1)

Nutrients ivNutrients ivFluids

Electrolytes

Glucose

Amino Acids

Triglycerides

VitaminsTrace Elements

PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss

TissueTissueMetabolism Metabolism RebuildingRebuilding

20052005

PN Substrate Admixing PN Substrate Admixing insideinside the Body the Body (Multi(Multi--bottle System)bottle System)

Glucose (additives)

Amino Acids(additives)

Lipid

20052005

Glucose

Muumlhlebach Curr Opin Cin Nutr Metabol Care 20058291

Comp

onen

ts

ErrorsDosingAdministration

ComplicationsComplications(Safety)(Safety)

MetabolicMetabolicMicrobialMicrobialMechanicalMechanicalEconomicEconomic )

Amino acidsGlnhellip

TriglyceridesLCT MCT Ω-3

Trace elements Fe Zn Mn Cu Cr Mo Se F J

ElectrolytesNa K Ca Mg P Cl

VitaminsA B C D E K


20052005

ParenteralParenteral Nutrition (PN)Nutrition (PN)bull Effective when indicatedbull Higher risk of complications

ndash iv accessndash Correct dosingndash Aseptic preparation (individualisation)ndash Stability complex pharmaceutical interactionsndash Higher costs compared to ENndash Patients partly highly fragile (neonates

critically ill)ndash Long-term treatment (HPN)

bull Multi-professional approach (pharmacist)

20052005

ContentContentbull Parenteral Nutrition Characteristicsbull NST Pharmacistrsquos Role

20052005

Clinical Nutrition Clinical Nutrition MultiMulti--professional Processprofessional Process

Nutrition Support Team

PatientPatientOutcomeOutcome

Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral

AdmixingAdministration

GMPHandling

Benefits from NST (Review) JPEN 200428(4)251

20052005

PN Pharmaceutical TasksPN Pharmaceutical Tasks

Acquisition and DeliveryPurchase andor preparation ()Distribution

Drug use and administrationRecommendations and guidelines (dosages interactions iv administration)

Control and ReviewProduct qualityHandling (correctnesslegality CIRS safety)Analysis of indications outcomeCost

Stock management Waste

Selection and Documentation of Products

20052005 Hospital Manufacture and Hospital Manufacture and CompoundingCompounding

20052005

20052005

Risk reduction (Safety uarr)

bull Mechanical Documented stability of the admixtures

bull Metabolic Appropriate nutrient administration(individualisation)

bull Infective Aseptic compounding (ready to use)

bull Economic Preparation cost Utilisation review

bull Convenience AIO ready to use single container

PN Pharmaceutical SupportPN Pharmaceutical SupportCompounding AdmixingCompounding Admixing

20052005

ContentContentbull Parenteral Nutrition Characteristicsbull NST Pharmacistrsquos Rolebull Delivery Systems and their limits

20052005

AIO admixtureLimited stability

DextroseAmino acidsLCT (MCT) fatNa+

K+

Ca++

Mg++

PhosphateFe Zn Mn Cu Cr Mo Se F J(Vit A B C D E K)

Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid

Trace elementsVitamins

1

2

3

4

5

Ready to use AIO Admixture Safe PracticesReady to use AIO Admixture Safe Practices

Muumlhlebach Curr Opin Clin Nutr Metabol Care 20058291 Driscoll JPEN 200327433

IndustrialIndustrialProductionProduction

20052005

Lipid Lipid PeroxidationPeroxidation in EVAin EVA--AIO AdmixturesAIO AdmixturesInfluence of Trace Elements (TE) Influence of Trace Elements (TE)

and Storage Conditionsand Storage Conditions

0

1

2

3

4

1 4 8 14 19 29Days of storage

Peroxide values[mmol peroxidesL]

08

Steger Muumlhlebach JPEN 20002437-41

20-30degC daylight with TE20-30degC daylight

2-8degC light-protected with TE2-8degC light-protected

20052005 Industrial AIO Premixes Industrial AIO Premixes (Standards)(Standards)The 3The 3--Chamber BagChamber Bag

Injection port

Breakable connectionor seal

Infusion port

Glucose Lipid

Amino acidsCover wrap

(Oxygen protection)

Muumlhlebach Curr Opin Clin Nutr Metabol Care 20058291

Container polymer(Sterilisation)

20052005 Standardised PN in HospitalsStandardised PN in HospitalsNutrition 200420528Nutrition 200420528--535535

Switzerland 86 adult standard PN (HP 16 compounded)

France79 adult standard PN(HP 18 compounded )

Belgium86 adult standard PN

(HP 56 compounded)

HospCategory Median Min-

Max Ratio MedianMin-Max

Ratio Median Min-Max Ratio

Univ 6lsquo983(4) 1lsquo874-9lsquo725

60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)

2lsquo419-39lsquo500 154 6lsquo041 (1)

600-41lsquo300

95

Non-Univ 1lsquo351 (12) 39 2lsquo490

(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-

3lsquo15932 1lsquo966 (6)

380-3lsquo600

92

Private 2lsquo357 (6)384-

12lsquo62975

Ratio no of PN bags per yearbed in 2000 Home PN proportion 5-7 (CH B) 20 (F)

20052005

Duration of HPNNumber of Regimens [n] Reasons for Adaptations

Regimens per patientRegimens per patient 75 plusmn 6575 plusmn 65

Patient No of regimens [n]

Nutritional requirement

Product requirement

Stability reasons

AB 2 7 BK 4 3 1 BS 5 5 FS 11 16 3 1 JF 4 3 1 KA 4 4 2 RS 24 38 4 1 UM 13 15 3 VE 3 3 VF 8 36 XM 4 7 Total 82 137 14 2 Mean plusmn SD 75 plusmn 65 125 plusmn 130

HPN Need for Individualisation of PNHPN Need for Individualisation of PN

Clin Nutr 200019(suppl1)60

0 12 24 36 48 60 72 84 96 108 120ABBKBSFSJFKARSUMVEVFXM

Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11

Mean Mean plusmnplusmn SDSD [month] 526 plusmn 405[month] 526 plusmn 405

20052005

ContentContentbull Parenteral Nutrition Characteristicsbull NST Pharmacistrsquos Rolebull Delivery Systems and their limitsbull Pharmacistrsquos Role in PN Safety

20052005







X

20052005

Lipid Emulsion DestabilisationLipid Emulsion Destabilisation

reversible irreversible-

Lecithin emulsifierempty 02 - 04 microm

MFTmaxmean max droplet diameter

20052005

Droplet Distribution of iv Lipid EmulsionsDroplet Distribution of iv Lipid EmulsionsNormal Probability Curve Normal Probability Curve

From Driscoll DF Examination of selection of light-scattering and light obscuration acceptance criteria for lipid injectable emulsions Pharm Forum 200430(6)2244-53

Large Diameter Tail bdquoUnstableldquo

Large Diameter Tail bdquoStableldquo

Mean Droplet Size (~03 microm)

Diameter [microm]

20+ microm005 03 5

Fat

20052005

PFAT5 Dose Increase over 24-hour Infusion in Rats (23 mlhr)Half-life of increase 12 hours

0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]

Dose Rate (DR) from measuredPFAT5

DR PFAT5(t)= DR PFAT5(0)+10-7e(0573t)DR PFAT5(t) = DR PFAT5(0) + 1610-7 e(0573t)

Dose Rate (DR) from Measured PFAT5

1000

0500

0000

LB027

20052005

Lipid Emulsion Stability Influence of Lipids and Amino Acids

Schmutz CW Werner R Keller U Muumlhlebach SClin Nutr 199312(S2)59

AIO PN 5 g lipidL 6 g NL 144 g dextrose L pH 49-53Na+K+ (60mM) P (19 mM) trace elementsCa++ (75 mM) Mg++ (10mM)

MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005

ANOVA of MFTmax with repeated measures and two group factors

Significance over time (10 days) (p-values)

20052005

Lipid Emulsion Stability (Lipid Emulsion Stability (MFTMFTmaxmax) ) Influence of Amino acidsInfluence of Amino acids

Clin Nutr 199312(S2)59

AIO-Stability using Intralipidreg (MFTmax)

Ca++ 75 mM Mg++ 10 mMM

FTm

ax[micro

m]

45

Days after compounding

20052005 Bag Plastic Film layers Bag Plastic Film layers Physical Phenomena OccurringPhysical Phenomena Occurring

Desorption

Solution Film Outer side

Permeation

Migration

Adsorption


20052005

Effect of Packaging Container on Effect of Packaging Container on Lipid Emulsion CharacteristicsLipid Emulsion Characteristics

PFAT5 Levels in Various LipidsManufacturer G-Lipids (n) P-Lipids (n) 3C-P Lipids (n)

A 0046plusmn0004 (4) 0120plusmn0023 (2) 0159plusmn0015 (2)B 0028plusmn0011 (3) Not Available 0006plusmn0002 (2)

LB028 The effects of packaging containers and manufacturer on the large-diameter tail of the globule size distribution

of lipid injectable emulsions - Part 2D F Driscoll1 A Thomas2 K Kluetsch2 B R Bistrian1 J Nehne2

1Medicine Harvard Medical School Boston United States 2Hospital Care B Braun Melsungen Germany

20052005

Medication Errors with Medication Errors with ParenteralsParenterals

Taxis K Barber N Taxis K Barber N EurEur J J ClinClin PharmacolPharmacol 200459815200459815--77

Multiple Step Preparation Admixing (Ready to use)

IncompatibilitiesAdmixing incompatible drugs

20052005

50 microm

Ca2+ + H3PO4Ca(H2PO4)2 + CaHPO4

Solubility (H2O)

RDA iv [mmolkg]Neonates Adults

Calcium 05 - 15 01 - 02Phosphate 06 - 13 01 - 09Vol [mlkg] 120 25 - 30

Calcium phosphate PrecipitationCalcium phosphate Precipitation

April 18 1994 FDA-Alert

20052005

Nutritional Care in HospitalsNutritional Care in Hospitals

Council of Europe (2002)

4Responsibility defined4Education and training4Patient-oriented4Multidisciplinary nutrition support teams4Implementation top down

(Guidelines and recommendations)Clinical Nutrition 200120(5)455-460 Akt Ernaumlhr Med 200328133-136

Aim Prevent treat undernutrition to improve patientlsquos outcomeBest use of clinical nutrition

PhysicianPharmacistDieticianNurse Other healthprofessionals

20052005

PN PN PharmaceuticalPharmaceutical TasksTasks






20052005

DrugActive ingredientSolvent

VehicleInfusion fluidContainer

Good ManufacturingPractices

AsepsisDocumentation

AdministrationParenteral AccessInfusion time

AIO AdmixtureLipids

GlucoseAmino acidsElectrolytes


Drug admixing in PN Drug admixing in PN Pharmaceutical AspectsPharmaceutical Aspects

Adapted from bdquoBasic in Clinical Nutritionldquo 3rd edition Galen (Prague) 2004

20052005 Lipid Peroxide Formation Vitamins Lipid Peroxide Formation Vitamins (NICU)(NICU)

0

100

200

300

400

500

600

700

0 1 2 4 8 12 24

Fig Trend in peroxide formation in a lipid emulsion with (1 a b ab) and without fat soluble vitamins (contr)

The emulsion was pumped through the orange coloured infusion system at different flow and lighting conditions

pero

xide

con

c [micro

mol

TB

H-e

ql-1

]

time [h]1 07 ml h-1 daylight a 01 ml h-1 daylightb 07 ml h-1 phototherapy light ab 01 ml h-1 phototherapy lightcontr 01 ml h-1 phototherapy light

Graumlflein Muumlhlebach Clinical Nutrition 200423892

Intralipid 20 plusmn Vitalipid Infant (AD2K1E)Light-protecting tubings syringe pumpFOX Assay tert-butyl hydroperoxide (TBH) as reference

20052005

Drug Drug NutrientNutrient Interaction Interaction CiclosporinCiclosporin ((SandimmunSandimmunregreg) admixed to iv ) admixed to iv IntralipidIntralipidregreg

0

1

2

3

4

5

6

7

0 1 2 3 4

CyA-Konzentration [microMolCyAmMol Triglycerid]

FFA-

Relea

se [micro

MolM

in] 100 lipase activity

Ciclosporin CyA

Sandimmun ivCyA+ CremophorEtOH

SolventCremophorEtOH

Fig 1 Lipase inactivation by CyA Sandimmuntradeiv or solvent in lipid emulsion Solvent (CyA-free) is expressed corresponding to the concentration in Sandimmuntradeiv

Clinical Nutrition 200120(S3)27

20052005


20052005

PN Delivery Systems 3PN Delivery Systems 3--C C BagsBagsBottles with

singlecomponents

Bottles withcombined

components

Two in oneAdmixtures

All-in-one(3 in 1)

admixturesAmino acids

Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005

Pharmacistrsquos RolePharmacistrsquos RoleSafe PracticesSafe Practices

Glucose Lipid

Amino acids


20052005

Pharmacistrsquos RolePharmacistrsquos RolePN as Drug VehiclePN as Drug Vehicle

20052005

20052005

bull Duration of PN [d] 7-78 (min-max) 14 (mean)12 (median)

bull Indication Guidelines (ASPEN acute93) 77 (7192) fulfilled

bull Chart Review Requirements 50 fulfilled (Check lists) Prescriptions 28 incomplete

Lab tests 64 incomplete

bull Complications Hyperglycaemia 30 ( gt 10mM) Catheter-related 7 ( 23infections)

Akt Ernaehr Med 19982343-49

ResultsResults

Quality of Hospital PN Use Quality of Hospital PN Use Concordance to local guidelinesConcordance to local guidelines

92113 consecutive surgical patients with PN prospective analys92113 consecutive surgical patients with PN prospective analysis over 9 monthsis over 9 months

20052005

Quality Increase of PN TreatmentQuality Increase of PN Treatment

Nutrition Guidelines (Nutrition Support Team)

bull Standardisation of PN treatments (unified concept)bull Less inappropriate treatments (errors )bull Reduced costs

Adapted from Woolf SH Arch Intern Med 1992152946-52

20052005 PN Economic Importance PN Economic Importance in Hospitalsin Hospitals

Drug Products Basic iv Fluids for infusion Parenteral Nutrition Dalteparin (LMWH Coagulation disorders) Rituximab (MabTherareg Antineoplastics) Gamma Globulines iv (Immunology) Iopromid (Ultravistreg Constrat media) Trastuzumab (Herceptinreg Antineoplastics) Erythropoetin (Hemodialysis) Docetaxel (Antineoplastics) Piperacillin + Tacobactam Paclitacel (Antineoplastics) Carboplatin (Antineoplastics) Gemcitabin (Antineoplastics) Iomeprol (Iomeronreg Constrat media l) Infliximab (Remicadereg) Cisplatin (Antineoplastics) Hemodialysis Concentrates (Hemodialysis) Amoxicillin + Clavulansaumlure (Anti-Infection) (Pharmacy KSA Acquisition Costs 2004)

20052005

PharmaconutritionPharmaconutritionDifferent Types of Lipid EmulsionDifferent Types of Lipid Emulsion

bull Soybean Safflower Oil (Ω-6 Ω-3 ~ 7 1)Arachidonic acid PEG24 LT24 (SIRS)

bull MCT LCT (Ω-6 Ω-3 ~ 7 1)Structured Lipid Emulsion

bull SMOF (Ω-6 Ω-3 ~ 25 1)Soybean (30)-MCT (30)-Olive Oil (25)-Fish Oil (15) EPA DHA

Clinical Nutrition 200524 (Supplement 1) 1-30 New Lipid in Parenteral Nutrition

20052005

iv Drug Errors at Ward Leveliv Drug Errors at Ward LevelAdmixing amp AdministrationAdmixing amp Administration

Identification(prescription)

(3)

Ready to use(0)

1-step(0)

Multi-step(14)

IdentificationPatient(0)

Bolus(73)

Small volumeInfusion

(9)

Large volumeInfusion

(0)

KTaxis N Barber bdquo iv drug errorsldquo BMJ 2003326684

20052005

Incompatibility reactionsIncompatibility reactions

Chemical Incompatibilitiesbull Oxidation Reductionbull Hydrolysisbull Polymerisationbull Decarboxylation

(CO2 formation)bull Racemate formationbull Complexation

bdquoChem-physik Inkompatibilitaumlten parenteral verabreichter Arzneimittelldquo in Grundlagen der Arzneimitteltherapie 16th edition 234-9 Documed Basel 2005

Lipidperoxidation

Maillard-Reaction

20052005

ParenteralParenteral NutritionNutritionThe Role of the Pharmacist in the Era of The Role of the Pharmacist in the Era of

33--chamber Bagschamber Bags

Stefan Muumlhlebach Prof DrSwissmedic Berne (Switzerland)

Stefanmuehlebachswissmedicch

20052005


20052005


(Fluids can harm)

20052005


20052005


(Total)(Total)


(Partial)(Partial)




Digestion

Assimilation

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005


(Fluids can harm)

20052005


20052005


(Total)(Total)


(Partial)(Partial)




Digestion

Assimilation

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


(Fluids can harm)

20052005


20052005


(Total)(Total)


(Partial)(Partial)




Digestion

Assimilation

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005


(Total)(Total)


(Partial)(Partial)




Digestion

Assimilation

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


(Total)(Total)


(Partial)(Partial)




Digestion

Assimilation

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005



Electrolytes

Glucose

Amino Acids

Triglycerides


PORT-A-CATH

HICKMANN BROVIAC

iv Accessiv Access

Fat

Protein

Glycogen

N-Loss


20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


Glucose (additives)


Lipid

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005

Glucose


Comp

onen

ts








VitaminsA B C D E K


20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005




Diagnosis

Nutritional state

PatientEvaluation

Malnutritionrisk

Prescription

EnteralParenteral


GMPHandling


20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005








20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction


20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005








20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005



K+

Ca++

Mg++


Components(gt 50)

DextroseNa K Ca P

Amino acidsNa K Mg

Lipid


1

2

3

4

5




20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005



0

1

2

3

4



08





Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction


Injection port


Infusion port

Glucose Lipid


(Oxygen protection)







(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction





(HP 56 compounded)





60-7lsquo506

4-2lsquo890

51 13lsquo017 (18)


600-41lsquo300

95


(19)350-6lsquo760

49 1lsquo375 (1)20-

16lsquo47268

Regional 651 39 267 (5)30-


380-3lsquo600

92


12lsquo62975


20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





Product requirement

Stability reasons





Mean

Patie

nt

[months]

n=4n=8

n=3n=13

n=24n=4

n=4

n=4n=2

n=5n=11


20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







X

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005






Diameter [microm]

20+ microm005 03 5

Fat

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


0000

0500

1000

1500

2000

2500

3000

3500

0 1 6 12 17 18 19 20 21 22 23 24 25

Time [hrs]

Dos

e R

ate

(PFA

T5 [

] hr

)

0000

0500

1000

1500

2000

2500

3000

3500

PFA

T 5 [

]




1000

0500

0000

LB027

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005




MCT vs Lipovenoumls

Amino Acids

Lipids Amino Acids

X Lipids

Hausmann-Amin vs

Vamin

0002

0111

0594

Vamin vs

Proteinsteril

0786

0241

0026

Hausmann-Amin vs

Proteinsteril

0011

0934

0005



20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





FTm

ax[micro

m]

45



Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction


Desorption


Permeation

Migration

Adsorption


20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005

50 microm


Solubility (H2O)





20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005






AIO AdmixtureLipids






0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction


0

100

200

300

400

500

600

700

0 1 2 4 8 12 24



pero

xide

con

c [micro

mol

TB

H-e

ql-1

]




20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


0

1

2

3

4

5

6

7

0 1 2 3 4


FFA-

Relea

se [micro

MolM


Ciclosporin CyA





20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


singlecomponents


components


All-in-one(3 in 1)


Glucose

Lipid

Ready-to-use (-) (+) + + +

21

AIO


20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


Glucose Lipid

Amino acids


20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005


20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







ResultsResults



20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005







20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction



20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005






20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005



(3)

Ready to use(0)

1-step(0)

Multi-step(14)


Bolus(73)


(9)


(0)


20052005





Lipidperoxidation

Maillard-Reaction

20052005





Lipidperoxidation

Maillard-Reaction

Documents

ParenteralNutrition: The Role of the Pharmacist in the Era ... · 2005 Parenteral Nutrition: The Role of the Pharmacist in the Era of 3-chamber Bags Stefan Mühlebach, Prof. Dr. Swissmedic,