A.S.P.E.N. Position Paper

TLDR

Parenteral multivitamin and multi‑trace‑element preparations available in the U.S. meet most PN patient needs but require significant modifications. The paper recommends separate parenteral vitamin D preparations for refractory deficiency, routine addition of carnitine to neonatal PN, and routine addition of choline to adult and pediatric PN, with development of a commercial parenteral choline product. Single‑entity trace‑element products can satisfy individual patient needs when multi‑element products are unsuitable.

Abstract

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).