What is the preferred iron formulation for PN dosage and what must be done before administration?

• A. The dextran formulation, with a test dose before PN to evaluate tolerance and avoid anaphylactic reactions
• B. Iron sucrose, given without testing
• C. Ferrous sulfate oral, taken daily
• D. Ferric gluconate IV without testing

Answer: (A)

When you’re adding iron to parenteral nutrition, the safety of IV iron formulations matters because some carry a higher risk of severe allergic reactions. Dextran-containing IV iron is effective for delivering iron in PN, but it has a notable risk of anaphylactic-type reactions. Because of that risk, a small test dose is given before the full PN dose to check for tolerance and catch any hypersensitivity early. If the patient tolerates the test dose, the remainder of the iron can be administered as part of the PN.

Other IV iron options, like iron sucrose or ferric gluconate, have lower hypersensitivity risk and are not routinely started with a test dose. Oral iron isn’t used in PN since the route is IV, and the question focuses on the safety step required with the dextran formulation.