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19 MARZO 2026

3-in-1 vs 2-in-1 Parenteral Nutrition in Adults: A Review

Autori: Eoin Slattery, MD, MRCPI; Martha M. Rumore, PharmD, JD, LLM, FAPhA; Janine S. Douglas, RPh, MS; and David S. Seres, MD, ScM, PNS

Lingua del contenuto: English

Data di Pubblicazione: 28 maggio 2026

Citazione:

DOI: 10.1177/0884533614533611

Parole chiave: intravenous fat emulsions; nutritional support; safety; parenteral nutrition

Solo Ad Uso Interno
scientific article
Nutrizione Parenterale Parenteral Nutrition

Short Abstract

This review evaluates the safety and efficacy of 3-in-1 (total nutrient admixture) versus 2-in-1 parenteral nutrition (PN) formulations in adult patients. While some institutions favor 2-in-1 mixtures with separate intravenous fat emulsions due to historical fears of microbial contamination, emulsion instability ("cracking"), and calcium phosphate precipitation, this analysis suggests these concerns are largely outdated for modern adult care. The authors conclude that the available data support the safe adoption of 3-in-1 PN as the standard of care, as it is more convenient and offers potential clinical advantages when prepared and administered properly.

Abstract

Parenteral nutrition (PN) provides a means of nourishment for patients in whom oral or enteral nutrition is not possible or practical. Initial formulations consisted of carbohydrates (dextrose), amino acids, vitamins, trace minerals, electrolytes, and water. A stable intravenous fat emulsion (IVFE) permitted the combination of all 3 macronutrients in the same admixture (3-in-1 or total nutrient admixture [TNA]). Many institutions have adopted these TNAs as the standard formulation. Others, due to a variety of concerns (including historical concerns regarding stability), continue to administer PN as a formulation of dextrose and amino acids (2-in-1) with separate IVFE infusions. The aim of this article is to review the literature regarding the use of TNA vs 2-in-1 formulations. The published data were critically analyzed, and a preferred strategy was suggested based on an interpretation of the data. Concerns surrounding the safety of 2-in-1 vs 3-in-1 PN formulations can be grouped with respect to those regarding infections, emulsion instability (“cracking”), and precipitant formation. These concerns are largely historical and would seem to be no longer relevant to adult PN formulations. We believe that the available (limited) data support the safe transition to the 3-in-1 formulation as the standard of care in adult PN. (Nutr Clin Pract. 2014;29:631-635)

3-in-1 vs 2-in-1 Parenteral Nutrition in Adults: A Review