Compatibility of Multivitamin Injection with Isolyte M
Multivitamin injections (M.V.I. Adult/INFUVITE Adult) should be added to lipid emulsions or lipid-containing mixtures rather than electrolyte solutions like Isolyte M to maximize vitamin stability and minimize losses. 1, 2, 3
Why Lipid-Based Administration is Preferred
The evidence strongly supports mixing multivitamins with lipid emulsions rather than aqueous electrolyte solutions:
Water-soluble vitamins should be added to lipid emulsion or a mixture containing lipids to increase vitamin stability, as this reduces photo-degradation and adsorptive losses of fat-soluble vitamins. 1, 2, 3
Fat-soluble vitamins (A, D, E, K) undergo substantial losses during IV infusion in aqueous solutions, with retinol delivery potentially being below 40% of intended dose due to adsorption onto tubing materials. 3
Vitamin A experiences particularly severe losses when given with water-soluble solutions; therefore, parenteral lipid-soluble vitamins should be given with lipid emulsion whenever possible. 1
Practical Administration Guidelines
While the evidence doesn't explicitly prohibit mixing with electrolyte solutions like Isolyte M, the guidelines make clear that this is suboptimal:
Vitamins should be administered daily when possible, with lipid-soluble vitamins given simultaneously with lipid emulsions to ensure adequate delivery. 1, 2
Using shorter IV tubing and shorter infusion times can reduce vitamin losses if lipid emulsions are not available, though this remains inferior to lipid-based administration. 3
Clinical Decision Algorithm
If lipid emulsion is part of the parenteral nutrition regimen: Add multivitamins directly to the lipid emulsion or three-in-one admixture. 1, 2, 3
If only electrolyte solutions are available: Multivitamins can technically be mixed with Isolyte M, but expect significant losses of fat-soluble vitamins (particularly vitamin A), requiring potentially higher doses or more frequent monitoring. 1, 3
For optimal vitamin delivery: Always prioritize lipid-containing formulations when administering parenteral multivitamins. 1, 2
Important Caveats
The exception is vitamin K, which can be given weekly rather than daily and may be administered separately from lipid emulsions. 1, 2
Routine monitoring of vitamin concentrations (except vitamin D) is not generally recommended unless clinically indicated, though patients on long-term parenteral nutrition may need periodic assessment. 1, 2