Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution

Steven E. Hill, Leslie S. Heldman, Elwin D H Goo, Paul E. Whippo, Joseph C. Perkinson

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Background: Paroxysmal respiratory failure and death occurred in two young adult females with pelvic infections. Autopsy revealed an amorphous material containing calcium obstructing the pulmonary microvasculature of each patient. Both patients received an identical total nutrient admixture (TNA) solution before their deaths. Methods: Infusion of TNA into an animal model was undertaken in an effort to reproduce the clinical effect. Laboratory investigation was also performed to isolate a precipitate and identify the factors contributing to precipitation. Results: A nonvisible precipitate containing calcium, phosphorus, and organic material was isolated from the TNA solution. Infusion of the formulation into healthy pigs resulted in sudden death within 4 hours. Alteration of the amino acid component, mix sequence, agitation technique, and mixing container influenced precipitate formation. Conclusion: Pulmonary embolization of a precipitate containing calcium phosphate resulted in the death of two patients. The pH of the amino acid component, transient elevation of calcium and phosphorus concentrations during mixing, and the lack of agitation during automated preparation of the formulation were identified as the etiologic factors producing the fatal precipitate.

Original languageEnglish (US)
Pages (from-to)81-87
Number of pages7
JournalJournal of Parenteral and Enteral Nutrition
Volume20
Issue number1
StatePublished - Jan 1996

Fingerprint

embolism
Embolism
nutrient solutions
lungs
death
Calcium
Food
Lung
Phosphorus
agitation
calcium
Pelvic Infection
Amino Acids
Sudden Death
Microvessels
phosphorus
Respiratory Insufficiency
amino acids
calcium phosphates
Young Adult

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution. / Hill, Steven E.; Heldman, Leslie S.; Goo, Elwin D H; Whippo, Paul E.; Perkinson, Joseph C.

In: Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 1, 01.1996, p. 81-87.

Research output: Contribution to journalArticle

Hill, Steven E. ; Heldman, Leslie S. ; Goo, Elwin D H ; Whippo, Paul E. ; Perkinson, Joseph C. / Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution. In: Journal of Parenteral and Enteral Nutrition. 1996 ; Vol. 20, No. 1. pp. 81-87.
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