Use of Alternative Calcium Gluconate in Sodium Chloride Co-Infused With Parenteral Nutrition for Neonates and Infants During National Shortage.

Objective: The coronavirus pandemic led to many supply chain shortages including parenteral nutrition (PN) components, and for our institution, a critical shortage of calcium gluconate vials. Our institution switched to an alternative product, calcium gluconate in sodium chloride (Ca-gluconate-in-NaCl), and owing to lack of specific gravity data, it could not be placed as an additive in our compounder. Instead, it had to be used as a continuous infusion, co-infused with PN. The purpose of this study was to determine if the alternative product led to significant electrolyte abnormalities affecting calcium homeostasis in patients requiring PN.

Methods: This was a retrospective review of the electronic health record for all infants aged 0 days to 12 months from March 1, 2022, through May 31, 2022, who received PN and a continuous Ca-gluconate-in-NaCl infusion at our institution. Associations between dosing and adverse events were explored with ordinal and logistic regression.

Results: A total of 39 patients were included in our study. Ca-gluconate-in-NaCl was provided with PN for a median of 7 days. Hypocalcemia occurred in 16 of 39 (41%) study infants. Seven patients experienced mild hypocalcemia (8-8.5 mg/dL; p = 0.875), 7 experienced moderate hypocalcemia (7-7.9 mg/dL; p = 0.339), and 2 experienced severe hypocalcemia (<7 mg/dL; p = 0.214). One patient who experienced severe total serum hypocalcemia also experienced hypocalcemia as defined by ionized calcium concentrations (<1.1 mmol/L; p = 0.344).

Conclusions: Ca-gluconate-in-NaCl infused via Y-site with PN could be a viable alternative during shortage of calcium gluconate vials for at least 7 days in infants requiring PN.