Endocrine Abstracts

Introduction: Parenteral nutrition (PN) is indicated in patients in which gastrointestinal tract is inaccessible or is severely affected. In our hospital, specialists often use commercial three-compartment bags of PN that provide standard nutritional requirements regardless a total parenteral nutrition (TPN) with macro and micronutrients adjusted to each patient by Endocrinology and Nutrition Service.

Objectives: To assess the use of commercial premixed PN with respect to TPN with adequate daily requirements.Material and Methods: Cross-sectional study carried out during four months in patients who are treated with commercial premixed PN in our hospital. Pharmacy provided us the list of patients treated with that preparations. We collected the following variables: who indicates it, reason, duration, degree of malnutrition, monitoring performed and decision after our evaluation.

Results: Data from 104 patients were analyzed, 63% men. Average age: 63.5±16.8 years. Reason for hospitalization: 58.8% elective surgery, emergency surgery 20.5% and 20.5% others. Reason to start commercial PN: 39.6% postoperative ileus, need of intestinal rest 36.6% and obstruction 6.9%.Our performance was accomplished by specialist interconsultation in 66.7% and the rest was for listing of Pharmacy (not advised by their attending physician).Mean time with commercial PN: 2.4±2.1 days; 1.97 days in patients with interconsultation specialist vs 3.5 days when we were advised by Pharmacy (P=0.001). 37.9% had moderate malnutrition and 35.6% had severe malnutrition.Commercial PN covered calories requirements in 21.1% and protein requirements in 5.6%. 22.8% had no indication of PN. 46.9% of the prescribed commercial PN advised by pharmacy were wrongly indicated vs 9% of commercial PN advised by interconsultation After our evaluation: 70.3% were changed to TPN and 19.8% were suspended.

Conclusion: Despite the availability of a Endocrinology and Nutrition Service, there are a high percentage of patients who are administered commercial premixed PN without adequate indication and a high percentage of patientsin which daily nutritional requirements are not warranted and need an individualized parenteral nutrition.

(P=0.001)

After our evaluation: 70.3% were changed to TPN and 19.8% were suspended.

Conclusion: Despite the availability of a Nutrition Service, there are a high percentage of patients who are administered commercial premixed PN without adequate indication and a high percentage of patientsin which daily nutritional requirements are not warranted and need an individualized parenteral nutrition.