Sodium Acetate in TPN

[JACK]

We have started using Sodium acetate as an additive in our TPN. It has shown to be very beneficial in neonates. A nice abstract link is as follows (http://pt.wkhealth.com/pt/re/adcn/abstract.00042223-199707000-00003.htm;jsessionid=GNySJG81pcQhGQHwc2GLMGJSnDFxk yGgbZnDvfTHGPtgtDTX9MpJ!-362743511!181195628!8091!-1)

I just wanted to ask the community out there how is their experience with this additive? Any complications? What about use in nenonates with cholestasis?

Does acetate conversion to bicarbonate work in presence of severe liver disease?

How does the increased pH affect the ultimate Ca and PO4 stability?

[charris]

Thanks for the abstract. We've been using Na acetate in our TPN for a number of years and have the same good results as the study. Just to clarify, the increased pH that they report would be in the baby not in the TPN bag. The TPN bag would likely be a little acidic from ingredients like cysteine HCl, which then would increase calcium & Po4 stability, however when the baby metabolizes the acetate to bicarb the blood pH rises a little.
We haven't noticed a difference with acetate conversion to bicarb in liver disease- haven't studied it though.

[ammar]

Hi JACK

we never used sodium acetate in our practice of TPN because it is not diponible at our hospitals. I would like to know is that absolutely necssary and what harm we made to our premies.

[doctorf]

HI
i would like to know the dose of sodium acetat to be added in TPN
thank you

[charris]

This is our standard formula which can be modified as needed:
amino acid 3% (Trophamine), dextrose 10%, NaCl 5 mmol/L, Na Acetate 30 mmol/L, K Phosphate 17 mmol/L (= K 25 mmol/L), Ca Gluconate 23 mmol/L, Mg sulph.1.8 mmol/L, cysteine HCl 1200 mg/L, vitamins & trace elements. You can see that most of the sodium is in the form of acetate.