Blood vitamin levels of long-term adult home total parenteral nutrition patients: the efficacy of the AMA-FDA parenteral multivitamin formulation.

Although the AMA-FDA parenteral adult multivitamin formula is now widely used, there are no published data on the efficacy of this formulation in maintaining adequate vitamin nutriture in patients on long-term parenteral nutrition. Blood levels of its constituent nutrients were determined in 16 clinically stable home total parenteral nutrition patients with severe gastrointestinal dysfunction, the majority of whom had been on home total parenteral nutrition for 1 to 9 yr and most of whom were ingesting some food orally. The daily formula (MVI-12) was added to the basic total parenteral nutrition formula in 2-day batches; the vitamins were thus infused approximately 3 hr after preparation on day 1 and after 27 hr on day 2. The duration of infusions was from 8 to 16 hr. Blood was drawn approximately 36 hr after completion of the last vitamin infusion. Plasma, trichloroacetic acid-treated plasma, and whole blood were frozen until analyzed for the vitamins by microbiologic or chemical methods. All vitamin levels, except for vitamin D metabolites, were measured four times in each patient between the 4th and 36th wk while receiving daily MVI-12. Single determinations of 25-OH and 1:25 (OH)2 vitamin D were made in eight of the 16 patients between the 61st and 84th wk while on MVI-12. Repeat values during this extended period were also made on five of the patients for vitamins A and E. These values were compared with serum vitamin levels obtained on an earlier formulation (MVI concentrate, Berocca C, and folate each given twice weekly and B12 given once weekly). The AMA-FDA formula given daily maintained blood levels above the lower normal limits for most of its constituent vitamins and vitamin D metabolites for the great majority of stable home total parenteral nutrition adults with unexplained occasional exceptions. However, almost half of the vitamin A levels and some of the pantothenate and biotin values were above the normal range; these tended to be associated with the presence of renal disease. Ascorbic acid and thiamin levels tended to be clustered in the lower normal range. Because of evidence for loss of ascorbic acid standing in total parenteral nutrition solutions for 24 hr prior to infusion, it is recommended that the vitamin formulation be added to the total parenteral nutrition solution just prior to infusion.