Which additive has greatest risk of destabilizing IVFE in a TNA?

• A. Sodium chloride
• B. Iron dextran
• C. Potassium phosphate
• D. Calcium acetate

Answer: (B)

The stability of an intravenous fat emulsion in a total nutrient admixture depends on the protective layer around fat droplets and how additives interact with it. Iron dextran is particularly risky because iron ions readily interact with the phospholipid stabilizers of the emulsion, promoting droplet aggregation and coalescence. Iron can also catalyze lipid oxidation, further destabilizing the emulsion. This direct interference with the fat droplets makes iron dextran the additive with the greatest risk of destabilizing IVFE. Sodium chloride is mainly an electrolyte and typically does not disrupt the emulsion; calcium acetate and potassium phosphate can cause precipitation or ionic interactions, but their destabilizing potential is not as direct or as pronounced as that of iron dextran.