[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
September 1977

Vitamin Requirements in Patients Receiving Total Parenteral Nutrition

Author Affiliations

From the Departments of Biochemistry (Dr Nichoalds) and Physiology (Dr Meng), Vanderbilt University School of Medicine, Nashville, Tenn, and the Department of Surgery, Letterman Army Institute of Research, The Presidio of San Francisco (Dr Caldwell).

Arch Surg. 1977;112(9):1061-1064. doi:10.1001/archsurg.1977.01370090043008

• This study represents an initial attempt to define intravenous vitamin requirements in adult patients receiving total parenteral nutrition (TPN). We have investigated two different vitamin formulations for their ability to maintain normal circulating blood levels of vitamins A, C, E, B12, folic acid, and riboflavin. Administration of 1.1 ml of Multi-Vitamin Infusion (MVI) solution supplemented with 100 μg of folic acid, 10 μg of vitamin B12, and 100 mg of vitamin C, per liter of TPN infusate (patients received an average of about 3 liters/day), maintained normal or higher than normal levels of vitamins C, B12, and riboflavin, but resulted in less-than-normal levels of vitamins A, E, and folic acid. Increasing the amount of MVI to 1.4 ml and the folic acid to 200 μg, and decreasing the ascorbic acid to 70 mg and vitamin B12 to 5 μg/liter of TPN infusate, resulted in normal blood levels of all tested vitamins within two weeks after initiating TPN therapy, and normal blood levels were then maintained at this dosage for additional periods of time up to three weeks.

(Arch Surg 112:1061-1064, 1977)

Dudrick SJ, Copeland EM, MacFayden BY:  Long-term parenteral nutrition: Its current status . Hosp Prac 10:47-58, 1975.
Meng HC:  Parenteral nutrition: Principles, nutrient requirements and techniques . Geriatrics 30:79-107, 1975.
Cooperman JM:  Microbiological assay of serum and whole-blood folic acid activity . Am J Clin Nutr 20:1015-1024, 1967.
Wright LD, Skeggs HR, Rubin SH, et al:  Microbiological methods in vitamin research , in Gyorgy P (ed): Vitamin Methods . New York, Academic Press Inc, 1951, vol 11, pp 683-712.
Neeld JB Jr, Pearson WN:  Macro- and micromethods for the determination of serum vitamin A using trifluoroacetic acid . J Nutr 79:454-462, 1963.
Lowry OH, Lopez JA, Bessey OA:  The determination of ascorbic acid in small amounts of blood serum . J Biol Chem 160:609-615, 1945.
Fabianek J, DeFilippi J, Rickards T, et al:  Micromethol for tocopherol determination in blood serum . Clin Chem 14:456-462, 1968.
Nichoalds GE:  Assessment of status of riboflavin nutriture by assay of erythrocyte glutathione reductase activity . Clin Chem 20:624-628, 1974.
Recommended Dietary Allowances , ed 8. Food and Nutrition Board, National Research Council, National Academy of Sciences, Washington, DC, 1974.
Guidelines for Multivitamin Preparations for Parenteral Use . Department of Foods and Nutrition, American Medical Association, Chicago, 1975.
Greene HL, Merenstein GB, Hambidge M, et al:  Trace elements and vitamins (V) in total parenteral nutrition (TPN) . Pediatr Res 7:109, 1973.
Greene HL:  Vitamins , in White PL, Nagy ME (eds): Total Parenteral Nutrition . Acton, Mass, Publishing Sciences Group Inc, 1974, pp 241-256.