Abstract:
Disclosed are aqueous multivitamin/trace elements formulations stabilized by a water soluble, organic acid that contains carbon-to-carbon unsaturation and water soluble salts thereof selected from the group consisting of maleic acid, fumaric acid, maleamic acid and acrylic acid.

Description:
This application is a continuation-in-part of application Ser. No. 866,842, filed May 27, 1986 issued on Apr. 26, 1988 as U.S. Pat. No. 4,740,373. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to a method of stabilizing aqueous parenteral solutions of multivitamins in the presence of trace elements and compositions produced thereby for human and veterinary administration. 
     As is well known, in addition to the various basic nutritive materials which are required by humans and animals, a variety of other nutrients and essential elements are also required for the maintenance of good health. The present invention is directed to nutrients and essential elements, sometimes called &#34;micronutrients&#34;, from which relatively very small amounts are needed to provide a well-balanced, healthy diet. For convenience, the compositions of the invention will be described as relate to humans, however, the same can as well be used for veterinary purposes. While the compositions of the invention may be used as regular supplements to nutrients obtained through the digestive system, it especially concerns total parenteral nutrition to provide nutritional support for persons unable to meet their nutritional requirements through the digestive system, i.e. for nutritional rehabilitation of patients. 
     Total parenteral nutrition (TPN) has been used for many years and an expanded knowledge of nutritional requirements led to the development of a wide array of products from which the TPN solutions can be formulated. The Nutritional Advisory Group of the American Medical Association (AMA) has developed recommendations for the parenteral use of multivitamin preparations. The guidelines for adult formulations are as follows (JPEN 3: 258-262, 1979) 
     
         ______________________________________                DailyVitamin              Administration______________________________________A                    3,300   IUD                    200     IUE                    10      IUAscorbic Acid        100     mgFolacin              400     mcgNiacin               40      mgRiboflavin           3.6     mgThiamin              3       mgPyridoxine (B6)      4       mgCyanocobalamin (B12) 5       mcgPantothenic Acid     15      mgBiotin               60      mcg______________________________________ 
    
     The medical profession has focused increasing attention on the importance of trace elements in the nutritional management of medical, surgical, and traumatic conditions. The AMA has also published guidelines for trace element preparations for parenteral use (JPEN 3: 263-267, 1979): 
     
         ______________________________________               DailyTrace Elements      Administration______________________________________Zinc                2.5-4    mgCopper              0.5-1.5  mgChromium            10-15    mcgManganese           0.15-0.8 mg______________________________________ 
    
     The AMA did not address other trace elements, however, there are increasing data for the role of these various trace elements in good nutritional support. It is generally known that the &#34;essential elements&#34;, i.e. calcium, magnesium, sodium and potassium, furthermore zinc, manganese, copper, cobalt, chromium, iron, molybdenum, vanadium, selenium and nickel are indispensable for the normal function of living organisms. The essential elements are the constituents or activators of numerous enzyme systems, they are in close correlation with the level of certain vitamins in the organism and with the function of the hormone system. The deficiency of essential elements greatly suppresses the biosynthesis of proteins, enzymes, hormones and other biologically active substances required to control the normal functions of the living organism as a whole. 
     The JPEN 5: 424-429, 1981 reports on health disorders associated with the insufficiency of some essential trace elements in TPN: Zinc deficiency manifests in a variety of diseases including acrodermatitic skin lesions, impaired immunity, poor growth, impaired wound healing, and mental disturbances; copper deficiency results in hematologic abnormalities, usually anemia with leukopenia and neutropenia; chromium deficiency has been recognized to play a role in glucose intolerance, weight loss, peripheral neuropathy or encephalopathy; and selenium deficiency in experimental animals was observed to cause liver necrosis, pancreatic atrophy, and muscular dystrophy. Manganese is an actuator of several enzymes being involved in protein synthesis and function of the central nervous system. It is essential for bone structure and reproduction. 
     2. Description of the Prior Art 
     In general, liquid multivitamin preparations of the prior art are packaged in two separate vials or syringes, or double compartment vials or syringes to prevent interaction between some of the vitamins. Such interaction results in discoloration of the solution and loss of potency. Another approach to solve the interaction problem resulted in lyophilizing multivitamin preparations and reconstituting the same just prior to injection. 
     The ingredients interaction problem is even more serious when, in addition to containing multivitamins, the preparation also contains trace elements, especially copper. To circumvent the problem, the prior art, again, provided a two or three package system, one or two of which contained the multivitamin and one the trace elements. The contents of the packages were either separately infused into the patient or were admixed just prior to infusion. While the former method is undesirably cumbersome, the latter method is unsatisfactory for the reason that the reactions between the trace elements and the multivitamins are so rapid that the browning reaction and turbidity can be observed within minutes of admixing the two phases. In addition, the interaction could cause clogging of the infusion needle and the introduction of solid particles into the vein of the patient. This problem could be especially serious with infusions mixed several hours prior to addition to TPN solutions. 
     The present invention is designed to solve the above-described problems and to provide multivitamin/trace elements formulations in aqueous solution for parenteral administration to patients. 
     SUMMARY OF THE INVENTION 
     It is a main object of the present invention to administer to patients multivitamins and trace elements together as one entity in an infusion mixture. Heretofore such administration was not possible due to the instantaneous reaction of trace elements with several of the vitamins forming darkly colored, turbid solutions with heavy precipitation occurring within minutes. Examples of such undesirable reactions include reaction of copper with vitamin C, riboflavin, folic acid and vitamin B 12 . 
     It is another object of the present invention to provide a multivitamin/trace elements formulation which is stable for at least 4 to 8 hours at room temperature or 8 to 12 hours refrigerated so as to allow normal manipulative time in hospital infusion. 
     It has been surprisingly discovered that the rapid inter-reactions between vitamins and trace elements can be prevented by the use of a water soluble, organic acid that contains carbon-to-carbon unsaturation and water soluble salts thereof. Such organic acids include: maleic acid, fumaric acid, maleamic acid and acrylic acid. Water soluble saturated weak organic acids, such as citric acid, acetic acid, tartaric acid, gluconic acid, succinic acid, lactic acid, and oxalic acid showed no stabilizing effects. Cyanoacetic acid which has an unsaturated carbon to nitrogen bond was also ineffective in stabilizing the multivitamin/trace elements formulations. 
     In accordance with this discovery, several embodiments of the invention are provided as will be described hereunder. 
     a. One embodiment of the present invention lies in an injectable, two compartment, one unit vial or syringe, aqueous liquid-liquid preparation of multivitamins/trace elements maintained separately, one of the two compartments, in addition to containing the active ingredients, contains a sufficient amount of a water soluble organic acid having carbon-to-carbon unsaturation to stabilize the injectable combination preparation. 
     b. Still another embodiment of the present invention is the same as that described in (a) except the container is a two-unit vial or syringe package. 
     c. A further embodiment of the present invention provides for lyophilization of the respective solution or solutions referred to in (a) and (b) which are reconstituted prior to infusion. 
     The stabilizer can be added separately or combined with either multivitamins or trace elements. 
     The various embodiments of the present invention are useful for adult, pediatric, neonatal or TPN regimen and also for veterinary application. 
     It has been found that a molar ratio of 3 to 30 times of stablizer to combined trace elements is necessary to effectively stabilize either the multivitamin or the trace elements containing solution which corresponds to about 0.5 to 5.0% w/v of stabilizer in the solution. The preferred method of stabilization is the use of 5 to 10 molar ratio of the water soluble unsaturated organic acid in the trace elements solution. While the mechanism of stabilization is not understood, it is postulated that stabilization is due to weak bonding of the trace element(s) to the unsturated carbon-carbon (double) bond. 
     DETAILED DESCRIPTION OF THE INVENTION 
     In general, the multivitamin/trace elements formulations of the present invention are directed by therapeutic considerations based on judgements of those skilled in the art of nutrition. For special deficiencies additional components or amounts may be added. Tables I and II show the amounts of the various vitamins and trace elements considered advantageous for use in TPN formulations. 
     
                       TABLE I______________________________________Vitamin Range                  Broad      PreferredActive   Forms         Range      Range*______________________________________Vitamin A,    alcohol,        230-10,000                             3,300-5,000IU       palmitate,    acetateVitamin B.sub.1,    hydrochloride,                  0.05-45.0  3.0-6.0mg       mononitrate,    phosphate    estersVitamin B.sub.2,    riboflavin,   0.07-10.0  3.0.6.0mg       riboflavin-5-    phosphate    sodium saltVitamin B.sub.6,    hydrochloride 0.04-12.0  4.0-6.0mgVitamin C,    Vitamin C,       4-1,000 100-200mg       sodium    ascorbateVitamin D,    ergocal-        44-1,000 200-400IU       ciferol,    calciferolVitamin E,    d or dl       0.66-10     5-10IU       tocopheryl,    d or dl tocopheryl    acetateNiacinamide,    niacinamide,  0.25-100   40-60mg       niacinPantothenic    d-panthenol,  0.3-25     10-15Acid, mg calcium    pantothenateVitamin K,    phytonadione, 0.04-1.0   0.10-0.5mg       menadiole,    menadione    bisulfite,    menadiol    phosphateBiotin, mcg    biotin         10-100    25-60Folic Acid,    folic acid,    5-800     400-600mcg      sodium    folateVitamin B.sub.12,    cyanoco-      0.04-10    2-5mcg      balamin,    cobalamin,    hydroxy    cobalamin______________________________________ *Preferred Range for adult formula 
    
     
                       TABLE II______________________________________Trace Element Range               Broad       PreferredActive  Forms       Range       Range*______________________________________Zinc    chloride,            100    mcg-10 mg 3-6    mg   sulfate   acetate,   citrate,   lactate,   nitrate,   tartrateCopper  chloride,            20     mcg-2.8 mg                             0.4-1.5                                    mg   sulfate,   acetate,   nitrate,   gluconateManganese   chloride,            2      mcg-2.5 mg                             0.15-0.80                                    mg   sulfate   acetate,   nitrateChromium   chloride,            0.14   mcg-20 mcg                             10-15  mcg   sulfate,   acetate,   nitrate______________________________________ *Preferred Range for adult formula 
    
     In addition to the active ingredients of vitamins and trace elements, excipients conventionally used in infusable solutions can be used, illustrative examples and amounts of which are shown in Table III. 
     
                       TABLE III______________________________________Excipients______________________________________Antioxidants and          thiourea, thioglycerol, thio-Stabilizers    sorbitol, cysteine, glycine,(0.005-2.0% w/v)          sodium formaldehyde sulfoxylate,          butylated hydroxyanisole, butyl-          ated hydroxytoluene, nordihydro-          gluaiaretic acid, ethyl hydro-          caffeate, gentistic acid ethonal-          amide, propyl gallate, ascorbyl          palmitate, iron salts.Solvents       propylene glycol, glycerin,(0.01 to 30% v/v)          alcohol, polyethylene glycol.Solubilizers   polyoxylated sorbitol fatty acid(0.01 to 5% w/v)          esters, polyoxylated vegetable          oils.Preservatives  (for multidose units) parabens,(0.01 to 1.0% w/v)          chlorobutanol, phenol, benzyl          alcohol.______________________________________ 
    
     The multivitamin/trace elements formulations of the present invention may be prepared using commercially available ingredients by methods well-known in the prior art. (Suppliers of raw materials include Hoffman-LaRoche Co., R. W. Greef &amp; Co., H. Reisman Corp., Roussel Corp. and Rhone Poulenc Inc.) 
    
    
     The following examples will illustrate formulations according to the present invention. 
     EXAMPLE 1 (Adult) 
     Ten grams of maleic acid is dissolved in 900 mL of water for injection. To this is added 
     
         ______________________________________0.536    g         copper chloride (2H.sub.2 O)1.68     g         zinc chloride0.364    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     The mixture is stirred until the solution is complete and adjusted to 1 liter volume. 
     Five mL of this mixture containing 
     
         ______________________________________1.0 mg              copper4.0 mg              zinc0.5 mg              manganese 10 mcg             chromium______________________________________ 
    
     is added to a vial of lyophilized or liquid multivitamin solution containing the following vitamins per unit dose: 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E0.15       mg          vitamin K.sub.16.0        mg          thiamin3.6        mg          riboflavin6.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid600        mcg         folic acid200        mg          ascorbic acid.______________________________________ 
    
     EXAMPLE 2 (Adult) 
     Five grams of fumaric acid is dissolved in 900 mL of water for injection and 
     
         ______________________________________1.18    g         copper sulfate (5H.sub.2 O)3.54    g         zinc sulfate (7H.sub.2 O)0.307   g         manganese sulfate (H.sub.2 O) and15.04   mg        chromium sulfate are added and             dissolved.______________________________________ 
    
     The solution is then brought to 1 liter volume. A 5 mL aliquot is taken containing 
     
         ______________________________________1.5        mg           copper4          mg           zinc0.5        mg           manganese10         mcg          chromium______________________________________ 
    
     and is added to a liquid or lyophilized multivitamin mixture for infusion purposes, the multivitamin mixture containing the following vitamins: 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E3.0        mg          thiamin3.6        mg          riboflavin4.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid400        mcg         folic acid100        mg          ascorbic acid.______________________________________ 
    
     EXAMPLE 3 (Adult) 
     Twenty grams of tris maleate is added to 900 mL of water for injection and stirred to dissolve. Then the following trace elements are added and dissolved: 
     
         ______________________________________0.79     g         copper sulfate (5H.sub.2 O)2.1      g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     The solution is q.s. to 1.0 liter and 5 mL aliquot containing 
     
         ______________________________________1.0        mg           copper5.0        mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is mixed with one unit dose of multivitamin solution for infusion delivery. The vitamin concentration is shown in Example 1. 
     EXAMPLE 4 (Adult) 
     Twenty five grams of maleic acid is dissolved in 900 mL water for injection and 
     
         ______________________________________1.072    g         copper chloride (2H.sub.2 O),2.52     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1.0 liter. 
     Five mL aliquot containing 
     
         ______________________________________2          mg           copper6          mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of multivitamin or lyophilized multivitamin solution. This is mixed for subsequent addition to the infusion solution. The concentration of vitamins is the same as that shown in Example 1. 
     EXAMPLE 5 (Adult) 
     Twenty grams of sodium maleate is dissolved in 900 mL of water for injection. To this is added 
     
         ______________________________________0.5366    g        copper chloride (2H.sub.2 O)1.68      g        zinc chloride0.364     g        manganese chloride (4H.sub.2 O)10.25     mg       chromium chloride (6H.sub.2 O)______________________________________ 
    
     The mixture is stirred until the solution is complete and adjusted to 1 liter. Five mL of this mixture, containing the same concentration of trace elements as in Example 1, is added to a unit vial of lyophilized or liquid multivitamins. 
     The composition of the multivitamin mixture used in this example is 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E3.0        mg          thiamin3.6        mg          riboflavin4.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid400        mcg         folic acid100        mg          ascorbic acid2.5        mg          thiourea.______________________________________ 
    
     EXAMPLE 6 (Pediatric) 
     Five grams of maleic acid is dissolved in 900 mL water for injection and 
     
         ______________________________________0.161   g         copper chloride (2H.sub.2 O)0.63    g         zinc chloride0.072   g         manganese chloride (4H.sub.2 O) and2.05    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is brought to 1 liter. 
     Five mL of this mixture containing 
     
         ______________________________________0.3        mg           copper1.5        mg           zinc0.1        mg           manganese2          mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid pediatric multivitamin solution. The composition of multivitamin pediatric solution is 
     
         ______________________________________2,300      IU          vitamin A400        IU          vitamin D7          IU          vitamin E0.2        mg          vitamin K.sub.117         mg          niacinamide1.4        mg          riboflavin1.2        mg          thiamin1.0        mg          pyridoxine5.0        mg          pantothenic acid80         mg          ascorbic acid20         mcg         biotin1.0        mcg         vitamin B.sub.12140.0      mcg         folic acid.______________________________________ 
    
     EXAMPLE 7 (Neonatal) 
     2.5 grams of maleic acid is dissolved in 900 mL water for injection and 
     
         ______________________________________0.032   g         copper chloride (4H.sub.2 O)0.25    g         zinc chloride0.014   g         manganese chloride (4H.sub.2 O) and0.61    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1 liter and 5 mL of this mixture containing 
     
         ______________________________________0.06       mg           copper0.6        mg           zinc0.02       mg           manganese0.6        mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamin containing the following vitamins: 
     
         ______________________________________1,400      IU          vitamin A200        IU          vitamin D4          IU          vitamin E0.1        mg          vitamin K.sub.110         mg          niacinamide0.8        mg          riboflavin0.7        mg          thiamin0.6        mg          pyridoxine3.0        mg          pantothenic acid50         mg          vitamin C12         mcg         biotin0.6        mcg         vitamin B.sub.1290.0       mcg         folic acid.______________________________________ 
    
     EXAMPLE 8 (Adult) 
     
         ______________________________________0.536    g         copper chloride (2 H.sub.2 O)1.26     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are dissolved in 900 mL water for injection. The solution is adjusted to pH 2 with hydrochloric acid and the volume is brought to 1 liter. 
     5 mL of this mixture containing 
     
         ______________________________________1.0        mg           copper3.0        mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamins containing the following vitamins: 
     
         ______________________________________3,300     IU           vitamin A200       IU           vitamin D10        IU           vitamin E0.15      mg           vitamin K.sub.16.0       mg           thiamin3.6       mg           riboflavin6.0       mg           pyridoxine40        mg           niacinamide60        mcg          biotin5.0       mcg          vitamin B.sub.1215.0      mg           pantothenic acid600       mcg          folic acid200       mg           ascorbic acid1%        w/v          maleic acid0.3       mg           iron peptonate1.0       mg           disodium edetate.______________________________________ 
    
     EXAMPLE 9 (Adult) 
     Ten grams of maleamic acid is dissolved in 900 mL of water for injection. To this is added 
     
         ______________________________________0.536    g         copper chloride (2H.sub.2 O)1.68     g         zinc chloride0.364    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     The mixture is stirred until the solution is complete and adjusted to 1 liter volume. 
     Five mL of this mixture containing 
     
         ______________________________________1.0        mg           copper4.0        mg           zinc0.5        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a vial of lyophilized or liquid multivitamin solution containing the following vitamins per unit dose: 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E0.15       mg          vitamin K.sub.16.0        mg          thiamin3.6        mg          riboflavin6.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid600        mcg         folic acid200        mg          ascorbic acid.______________________________________ 
    
     EXAMPLE 10 (Adult) 
     Twenty five grams of maleamic acid is dissolved in 900 mL water or injection and 
     
         ______________________________________1.072    g         copper chloride (2H.sub.2 O),2.52     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1.0 liter. 
     Five mL aliquot containing 
     
         ______________________________________2          mg           copper6          mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of multivitamin or lyophilized multivitamin solution. This is mixed for subsequent addition to the infusion solution. The concentration of vitamins is the same as that shown in Example 9. 
     EXAMPLE 11 (Adult) 
     Five grams of acrylic acid is added to 900 mL of water for injection and stirred to dissolve. Then the following trace elements are added and dissolved: 
     
         ______________________________________0.79    g         copper sulfate (5H.sub.2 O)2.1     g         zinc chloride0.144   g         manganese chloride (4H.sub.2 O) and10.25   mg        chromium chloride (6H.sub.2 O).______________________________________ 
    
     The solution is q.s. to 1.0 liter and 5 mL aliquot containing 
     
         ______________________________________1.0        mg           copper5          mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is mixed with one unit dose of multivitamin solution for infusion delivery. The vitamin concentration is shown in Example 9. 
     EXAMPLE 12 (Adult) 
     Seven grams of acrylamide is dissolved in 900 mL water or injection and 
     
         ______________________________________1.072    g         copper chloride (2H.sub.2 O),2.52     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1.0 liter. 
     Five mL aliquot containing 
     
         ______________________________________2          mg           copper6          mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of multivitamin or lyophilized multivitamin solution. This is mixed for subsequent addition to the infusion solution. The concentration of vitamins is the same as that shown in Example 9. 
     EXAMPLE 13 (Adult) 
     Seven grams of fumaric acide disodium salt is dissolved in 900 mL of water for injection and 
     
         ______________________________________1.18    g         copper sulfate (5H.sub.2 O)3.54    g         zinc sulfate (7H.sub.2 O)0.307   g         manganese sulfate (H.sub.2 O) and15.04   mg        chromium sulfate are added and______________________________________ 
    
     dissolved. The solution is then brought to 1 liter volume. A 5 mL aliquot is taken containing 
     
         ______________________________________1.5        mg           copper4          mg           zinc0.5        mg           manganese10         mcg          chromium______________________________________ 
    
     and is added to a liquid or lyophilized multivitamin mixture for infusion purposes, the multivitamin mixture containing the following vitamins: 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E3.0        mg          thiamin3.6        mg          riboflavin4.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid400        mcg         folic acid100        mg          ascorbic acid.______________________________________ 
    
     EXAMPLE 14 (Pediatric) 
     Six grams of fumaric acid disodium salt is dissolved in 900 mL water for injection and 
     
         ______________________________________0.161    g        copper chloride (2H.sub.2 O)0.63     g        zinc chloride0.072    g        manganese chloride (4H.sub.2 O) and2.05     mg       chromium chloride (6H.sub.2 O)______________________________________ are added and dissolved. The solution is brought to 1 liter. 
    
     Five mL of this mixture containing 
     
         ______________________________________  0.3 mg           copper  1.5 mg           zinc  0.1 mg           manganese  2   mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid pediatric multivitamin solution. The composition of multivitamin pediatric solution is 
     
         ______________________________________2,300      IU          vitamin A400        IU          vitamin D7          IU          vitamin E0.2        mg          vitamin K.sub.117         mg          niacinamide1.4        mg          riboflavin1.2        mg          thiamin1.0        mg          pyridoxine5.0        mg          pantothenic acid80         mg          ascorbic acid20         mcg         biotin1.0        mcg         vitamin B.sub.12140.0      mcg         folic acid.______________________________________ 
    
     EXAMPLE 15 (Neonatal) 
     Three grams of fumaric acid disodium salt is dissolved in 900 mL water for injection and 
     
         ______________________________________0.032   g         copper chloride (4H.sub.2 O)0.25    g         zinc chloride0.014   g         manganese chloride (4H.sub.2 O) and0.61    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1 liter and 5 mL of this mixture containing 
     
         ______________________________________0.06       mg            copper0.6        mg            zinc0.02       mg            manganese0.6        mcg           chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamin containing the following vitamins: 
     
         ______________________________________1,400      IU          vitamin A200        IU          vitamin D4          IU          vitamin E0.1        mg          vitamin K.sub.110         mg          niacinamide0.8        mg          riboflavin0.7        mg          thiamin0.6        mg          pyridoxine3.0        mg          pantothenic acid50         mg          vitamin C12         mcg         biotin0.6        mcg         vitamin B.sub.1290.0       mcg         folic acid.______________________________________ 
    
     EXAMPLE 16 (Adult) 
     
         ______________________________________0.536    g        copper chloride (2H.sub.2 O)1.26     g        zinc chloride0.144    g        manganese chloride (4H.sub.2 O)10.25    mg       chromium chloride (6H.sub.2 O)______________________________________ 
    
     are dissolved in 900 mL water for injection. The solution is adjusted to pH 2 with hydrochloric acid and the volume is brought to 1 liter. 
     5 mL of this mixture containing 
     
         ______________________________________  1.0 mg           copper  3.0 mg           zinc  0.2 mg           manganese  10  mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamins containing the following vitamins: 
     
         ______________________________________3,300    IU         vitamin A200      IU         vitamin D10       IU         vitamin E0.15     mg         vitamin K.sub.16.0      mg         thiamin3.6      mg         riboflavin6.0      mg         pyridoxine40       mg         niacinamide60       mcg        biotin5.0      mcg        vitamin B.sub.1215.0     mg         pantothenic acid600      mcg        folic acid200      mg         ascorbic acid0.75%    w/v        fumaric acid disodium salt0.3      mg         iron peptonate1.0      mg         disodium edetate.______________________________________ 
    
     EXAMPLE 17 (Pediatric) 
     Five grams of maleamic acid monosodium salt is dissolved in 900 mL water for injection and 
     
         ______________________________________0.161   g         copper chloride (2H.sub.2 O)0.63    g         zinc chloride0.072   g         manganese chloride (4H.sub.2 O) and2.05    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is brought to 1 liter. 
     Five mL of this mixture containing 
     
         ______________________________________  0.3 mg           copper  1.5 mg           zinc  0.1 mg           manganese  2   mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid pediatric multivitamin solution. The composition of multivitamin pediatric solution is 
     
         ______________________________________2,300      IU          vitamin A400        IU          vitamin D7          IU          vitamin E0.2        mg          vitamin K.sub.117         mg          niacinamide1.4        mg          riboflavin1.2        mg          thiamin1.0        mg          pyridoxine5.0        mg          pantothenic acid80         mg          ascorbic acid20         mcg         biotin1.0        mcg         vitamin B.sub.12140.0      mcg         folic acid.______________________________________ 
    
     EXAMPLE 18 (Neonatal) 
     2.5 grams of maleamic acid monosodium salt is dissolved in 900 mL water for injection and 
     
         ______________________________________0.032   g         copper chloride (4H.sub.2 O)0.25    g         zinc chloride0.014   g         manganese chloride (4H.sub.2 O) and0.61    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1 liter and 5 mL of this mixture containing 
     
         ______________________________________0.06       mg            copper0.6        mg            zinc0.02       mg            manganese0.6        mcg           chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamin containing the following vitamins: 
     
         ______________________________________1,400      IU          vitamin A200        IU          vitamin D4          IU          vitamin E0.1        mg          vitamin K.sub.110         mg          niacinamide0.8        mg          riboflavin0.7        mg          thiamin0.6        mg          pyridoxine3.0        mg          pantothenic acid50         mg          vitamin C12         mcg         biotin0.6        mcg         vitamin B.sub.1290.0       mcg         folic acid.______________________________________ 
    
     EXAMPLE 19 (Adult) 
     
         ______________________________________0.536    g         copper chloride (2H.sub.2 O)1.26     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are dissolved in 900 mL water for injection. The solution is adjusted to pH 2 with hydrochloric acid and the volume is brought to 1 liter. 
     5 mL of this mixture containing 
     
         ______________________________________1.0        mg           copper3.0        mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamins containing the following vitamins: 
     
         ______________________________________3,300      IU          vitamin A200        IU          vitamin D10         IU          vitamin E0.15       mg          vitamin K.sub.16.0        mg          thiamin3.6        mg          riboflavin6.0        mg          pyridoxine40         mg          niacinamide60         mcg         biotin5.0        mcg         vitamin B.sub.1215.0       mg          pantothenic acid600        mcg         folic acid200        mg          ascorbic acid1%         w/v         maleamic acid0.3        mg          iron peptonate1.0        mg          disodium edetate.______________________________________ 
    
     EXAMPLE 20 (Pediatric) 
     Two grams of acrylamide is dissolved in 900 mL water for injection and 
     
         ______________________________________0.161   g         copper chloride (2H.sub.2 O)0.63    g         zinc chloride0.072   g         manganese chloride (4H.sub.2 O) and2.05    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is brought to 1 liter. 
     Five mL of this mixture containing 
     
         ______________________________________0.3        mg           copper1.5        mg           zinc0.1        mg           manganese2          mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid pediatric multivitamin solution. The composition of multivitamin pediatric solution is 
     
         ______________________________________2,300      IU          vitamin A400        IU          vitamin D7          IU          vitamin E0.2        mg          vitamin K.sub.117         mg          niacinamide1.4        mg          riboflavin1.2        mg          thiamin1.0        mg          pyridoxine5.0        mg          pantothenic acid80         mg          ascorbic acid20         mcg         biotin1.0        mcg         vitamin B.sub.12140.0      mcg         folic acid.______________________________________ 
    
     EXAMPLE 21 (Neonatal) 
     Two grams of acrylamide is dissolved in 900 mL water for injection and 
     
         ______________________________________0.032   g         copper chloride (4H.sub.2 O)0.25    g         zinc chloride0.014   g         manganese chloride (4H.sub.2 O) and0.61    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are added and dissolved. The solution is q.s. to 1 liter and 5 mL of this mixture containing 
     
         ______________________________________0.06       mg           copper0.6        mg           zinc0.02       mg           manganese0.6        mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamin containing the following vitamins: 
     
         ______________________________________1,400      IU          vitamin A200        IU          vitamin D4          IU          vitamin E0.1        mg          vitamin K.sub.110         mg          niacinamide0.8        mg          riboflavin0.7        mg          thiamin0.6        mg          pyridoxine3.0        mg          pantothenic acid50         mg          vitamin C12         mcg         biotin0.6        mcg         vitamin B.sub.1290.0       mcg         folic acid.______________________________________ 
    
     EXAMPLE 22 (Adult) 
     
         ______________________________________0.536    g         copper chloride (2H.sub.2 O)1.26     g         zinc chloride0.144    g         manganese chloride (4H.sub.2 O)10.25    mg        chromium chloride (6H.sub.2 O)______________________________________ 
    
     are dissolved in 900 mL water for injection. The solution is adjusted to pH 2 with hydrochloric acid and the volume is brought to 1 liter. 
     5 mL of this mixture containing 
     
         ______________________________________1.0        mg           copper3.0        mg           zinc0.2        mg           manganese10         mcg          chromium______________________________________ 
    
     is added to a unit vial of lyophilized or liquid multivitamins containing the following vitamins: 
     
         ______________________________________3,300     IU           vitamin A200       IU           vitamin D10        IU           vitamin E0.15      mg           vitamin K.sub.16.0       mg           thiamin3.6       mg           riboflavin6.0       mg           pyridoxine40        mg           niacinamide60        mcg          biotin5.0       mcg          vitamin B.sub.1215.0      mg           pantothenic acid600       mcg          folic acid200       mg           ascorbic acid0.5%      w/v          acrylamide0.3       mg           iron peptonate1.0       mg           disodium edetate.______________________________________ 
    
     Physical stability data of a multivitamin formulation containing the vitamins of Table I in the presence of trace elements of Table II are shown in Table IV and Table IV A. In one set of experiments no stabilizer was used; in another set of experiments the water soluble saturated, weak organic acid stabilizers (citric, acetic, tartaric, gluconic, succinic, lactic, oxalic acids) were used; in the third set of experiments, maleic acid was used as the stabilizer; and in the fourth set of experiments acrylic acid was used as the stabilizer. 
     
                                           TABLE IV__________________________________________________________________________Physical Stability           Saturated Weak                    Maleic Acid                             Acrylic AcidTime   No Stabilizer           Organic Acids                    Stabilizer                             Stabilizer__________________________________________________________________________Initial  Turbid   Turbid   Clear    Clear(15 seconds)  Severe darkening           Severe darkening                    Very slight color                             Light color                    change2 hours  Slight precipita-           Slight precipita-                    Clear, no precipi-                             Clear, no precipi-Room temp.  tion     tion     tate. No further                             tate. Light color  Severe darkening           Severe darkening                    color change4 hours  Moderate precipi-           Moderate precipi-                    Clear, no precipi-                             Clear, no colorRoom temp.  tation   tation   tate. No further                             change. No  Severe darkening           Severe darkening                    color change                             precipitate8 hours  Heavy reddish           Heavy reddish                    Clear, no precipi-                             Clear, no colorRoom temp.  brown precipitate           brown precipitate                    tate. No further                             change. No  Severe darkening           Severe darkening                    color change                             precipitate24 hours  Heavy reddish           Heavy reddish                    Clear, no precipi-                             Clear, no colorRoom temp.  brown precipitate           brown precipitate                    tate. Slight                             change. No  Severe darkening           Severe darkening                    color change from                             precipitate                    original24 hours  Heavy reddish           Heavy reddish                    Clear, no precipi-                             Clear, no colorRefrigerated  brown precipitate           brown precipitate                    tate. No color                             change. No  Severe darkening           Severe darkening                    change from                             precipitate                    original__________________________________________________________________________ 
    
     Table V shows results of chemical stability tests conducted on vitamin C, vitamin B 1 , folic acid, and vitamin B 12  contained in a multivitamin formulation according to Table I in the presence of the trace elements of Table II. In one set of experiments the unsaturated water soluble acid stabilizer was used, while in another set of experiments the stabilizer was omitted. The remainder of the vitamins of Table I, namely, niacinamide, vitamin B 6 , vitamin B 2 , biotin, vitamin K, pantothenic acid, and vitamins A, D and E were found to be relatively stable in the presence of the trace elements without the presence of stabilizers. 
     
                       TABLE V______________________________________Chemical Stability         No Stabilizer                  Stabilizer______________________________________Vitamin C % Loss2 hrs. RT       14         44 hrs. RT       23         56 hrs. RT       30         58 hrs. RT       40         524 hrs. RT      93         1224 hrs. Refrig. 61         5Vitamin B.sub.1 % Loss2 hrs. RT        6         04 hrs. RT       14         26 hrs. RT        8         78 hrs. RT       15         424 hrs. RT      16         324 hrs. Refrig. 11         1Folic Acid % Loss2 hrs. RT        9         34 hrs. RT       10         36 hrs. RT       --         28 hrs. RT       --         524 hrs. RT      43         224 hrs. Refrig. 38         0Vitamin B.sub.12 % Loss2 hrs. RT       --         --4 hrs. RT       66         16 hrs. RT       --         --8 hrs. RT       100        024 hrs. RT      100        724 hrs. Refrig. --         --______________________________________ 
    
     The preceding specific embodiments are illustrative of the practice of the invention. It is to be understood, however, that other expedients known to those skilled in the art or disclosed herein, may be employed without departing from the spirit of the invention or the scope of the appended claims.