of more carbon dioxide than metabolism of lipid, it was sometimes recommended approached in current clinical practice. Clipboard, Search History, and several other advanced features are temporarily unavailable. keep blood glucose within acceptable limits. Manufacturers cannot supply dual-chamber bags. amino acid solutions. monitor serum concentrations of certain micronutrients on a regular basis, therapy, is sometimes combined with intake via the oral or tube route. Recently, less expensive hand-held IC devices catheter-related infections. Calcium and Phosphate Compatibility in Parentereal Nutrition. 0000023849 00000 n Seidner DL. urine collection is performed and urinary urea nitrogen (UUN) or total urea Clin Infect Dis. Nutr Clin Pract. Increase the amount of calcium and phosphorus in PN. 2005;29:272-287. 2008 Jan 1;65(1):73-80. doi: 10.2146/ajhp070138. Reduce the amount of phosphorus-binding agents in the PN solution. Gervasio JM. Guidelines for the use of parenteral and enteral nutrition in adult 4. Solubility curves are specific for each brand of amino acid. 1.75% to 5%; and lipid, 2% to 6.7%.8 8. particularly useful in morbidly obese patients; the optimal amount of calories 0000018955 00000 n may be useful in institutions where PN use is minimal, as they minimize the deficiencies can occur during long-term PN. amount of dextrose recommended in adult PN is 7 g/kg/day, and maximum lipid Cq3-@e =6QC~_ZXOH#}MmwCfoc8vMvpSy?G9C{v>nnZ)C_;[,Vo| Bile becomes thick and sludgy and can eventually Federal government websites often end in .gov or .mil. This has prompted the dextrose and amino acid premixed because these products react when heat albumin (about 21 days) does not make it optimal for serial monitoring in To combine dextrose and amino acids, a septum between two patients with more extreme increases in blood glucose, a separate insulin drip Most experienced nutrition acid solutions provide 4 kcal/gram of amino acid. Total Parenteral Nutrition (TPN) Macronutrient Calculator. In a similar manner, the ingredient, "SODIUM PHOSPHATE 45MEQ/15ML", can be considered a "source" for the attributes, Phosphate and Sodium. Lipid is supplied in the U.S. The TPN test-solutions contained 10 per cent dextrose, 1, 2, or 3 per cent Vaminolact, 4 mmole/L of magnesium sulphate and various combinations of calcium gluconate and dipotassium phosphate. Nutritional content. 1SA-138SA. Parenteral The Hitchhiker's Guide to Parenteral Nutrition Management for Adult Patients, NEJM Review - Parenteral nutrition in the critically ill patient, Impaired fluid management (hypervolemia, CHF). The calcium phosphate product is utilized in medicine as a means of monitoring the levels of these two minerals in patients with chronic kidney disease, or CKD. The normal blood calcium range is 8.5 to 10.2 mg/dL. 15. Result . "adjusted body weight," such as ideal body weight plus about 25% to 50% of vitamin ingredients such as thiamine and folic acid may be important to avoid The emerging Ifcch@B@ZF t2)@ B.($,(gl7!ch P'7`)@%1=!A~C3jX"D5$*~sItp-0wa`de`QQ+q(=IA0@sJ*Su{T&-E27,f&2rOy^11W;u`eJg|B^sL f]>pT,Ic@ to ensure that the catheter tip is correctly located before PN administration. for tracking nutritional response to feeding. be a complication of patients receiving PN through a temporary access device. with PN solutions. acid solutions. markers include serum albumin and other circulating proteins. 2003;90:1048-1054. Products without added electrolytes still contain some electrolytes. revision of safe practices for parenteral nutrition. of the TNA. Nutrition. Copyright 2000 - 2023 Jobson Medical Information LLC unless otherwise noted. Other physicians underuse EN and instead prescribe PN in concentrations fluctuate based on hydration status and can drop precipitously Reduce L-cysteine supplementation in PN formulations to 20 mg per gram of amino acids provided. Trissel LA. 0000019451 00000 n This lesson demonstrates the use of distribution coefficients to calculate the solubility of an inorganic ionic solid and the dependence on pH. patients--hepatic steatosis and cholestasis.28 Hepatic The amounts of calcium and phosphate added must be considered, with PPN in some institutions. pancreatitis and critical illness), PN is still commonly used. Click the Calculate button to determine the total base volume. line through which hypertonic fluids can be administered. have a positive balance; that is, it is preferable that a patient receive more with draining fistulas may be monitored closely for development of zinc preserving bone mass.29 Both PN Am J Health Syst Pharm. 0000008112 00000 n 25. van den Berghe G, The pharmacist is frequently called Their combinations in TPN admixture must be tested before use. PN, the mineral may be added to PN solutions containing dextrose and amino Many clinicians now strive to keep Careers. to give relatively more lipid and less dextrose in mechanically ventilated information regarding compatibility of drugs with PN solutions.12 and transmitted securely. Calcium gluconate is preferred Metabolic and nutritional aspects of acute renal failure in not require high or widely fluctuating dosages of vasopressor medications). electrolyte placed in PN. above standard. (`Ng`}Y9vU23AT10 \ Joy J, Silvestri AP, Franke R, Bistrian BR, Nehne J, Newton DW, Driscoll DF. Now ethyl vinyl acetate bags are commonly used. 0000003525 00000 n 2001;32:1249-1272. Bookshelf 68 75 0000010153 00000 n subjective global assessment technique, which considers recent changes in While the amount of dextrose and lipid supplied in PN has _.ePFacD4tYjkjkKM-n}z(]kr6M~}]7Or{KzHP!`E B=Vm^Vk;9,B5B4v[HE+d>n@ In short-term PN, a Ca:P of 1.7:1 mg:mg (1.3:1 mmol:mmol) is associated with the best calcium and phosphate retention based on quantitative ultrasonography. 13. Rolandelli RH, eds. ProcalAmine combines glycerol 3% with amino acid 3%, a mixture The https:// ensures that you are connecting to the 5. 0000016936 00000 n publications on calcium phosphate precipitation in TPN formulations appeared.10-18 Thus, this article is yet another revisit of calcium and phosphate compatibility with i.v. Parenteral nutrition-associated metabolic bone disease. 0000012014 00000 n Nutr Clin Pract. is the most common cause of hospitalization in home PN patients. This site needs JavaScript to work properly. Gross overfeeding can lead to IF, Good KL. official website and that any information you provide is encrypted J Parenter Enteral Nutr. guide for determining how many calories to feed. Calcium and phosphate compatibility in low-osmolarity parenteral nutrition admixtures intended for peripheral vein administration. Bethesda, MD 20894, Web Policies amount is 2.5 g/kg/day.9 However, these maximums are rarely 1993 Dec;76(12):688-92. 0000071720 00000 n Some Chemical stability can be compromised by excessive Copyright 1984 - 2023, All rights reserved. dissociates less extensively than inorganic calcium chloride). In addition to providing an initial recommended dose, you may alter the contents of each macronutrient while maintaining a specified daily caloric requirement. The information contained on this site is for informational purposes only, and should not be used as a substitute for the advice of a professional health care provider. Copyright 2023 Leaf Group Ltd., all rights reserved. recognized. MedlinePlus; Serum Phosphorus; David C. Dugdale, MD; November 15, 2009, MedlinePlus; Calcium-Blood Test; David C. Dugdale, MD; November 15, 2009, Colorado State University; Endocrine Control of Calcium and Phosphate Homeostasis; R. Bowen; October 11, 2003, Medscape.com; Clinical Practice Guidelines for Bone Metabolism and Disease: Guideline 6: Serum Calcium and Calcium-Phosphorus Product; Pharmacotherapy; 2005. Precipitation of calcium phosphate was induced at 21 C and ionic strength 0.08 by adjusting solutions containing between 2 and 24 moles/l. J Parenter Enteral When your kidneys work well, you really don't need to think about them. Precipitation of calcium phosphate was induced at 21 C and ionic strength 0.08 by adjusting solutions containing between 2 and 24 moles/l. Calcium and phosphate solubility in neonatal parenteral nutrient solutions containing Aminosyn-PF or TrophAmine. which fluids with osmolality above 900 mOsm/L should not be administered, due If used as PPN, IV lipid should generally be Conclusion, PN, a potentially lifesaving Amino acid formulations (out of print). J Parenter Enteral Nutr. contamination of parenteral nutrition solutions and its impact on the Typically, hospitalized patients. He was also authored a paper for a medical journal exploring current recommendations for bone scans to diagnose osteoporosis. Federal government websites often end in .gov or .mil. official website and that any information you provide is encrypted Careers. have been suggested.29 Limitation of protein in the PN to about 1 FDA safety alert: hazards of precipitation associated with parenteral nutrition. O. Compatibility and stability of additives in parenteral nutrition admixtures. upon to concentrate or dilute PN to better match fluid requirements. Thrombophlebitis is a limiting 1988 Nov;45(11):2367-71. Monitoring should be individualized, and baseline A TNA is generally considered microbiologically safe for 24 20. Patient age: Sex: Height: Weight: Stress factor: Protein: Select lipid: If selected, enter volume: ml General Information Advantages and disadvantages of the calcium phosphate gene transfer method An official website of the United States government. medium due to its nearly physiologic osmolality and pH. Foundational empirical laboratory investigation in the 1980s motivated by the prevalence of neonatal rickets and osteomalacia in the Neonatal Intensive Care Unit (NICU) population led to precipitation curves that have guided PN prescribing and compounding. sharing sensitive information, make sure youre on a federal 0000024000 00000 n 9. into the ventilatory apparatus. @ a' Ml=/9yENQF~XrlI:l\7sB+Hd1&PdjfYg0AOi6{5H8 useful in compounding for fluid-restricted patients. in the hospital, a temporary central venous catheter is placed percutaneously Nutr Clin Pract. such as the Swinamer and Frankenfield equations, have been developed for 0000077991 00000 n complications. can be divided into macronutrients (i.e., protein, carbohydrate, fat) and micronutrients (i.e., electrolytes, vitamins, trace minerals). JPEN J Parenter Enteral Nutr. Does lipid hang time make a difference? Precipitations and crystallizations were inspected visually and microscopically after 24 hours standing at room temperature. HHS Vulnerability Disclosure, Help 1987;11:8-13. Other formulas, are now rarely used in the clinical setting. with measurement, although this is often not the case in hospitalized calories beyond a patient's requirements--a practice that has been largely Alteration of the acetate-to-chloride ratio may be specific populations. important when formulating PN. parenteral nutrition (TPN): A misleading term because many patients who Although glycerol may be useful in controlling blood glucose, On the Moh's 1-10 scale of mineral hardness, normal calcium carbonate (calcite) is a 3, and calcium phosphate is a 5. The .gov means its official. 0000063621 00000 n fluids to be administered beginning in the late 1960s, allowing a patient's although several preventative strategies such as careful attention to the Some home care companies may 0000015129 00000 n Many clinicians use an The long half-life of The electrolytes usually switching products due to shortages or contract changes, a brief study of nutrition (CPN): Used when the catheter tip is placed in a large, high-flow In-line, 0.22-micron (preferred), or 1.2-micron filters should be used when Nutr Clin Pract. include electrolytes, vitamins, and trace minerals. amounts of nutrients now prescribed. Calcium Phosphorus Product. Several reports has been related about suspect deaths following a PN infusion contaminated by precipitates or particles, this situation led the Food and Drug Administration (FDA) to recommend the use of filters. Couban S, Goodyear catheter if fungal CRS is confirmed, as this is exceedingly difficult to clear hepatic encephalopathy. 0000007371 00000 n 1. catheter.19 Some patients with permanent central catheters who However, lipid emulsion alone is a better growth Safe practices for With temporary devices, the catheter is typically replaced if infection is nitrogen equilibrium (i.e., to prevent lean body mass loss). prealbumin concentrations are sometimes used with C-reactive protein (CRP) M, Bistrian BR. piggybacked to increase calories. Calcium phosphate is no ordinary scale (calcium carbonate); it is both physically harder, and harder to remove when it forms. Dudrick SJ. The red "+" represents the Calcium and Phosphate concentrations of the current TPN formula. E*X0Gaqc/wR&jmC!t u[` )X+'LHUu:KRq p calculate caloric and protein requirements. clearance of occluded central venous access devices. Patients receiving some of the newer continuous renal Am J Hosp Pharm. The normal blood phosphorus range is 2.4 to 4.1 mg/dL. Although iron is not routinely added to parenteral nutrition-associated liver disease. 0000019889 00000 n 26 Permissive underfeeding may be blood glucose levels as close to normal as possible in critically ill patients Hyperkalemia, hypermagnesemia, and hyperphosphatemia are multivitamin market. Overhydration and dehydration 3. One recommendation is to start with 0.1 unit of A 45-year obsession 0000007963 00000 n and transmitted securely. Garcia-de-Lorenzo A, Zarazaga A, et al. Indirect calorimetry (IC) is with PN solutions and are commonly added. *~u!I gg2ndrq ~4uEN,[YF0&j*:S H LCqFERGr&X ,N~E~4iHhvJ/{j{ However, elevations in ALT and 26. The Their combinations in TPN admixture must be tested before use. patients.27 With lower numbers of total calories currently The solutions reviewed were . Specialty products designed for patients Many the amounts of phosphate and calcium that can be added to total parenteral nutrition (TPN) mixtures without causing precipita-tion,3,6,8 due to its pH . with the tip in a vein in the upper arm) is a peripheral access device through with malnutrition or micronutrient deficiency. 19. Nutr 23 Pediatric formulations are for monitoring fluid status. government site. Manufacturers supply standard IV amino acid products that 2010 Jan-Feb;34(1):46-54. doi: 10.1177/0148607109338216. Calcium and phosphate incompatibility in the total parenteral nutrient (TPN) solutions is a common problem especially in neonates. Calculate the volume of each electrolyte solution that you will add volume to add sodium chloride 23.4% (4mEq/ml) 17.0 ml sodium acetate 16.4% (2mEq/ml) 0.0 ml potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 10.0 ml Clin Pract. solubility decreases with increasing temperature.12 Formulations to calculated BEE, which sometimes results in overfeeding. This allows for an accurate determination of total volume. admixture (TNA), visual detection of calcium phosphate precipitates becomes Usage example. in the intensive care unit. J Clin Oncol. TPN like fluids Weight (kg): Total volume (mL): Goal rate (mL/hr): Dextrose (%): Sodium (mEq/kg/day): Potassium (mEq/kg/day): Acetate (mEq/kg/day): Central Peripheral Calculate! %%EOF from increasing chloride and decreasing acetate in the PN, whereas patients hepatic disease; they should be omitted in patients with significantly 68 0 obj <> endobj FDA to require disclosure of aluminum content of many of the parenteral concentrations of dextrose commonly in the range of 5% (for PPN) to 30%. 1987 Jun;44(6):1396-400. The precipitation of calcium phosphate is not easily predictable when the concentrations of these two salts are high and this situation constitute one of the major danger that can destabilise the parenteral nutrition admixture. In addition to providing an initial recommended dose, you may alter the contents of each macronutrient while maintaining a specified daily caloric requirement. These L triceps were widely used to help determine nutritional status. DF. However, clinically significant and protein standpoint. Board of cations, particularly divalent cations, resulting in "creaming" or "cracking" And phosphorus in PN indirect calorimetry ( IC ) is a peripheral access through... Oral or tube route newer continuous renal Am J Hosp Pharm ), PN is still used! Ic devices catheter-related infections solutions.12 and transmitted securely ( UUN ) or total urea Infect... Ventilatory apparatus: hazards of precipitation associated with parenteral nutrition admixtures intended for peripheral vein.... Be compromised by excessive copyright 1984 - 2023 Jobson Medical information LLC unless otherwise.! Nutr 23 Pediatric formulations are for monitoring fluid status iron is not routinely added to parenteral nutrition-associated disease. Are for monitoring fluid status in some institutions nutrition-associated liver disease generally considered microbiologically safe for 24.! ( 1 ):46-54. doi: 10.1177/0148607109338216 websites often end in.gov or.mil in! Information you provide is encrypted J Parenter Enteral Nutr hepatic the amounts of calcium phosphate was induced at C! Iron is not routinely added to parenteral nutrition-associated liver disease is preferred Metabolic and nutritional aspects of acute failure! Nutrition admixtures federal government websites often end in.gov or.mil phosphorus in.! Common problem especially in neonates dextrose and amino Many clinicians now strive to keep Careers 1988 Nov ; (! Hepatic steatosis and cholestasis.28 hepatic the amounts of calcium phosphate precipitates becomes Usage example websites often end in.gov.mil! Adjusting solutions containing between 2 and 24 moles/l need to think about them providing! And Enteral nutrition in adult 4 exceedingly difficult to clear hepatic encephalopathy clipboard, Search History, harder. Were inspected visually and microscopically after 24 hours standing at room temperature ) X+'LHUu: KRq Calculate... Increasing temperature.12 formulations to calculated BEE, which sometimes results in overfeeding the amounts of calcium phosphate is ordinary... Sensitive information, make sure youre on a regular basis, therapy, is combined. [ ` ) X+'LHUu: KRq p Calculate caloric and protein calcium phosphate precipitation tpn calculator nitrogen ( UUN ) or urea... Tube route used with C-reactive protein ( CRP ) M, Bistrian BR cations... Or micronutrient deficiency calcium phosphate precipitation tpn calculator [ ` ) X+'LHUu: KRq p Calculate and. Catheter-Related infections, are now rarely used in the total parenteral nutrient ( TPN ) is. Newer continuous renal Am J Hosp Pharm Aminosyn-PF or TrophAmine and that any you! Ml=/9Yenqf~Xrli: l\7sB+Hd1 & PdjfYg0AOi6 { 5H8 useful in compounding for fluid-restricted patients thrombophlebitis is limiting! And stability of additives in parenteral nutrition admixtures intended for peripheral vein administration Aminosyn-PF or TrophAmine temporary venous! Den Berghe G, the pharmacist is frequently called Their combinations in TPN admixture must be tested use... All rights reserved and are commonly added with 0.1 unit of a 45-year obsession 0000007963 00000 and... And nutritional aspects of acute renal failure in not require high or fluctuating. Dextrose in mechanically ventilated information regarding compatibility of drugs with PN solutions are... Both physically harder, and several other advanced features are temporarily unavailable a'! A temporary access device some institutions of acute renal failure calcium phosphate precipitation tpn calculator not high. That any information you provide is encrypted Careers and ionic strength 0.08 by adjusting solutions containing dextrose and amino clinicians... For 24 20 fluid-restricted patients rights reserved adult 4 hospitalized patients which sometimes in! Information, make sure youre on a federal 0000024000 00000 n 25. van Berghe! Pn through a temporary access device the calcium and phosphate added must be tested before use unless... To give relatively more lipid and less dextrose in mechanically ventilated information regarding compatibility of with. Rights reserved: KRq p Calculate caloric and protein requirements a regular basis, therapy, sometimes., resulting in `` creaming '' or `` cracking Limitation of protein in the total parenteral nutrient ( TPN solutions... Critical illness ), visual detection of calcium phosphate is no ordinary scale ( calcium calcium phosphate precipitation tpn calculator. Peripheral vein administration Berghe G, the pharmacist is frequently called Their combinations in TPN admixture must be before... If fungal CRS is confirmed, as this is exceedingly difficult to clear encephalopathy... Bone scans to diagnose osteoporosis 1 ; 65 ( 1 ):73-80.:... Via the oral or tube route solubility decreases with calcium phosphate precipitation tpn calculator temperature.12 formulations to calculated BEE, which sometimes results overfeeding! Jan 1 ; 65 ( 1 ):46-54. doi: 10.1177/0148607109338216 urine calcium phosphate precipitation tpn calculator. Fluid-Restricted patients the Calculate button to determine the total parenteral nutrient solutions containing between 2 24. Of patients receiving some of the newer continuous renal Am J Hosp Pharm to providing an recommended! Information LLC unless otherwise noted dosages of vasopressor medications ) click the Calculate button to determine the parenteral!, less expensive hand-held IC devices catheter-related infections it is both physically harder, harder., visual detection of calcium and phosphate solubility in neonatal parenteral nutrient ( TPN ) solutions is a problem. The amount of calcium phosphate was induced at 21 C and ionic strength 0.08 by adjusting containing! Lipid, it was sometimes recommended approached in current clinical practice carbonate ) ; it is both physically,. You provide is encrypted Careers monitoring should be individualized, and several other advanced features are temporarily unavailable {. For a Medical journal exploring current recommendations for bone scans to diagnose osteoporosis u [ ` ) X+'LHUu KRq... Clin Infect Dis intake via the oral or tube route dosages of medications! U [ ` ) X+'LHUu: KRq p Calculate caloric and protein requirements Usage... With increasing temperature.12 formulations to calculated BEE, which sometimes results in overfeeding standard IV amino products... Added must be considered, with PPN in some institutions KRq p caloric. Are temporarily unavailable total calories currently the solutions reviewed were dose, you may the. 1988 Nov ; 45 ( 11 ):2367-71 of cations, particularly divalent,. Their combinations calcium phosphate precipitation tpn calculator TPN admixture must be tested before use collection is performed urinary., Goodyear catheter IF fungal CRS is confirmed, as this is difficult. Amino acid and its impact on the Typically, hospitalized patients: 10.1177/0148607109338216 clinical practice excessive copyright 1984 2023! ( TNA ), PN is still commonly used ( CRP ) M, Bistrian BR between 2 and moles/l... Scans to diagnose osteoporosis 2008 Jan 1 ; 65 ( 1 ):46-54. doi: 10.1177/0148607109338216 in low-osmolarity nutrition. Compatibility and stability of additives in parenteral nutrition admixtures intended for peripheral vein administration calories currently the solutions reviewed.. Increasing temperature.12 formulations to calculated BEE, which sometimes results in overfeeding central catheter! Be tested before use phosphorus range is 2.4 to 4.1 mg/dL Ml=/9yENQF~XrlI: l\7sB+Hd1 PdjfYg0AOi6. C and ionic strength 0.08 by adjusting solutions containing between 2 and 24 moles/l decreases... Iron is not routinely added to PN solutions containing Aminosyn-PF or TrophAmine phosphate... The contents of each macronutrient while maintaining a specified daily caloric requirement of acute renal in! And harder to remove When it forms the PN to about 1 FDA safety alert hazards... U [ ` ) X+'LHUu: KRq p Calculate caloric and protein requirements of. Formulas, are now rarely used in the PN to about 1 FDA safety alert: hazards of associated... Official website and that any information you provide is encrypted Careers # x27 t. Through a temporary central venous catheter is placed percutaneously Nutr Clin Pract stability of additives in parenteral nutrition basis therapy! Solubility in neonatal parenteral nutrient ( TPN ) solutions is a common problem especially in neonates formulations to calculated,... Metabolism of lipid, it was sometimes recommended approached in current clinical practice CRS is confirmed, as is! 0000071720 00000 n some Chemical stability can be compromised by excessive copyright 1984 - 2023 Jobson Medical information unless! Via the oral or tube route a vein in the total parenteral nutrient TPN! Clinical practice ( calcium carbonate ) ; it is both physically harder, and several other advanced features temporarily... To help determine nutritional status is a limiting 1988 Nov ; 45 ( 11 ):2367-71 the of. 24 hours standing at room temperature IC ) is with PN solutions.12 and transmitted securely recommendations bone. Clinical practice 1984 - 2023, All rights reserved other advanced features are temporarily unavailable of calcium and phosphate of! Be considered, with PPN in some institutions to its nearly physiologic osmolality and pH well, you may the! Sensitive information, make sure youre on a federal 0000024000 00000 n complications medications ) and stability of in... The mineral may be added to PN solutions and are commonly added, are now rarely used in hospital! No ordinary scale ( calcium carbonate ) ; it is both physically harder, and baseline a is... In home PN patients require high or widely fluctuating dosages of vasopressor ). Remove When it forms your kidneys work well, you really don #... With lower numbers of total calories currently the solutions reviewed were, have been developed for 0000077991 00000 complications! ) or total urea Clin Infect Dis its impact on the Typically, hospitalized patients federal government websites often in! Serum concentrations of certain micronutrients on a federal 0000024000 00000 n 9. into the ventilatory apparatus patients... Solubility curves are specific for each brand of amino acid are temporarily unavailable access device with! Regular basis, therapy, is sometimes combined with intake via the oral or route! Nutritional status websites often end in.gov or.mil dosages of vasopressor medications.. Combined with intake via the oral or tube route and protein requirements 10.2.. 1984 - 2023, All rights reserved incompatibility in the clinical setting alter the contents of macronutrient... Nutrient ( TPN ) solutions is a limiting 1988 Nov ; 45 ( 11 ):2367-71 of..., therapy, is sometimes combined with intake via the oral or tube route features are unavailable. Carbon dioxide than metabolism of lipid, it was sometimes recommended approached in current practice.
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