Total Parenteral Nutrition Prescriptions Research Articles

Trends in megestrol acetate prescription among Korean patients with biliary-pancreatic cancer and their impact.

85 Background: Chemotherapy-induced anorexia poses a significant challenge for cancer patients, particularly in biliary tract cancer (BTC) and pancreatic ductal adenocarcinoma (PDAC), known for their poor response to treatment. Megestrol acetate (MA), a commonly prescribed appetite stimulant, is associated with concerns regarding thrombosis and polypharmacy. Understanding the trends in MA prescription and its cascade effects is essential for optimizing cancer care. Methods: We conducted a retrospective cohort study using data from the Health Insurance and Review Assessment Service (HIRA) database in South Korea. The study included patients diagnosed with BTC and PDAC between 2008 and 2017. Prescription trends for MA, thrombosis events, anticoagulant prescriptions, and total parenteral nutrition (TPN) were analyzed. Statistical analysis included Chi-square tests and Kaplan-Meier estimates. Results: In our analysis of 41,670 patients with BTC and PDAC between 2008 and 2017, MA prescriptions increased notably, with PDAC patients rising from 7.85% to 51.84%. TPN prescriptions remained consistently high, especially among patients prescribed MA. For instance, in 2008, 94.71% of BTC patients prescribed MA received TPN, compared to 70.34% without MA. Similarly, in 2017, 87.56% of those prescribed MA received TPN, compared to 61.63% without MA. Among BTC patients with long-term MA prescriptions, 16.34% received anticoagulants, compared to 4.92% without MA (p<0.001). Among PDAC patients, 18.3% with long-term MA prescriptions received anticoagulants, compared to 7.12% without MA (p<0.001). Conclusions: The study highlights the escalating trend in MA prescriptions among BTC and PDAC patients, along with increased thrombosis diagnoses and anticoagulant prescriptions. These findings underscore the importance of understanding and managing the cascade effects of MA use and associated polypharmacy in optimizing cancer care and improving patient outcomes.

Pharmacist-led standardization of total parenteral nutrition improves postoperative nutritional status in colorectal cancer patients.

BackgroundTotal parenteral nutrition (TPN) is an essential treatment for patients who undergo abdominal surgery. Due to the gap of knowledge background between clinicians and pharmacists, the participation of the latter may improve TPN standardization. However, the impact on clinical outcome is unknown. In this study, we evaluated the impact of appropriacy and efficacy of TPN prescription, after a pharmacist-led TPN standardization program introduced.MethodsA pharmacist-led TPN standardization program was introduced in the Zhejiang Cancer Hospital and the clinical outcomes were assessed. The TPN standardization program includes a pre-established standard multidisciplinary evaluation standard, a computerized TPN management system and regular evaluations of TPN prescription performed by pharmacists. Any concerns were identified and improved via discussed with doctors. To evaluate the effect of pharmacists’ intervention in nutritional status and postoperative complications, an observational before-and-after cohort study was performed. All patients admitted in hospital with colorectal cancer (CRC) and receiving abdominal surgery in June 2019 (pre-intervention cohort) and June 2020 (post-intervention cohort) were retrospectively analyzed. Nutritional status of patients was evaluated using the levels of postoperative serum albumin, prealbumin, total protein, and their decrease extent. Surgical or TPN-related complications and recovery time were collated as the clinical outcomes.ResultsThere were no significant differences in the basic clinical information of the two cohorts, suggesting that the two groups are comparable. The average postoperative prealbumin levels were elevated in 2020 compared to 2019 (192.3±5.5 mg/L for 2019 and 229.5±4.8 mg/L for 2020, P<0.001). In addition, the post-intervention cohort showed a lower postoperative infection rate (11.6% vs. 18.2%), shorter duration of infection (9.4±1.4 vs. 7.7±1.0 days), lower incidence of postoperative albumin decrease (25.2% vs. 76.7%), prealbumin decrease (71.5% vs. 78.9%), and total protein decrease (25.2% vs. 72.2%), and lower incidence of TPN-related hypoglycemia (5.4% vs. 15.3%).ConclusionsPharmacist-led TPN standardization improved the postoperative clinical outcomes in patients with colorectal cancer (CRC).

Total Parenteral Nutrition Management Based on Intravenous Drug Compounding Service

Total parenteral nutrition treatment is complex and has serious and detrimental complications, including catheter-related blood stream infections, fluid and electrolyte imbalance, hyperglycemia and hypercalcemia. This research examines how Intravenous Drug Compounding Service (IDCS) figures in total parenteral nutrition prescriptions reviewed by pharmacists, strengthens hospital clinical care and improves patients&amp;rsquo; health. For this study, a total of 56164 nutritional prescriptions or medical orders from a hospital in Guangdong from 2016 to 2020 were randomly selected. According to whether IDCS was administered, the patients were divided into two experimental groups: the intervention group and the control group. The types and numbers of irrational prescriptions in the two groups were analyzed and compared, and further analysis of the role of IDCS in improving the level of nutritional prescriptions was performed. The results showed that the rate of irrational prescriptions in the intervention group from 2016 to 2020 was significantly lower than that in the control group, and the difference was statistically significant (P&amp;lt;0.01). The total irrational prescription rate in the intervention group was 32.53‱ on average, which was significantly lower than the 156‱ in the control group. The difference was statistically significant (P&amp;lt;0.01). After the administration of IDCS, the incidence rates of both total prescription errors and formulation errors were significantly lower than the incidence rate of irrational prescriptions without pharmacists&amp;rsquo; intervention. The study confirms the importance and necessity of IDCS, so that patients can receive more efficient nutrition and health management services.

Dosing errors in total parenteral nutrition prescriptions at a specialized cancer care hospital of Lahore: The role of clinical pharmacist

To determine the role of pharmacist in identifying the frequency of errors in total parenteral nutrition prescriptions in cancer patients for the years 2015 and 2016. Total parenteral nutrition has a high potential for medical errors because of its complex composition, thus leading to severe complications. Pharmacist review of the prescriptions reduces the risk of inappropriate prescribing, preparation, and administration of parenteral nutrition. An observational study was performed by collecting data of total parenteral nutrition prescriptions of 71 patients for the last two years from Pharmacy Department of specialized cancer care hospital. It was found that the frequency of dosing errors and incomplete prescriptions was higher in 2015 compared to 2016. Additionally, the frequency of macro and micronutrients dosing errors were higher in adults (23.4% and 66.2%) compared to pediatrics (14.6% and 46.6%). Furthermore, the frequency of illegible prescriptions was higher (5.03%) in year 2016 as compared to year 2015 (1.64%). Nevertheless, such dose interventions improved patient's weight (20%) and promoted enteral feeding (42.3%). Major complication was hypophosphatemia (39.4%) followed by hyperglycemia (10%) and catheter-induced infection, i.e. sepsis (4.2%). In conclusion, data suggested that pharmacist played instrumental role in identifying and rectifying total parenteral nutrition dosing errors for both micronutrients and macronutrients-with higher frequency in 2015 compared to 2016, leading to improvements in total parenteral nutrition-related complications and switches to enteral feeding.

Investigation on the utilization of parenteral nutrition preparations in 12 Hospitals of Jiangsu

Objective To investigate the use of parenteral nutrition preparations in Jiangsu Province, and to provide reference for the standardized management of parenteral nutrition preparations. Methods 720 cases using parenteral nutrition preparations from January 2017 to June 2017 in the department of general surgery of 12 hospitals in Jiangsu province were selected. The rate of nutritional risk screening, the indications of parenteral nutrition, the way of infusion, the rationality and economy of the prescriptions were retrospectively evaluated. The calorie, amino acid content, non-protein calorie/nitrogen ratio, glycolipid ratio and cation concentration of the patients received total parenteral nutrition were calculated. Results The total costs of parenteral nutrition preparations of 720 cases were 1.614 1 millions, and 346 cases did not have the indications for parenteral nutrition. The results of prescription comment showed that only 16 patients were screened for nutritional risk by Nutritional Risk Screening 2002 tool at admission. 544 cases were intravenous dripped with amino acid and fat emulsion from peripheral vein. In the 176 total parenteral nutrition prescriptions, there were 39 non-protein calorie/nitrogen ratio cases, 15 glycolipid ratio cases, 69 cation concentration cases, 61 calorie cases and 32 amino acid content cases failing to comply with the recommendation of the guidelines. Only 31 total parenteral nutrition prescriptions were completely reasonable. Conclusion The costs of parenteral nutrition preparations used in hospitals of Jiangsu are high but the rate of rationality is low. Nutrition support team should be established to regulate the use of parenteral nutrition preparations and save medical resources. Key words: Parenteral nutrition; Nutritional Risk Screening 2002; Nutritional risk screening; Nutrition support team

24 published papers from nutrition support pharmacist: a primitive review

Objective To understand the present situation and existing problems of the pharmaceutical care of Nutrition Support Pharmacists (NSP) in China and provide reference for pharmaceutical care of NSP. Method Literatures about pharmaceutical care from NSP were retrieved in domestic medical journals from January 2011 to January 2017, and totally 24 articles were analyzed and discussed. Result There were still many problems in NSP, such as the use of Nutritional Risk Screening, and the ratio of glucose/lipid ratio, ratio of non-protein energy to nitrogen ratio, the lack or excess of vitamin and trace elements and the use of insulin and propylene ammonia acyl glutamine in total parenteral nutrition prescription, TPN osmotic pressure and drip time, and the application of glucose and fat milk energy density. Conclusion The pharmaceutical care of NSP starts relatively late, there are still many problems, and the capacity and theoretical level of NSP need to be improved. Key words: Nutrition support pharmacists; Pharmaceutical care; Literature analysis; Total paren-teral nutrition

Impact of total parenteral nutrition standardization led by pharmacist on quality in postoperative patients with colorectal cancer

Background/objectivesAbdominal surgery significantly affects the structure and function of the gastrointestinal system of patients, total parenteral nutrition (TPN) is an important nutrition support method for postoperative patients. However, in the process of TPN practice, the excessive fat emulsion and compound amino-acid prescriptions ratio are often prescribed by doctors. To address the problem, we developed the computerized TPN prescription management system to promote the personalized provision of TPN. The purpose of this study is to evaluate the intervention effects of the computerized TPN prescription management system, which is designed by pharmacists in the Surgical Department of Abdominal Oncology at Zhejiang Cancer Hospital in July 2015.Subjects/methodsThe computerized TPN prescription management system applied in Surgical Department of Abdominal Oncology on 1 July 2015. The computerized TPN prescription management system was evaluated by comparing the patients who were treated 3 months after the application of the system with the control subjects who were treated 3 months prior to the application of TPN prescription management system in Surgical Department of Abdominal Oncology.ResultsIn total, 218 TPN prescription-treated patients with colorectal cancer received surgery treatment were analyzed, including 121 subjects who received the treatment 3 months prior to application of TPN prescription system (IPN period) and 97 subjects who received the treatment after 3 months of the system application (SPN period). The rates of optimized TPN prescriptions are 47.1% and 88.7% prior to and after application of TPN prescription review system, respectively (p < 0.001). In detail, prior to application of TPN prescription review system, abnormal glucose–lipid ratio and nitrogen–calorie ratio are the most common problems, which accounted for 74.3 and 97.9%, respectively (p < 0.01). Whereas the proportion of the insufficient dosage of amino acids is 62 and 96.9%, respectively (p < 0.01). Other problems are insufficient dosage of insulin and excessive fat soluble vitamin supplement. After application of TPN prescription review system, as the glucose–lipid ratio and nitrogen–calorie ratio are set up in fixed range according to the nutrition treatment guidelines, only a small amount of TPN prescriptions have the problem of insufficient dosage of compound amino acid. Furthermore, before and after the application of TPN management software, the gender, age, performance status (PS) score and BMI index of the two groups of colorectal cancer patients were not statistically different (p > 0.05). There were significant differences in albumin and prealbumin between the two groups after operation (p < 0.05), and there was a significant difference in total protein (p < 0.001). There were significant differences in alanine aminotransferase and indirect bilirubin between liver and kidney function (p < 0.01), and there were significant differences in aspartate aminotransferase and total bilirubin (p < 0.05). Other total cholesterol, l-γ-glutamyl transferase, direct bilirubin and creatinine were not statistically different (p > 0.05). Blood routine (WBC, Hb and lymphocyte), length of stay and recurrence rate were not statistically different (p > 0.05).ConclusionsThe application of TPN management software not only standardized the doctor’s TPN medical advice, but also improved the qualified rate of TPN doctor’s advice, thus ensuring the safety of the patient’s medication. It also had a positive effect on postoperative recovery of colorectal cancer patients, and ensured the efficacy of the treatment of patients. In addition, it reduced the workload of the pharmacist’s audit prescription and improved the efficiency of the audit prescription, and further emphasized the role and value of pharmacists.

Analysis of clinical effect of involvement of clinical pharmacists in perioperative total parenteral nutrition prescription for cancer patients

Objective To evaluate the effect of the intervention of involving clinical pharmacists in perioperative total parenteral nutrition (TPN) prescription, including rationality of prescriptions, the length of hospital stay and economic evaluation. Methods We respectively selected TPN prescriptions in September to November 2015 (pre-intervention) and December 2015 to February 2016 (post-intervention) from a surgery department of Harbin Medical University Cancer Hospital. The data regarding rationality of prescription, length of hospital stay, and economic benefit were analyzed in order to evaluate the effect of involvement of clinical pharmacists in TPN prescriptions. Results A total of 81 patients with 115 TPN prescriptions before the intervention and 92 patients with 124 TPN prescriptions after the intervention were recruited. Through comparative analysis, the rationality of TPN prescriptions increased significantly after the participation of clinical pharmacists in terms of the rational glucose: fat ratio, energy: nitrogen ratio, electrolyte concentration, and the choice of vitamin preparations; and the utilization of controversial treatments such as invert sugar and other drugs into ready-to-use TPN solution was decreased significantly; average daily cost of TPN was decreased from (1 021±218) yuan to (860±176) yuan (P 0.05). Compared with the data before the intervention, serum albumin levels after the intervention showed no statistically significant difference but pre-albumin levels were significantly higher after the participation of clinical pharmacists[(175.0±77.9)g/L vs.(153.2±64.8)g/L, P 0.05). Conclusion Engaging clinical pharmacists in TPN prescription can improve prescription rationality, ensure clinical drug safety, reduce the daily cost of nutrition treatment and thus reduce the economic burden of patients. Key words: Pharmacists; Parenteral nutrition; Inappropriate prescription; Intervention

中心静脈栄養 (TPN) 処方チェックリストを用いた薬剤師による患者モニタリング業務の有用性の評価

中心静脈栄養 (TPN) 処方チェックリストを用いた薬剤師による患者モニタリング業務の有用性の評価

Step towards Multiplatform Framework for Supporting Pediatric and Neonatology Care Unit Decision Process

Abstract Children are an especially vulnerable population, particularly in respect to drug administration. It is estimated that neonatal and pediatric patients are at least three times more vulnerable to damage due to adverse events and medication errors than adults are. With the development of this framework, it is intended the provision of a Clinical Decision Support System based on a prototype already tested in a real environment. The framework will include features such as preparation of Total Parenteral Nutrition prescriptions, table pediatric and neonatal emergency drugs, medical scales of morbidity and mortality, anthropometry percentiles (weight, length/height, head circumference and BMI), utilities for supporting medical decision on the treatment of neonatal jaundice and anemia and support for technical procedures and other calculators and widespread use tools. The solution in development means an extension of INTCare project. The main goal is to provide an approach to get the functionality at all times of clinical practice and outside the hospital environment for dissemination, education and simulation of hypothetical situations. The aim is also to develop an area for the study and analysis of information and extraction of knowledge from the data collected by the use of the system. This paper presents the architecture, their requirements and functionalities and a SWOT analysis of the solution proposed.

Audit of pharmacy TPN services on the neonatal intensive care unit (NICU)

<h3>Objective</h3> At The Whittington Hospital, pharmacy is responsible for providing a total parenteral nutrition (TPN) service to neonatal intensive care unit (NICU). The aims are to deliver a safe and beneficial service to patients, which is also cost-effective to the Trust. Neonatal TPN bags are manufactured off-site, and there are two main types of bag procured: Standard Stock Bags and Tailor-Made Bags. This audit was designed to investigate the management and delivery of TPN to NICU in the Trust over a 12-week period, focusing on the type of bag prescribed, usage and the expenditure. This in turn helped to determine new local standards of management with the aim of optimising the TPN service, with reduced costs and wastage. <h3>Methods</h3> Data was collected over 12-weeks (19 October 2009 to 8 January 2010) and expenditure calculated with pricing adapted from JAC and the Service Level Agreement held with external suppliers. <h3>Results</h3> Table 1 summarises the types and cost of bag used over the audit period and the number of which incurred wastage. Where there were differences in the TPN prescription compared to the standard formula, tailor-made bags were ordered. Table 2 summarises the main changes made. <h3>Conclusion</h3> Findings from the audit showed a high usage of tailor-made TPN compared to stock TPN, most of which were bespoke bags (bags with additions made to the standard stock formula). Since conducting the audit practice has been reviewed: a new stock order level has been put in place, in addition a new TPN prescription has been developed, which helps distinguish between the different bags available. Although TPN requirements are based on the individual patient, the audit suggests that the stock bag may need to be reviewed for a more favourable alternative (and in-line with the latest ESPGHAN recommendations). A re-audit is intended, where it is hoped that optimised management of the pharmacy TPN service to NICU will be demonstrated.

Total Parenteral Nutrition in the ICU

Malnutrition is seen commonly in critically ill patients and may contribute to overall morbidity and mortality. Total parenteral nutrition (TPN) is a specialized form of intravenous nutrition provided to patients with a nonfunctioning gut, malabsorption syndrome, or other indications that prevent enteral feeding. When used appropriately, TPN improves patient outcomes; however, inappropriate use can lead to infectious and metabolic complications. Dedicated multidisciplinary nutrition support teams (NSTs) improve patient safety and quality of care and can lead to tangible cost savings. This article describes indications for appropriate TPN use as developed by the Nutrition Care Committee of the Medical Board at Mount Sinai Hospital. The authors explain how to calculate goals for providing patient-specific nutrition, macronutrient and micronutrient compounding of the TPN formula, follow-up care, and the roles of indirect calorimetry and nitrogen balance. A sample TPN prescription and electronic nursing order set are provided.

How we managed total parenteral nutrition in our hospital in 2006–2007

Total parenteral nutrition (TPN) is an important supportive therapy for all the malnourished or at risk of malnutrition patients who meet the criteria set out in the national guideline. We analyzed and compared data for TPN administration, collected in the selected periods within 2 years. An audit in the 2006 resulted in the introduction of the proforma for TPN administration. A reudit in the 2007 aimed to assess the requirement for further changes including the introduction of Nutritional Support Team (NST). Many international studies confirm that managing parenteral nutrition by NST reduces line-related sepsis and episodes of inappropriate TPN administration. Data were collected retrospectively using a pharmacy-generated list of the all new TPN prescriptions. Thirty-one episodes of TPN administration were recorded between May and July 2007 and 53 episodes between January and May 2006. Information including demographics, duration and the person initiating TPN was collected for all cases (Table 1). A one-way analysis of variance test was used to look for statistical differences in the mean duration of TPN between two selected periods but there was no significant difference with a P value of 0.867.

Ergonomic and economic aspects of total parenteral nutrition

Ergonomics in total parenteral nutrition include the work performed in the (hospital) pharmacy and on the medical ward. This article reviews the developments in total parenteral nutrition ergonomics and the related cost-savings. Research focuses on the ergonomic advantages of multi-compartment total parenteral nutrition bags compared with the multi-bottle system, of multi versus single-layered total parenteral nutrition bags and of the presence of a nutritional team and training in clinical nutrition to improve regimen prescription and delivery. Three-compartment bags are safe, economic and ergonomic. It is important, however, to keep the knowledge of pharmacies to compound total parenteral nutrition for children and (adult) patients with specific pathologies. Research is ongoing in the development of bags with more than three compartments, to include for instance vitamins. This necessitates improvements in bag materials and wrapping. Progress can be made regarding total parenteral nutrition prescription and delivery, as well as in the incidence of related infections by promoting training in clinical nutrition and the implementation of a multidisciplinary nutritional support team.

徳島大学病院におけるＴＰＮ処方設計支援ソフトの使用評価と改良

Fluid therapy is a fundamental treatment for almost all inpatients, and nutritional therapy is the most important type of such therapy. Currently, total parenteral nutrition (TPN) is widely used to provide complete nutritional support but 30-40% of TPN recipients are considered to in a malnourished state due to inappropriate TPN prescriptions. Computer-assisted TPN prescription systems are thought to be useful to clinical professionals in solving this problem because they can perform complicated calculations that make it easy to draw up correct TPN prescriptions. So, we made a prototype system for aiding the preparation of TPN prescriptions based on Microsoft® EXCEL and it was tested by physicians, pharmacists, dietitians and nurses engaged in TPN therapy at Tokushima University Hospital. We also had them fill out a questionnaire on the system in which they rated it for ease of operation and usefulness according to a scoring system in which 5 indicated full marks.Our Computer-Assisted TPN Prescription System was improved on the basis of the questionnaire results and is now being effectively used by the nutrition support team (NST) in Tokushima University Hospital.

高カロリー輸液無菌調製における異物混入の原因に関する調査解析

Contamination of total parenteral nutrition (TPN) fluids is a problem occurring when preparing admixtures of them. In the present study, we carried out an investigation into the cause of contamination with a view to its prevention. For the TPN admixtures prepared in our pharmacy, we investigated the number prepared, their contents, the number that had contaminants and the nature of the contaminating substances. Contaminants were found in about 10% of the TPN admixtures and micro-infrared spectrophotometer analysis indicated that most of the contaminants were pieces of the rubber produced by coring. Further, an investigation of a correlation between TPN prescription contents and the incidence of contamination showed that the highest incidence of contamination occurred in preparations made by a particular pharmaceutical company. In order to prevent rubber particles from being produced, we need to be very careful when sticking the needle into the rubber stopper during the mixing of TPN admixtures. However as it is difficult to prevent contamination completely, we suggest checking TPN admixtures for contamination after mixing them and using in-line filters when they are administered to patients.

P0778 LONG TERM GROWTH CATCH-UP AFTER SMALL BOWEL TRANSPLANTATION FOR CONGENITAL MICROVILLUS INCLUSION DISEASE

Introduction: Congenital microvillus inclusion disease (CMID) causes serious watery diarrhea with nonspecific loss of ionic electrolytes, and the small bowel transplantation (SBTx) is indicated for this disease as an organic therapy. Here we report the long term follow-up of the growth of a case of CMID who had received the growth hormone (GH) therapy and underwent living-related SBTx. Methods: The patient is a 19-year-old boy. On the first day of birth he presented life-threatening dehydration and acidosis caused by severe watery diarrhea. At the age of two months, total parenteral nutrition (TPN) was introduced. Daily stool volume exceeded 2500 ml and extra-supply of NaCl, K+, and HCO3- was necessary. Almost totally depending on TPN, his growth had kept within normal range (height S.D. score: −2.0), but his growth rate after the age of 10 years declined. At the age of 11, he had a pathological bone fracture caused by phosphopenic rickets, and extra phosphorus was added to the TPN. Protein loss from intestine and hypoproteinemia were not seen. Results: At the age of 13, based on the diagnosis as GH deficiency, GH therapy was started, and initial pubertal signs appeared since 14 years old, but his growth rate was not improved (11 cm/2.7 yrs). At the age of 16 he received transplantation of an ileal graft (150 cm in length) from his grandmother. His histologically affected ileo-cecal valve and colon were reserved. At the time of transplantation his height S.D. score was -4.5. Postoperative immunosuppressive therapy consisted of a combination of tacrolimus, daclizumab, cyclophosphamide, and low-dose steroid. Thirteen months after the SBTx, free from TPN, he fed himself totally perorally, and GH therapy was restarted. After that his growth rate dramatically improved (19 cm/2.1 yrs, final height S.D. score: −2.2). Conclusion: The dramatic response of the growth to GH therapy after SBTx and establishment of peroral nutrition found in the case of CMID leads the following hypotheses: i) in CMID some growth-related factors may be lost from the affected small intestinal mucosa, ii) establishment of peroral feeding and the digestive and absorptive process from normal small intestinal mucosa may generate some growth-related factors which cannot be supplied by current TPN prescription.

Electronic parenteral and enteral nutrition.

With reports of deleterious effects of total parenteral nutrition (TPN) in adults in addition to our surveys, which indicated that 1/4, and as many as 1/2, of US academic medical centers were using excess glucose in TPN, our objective was to devise a computer program to optimize nutrients in parenteral and enteral nutrition in adult and pediatric patients. From review of the literature, body composition, including total body water and body cell mass (BCM), were calculated from large published databases. A computer program, based on a previous algorithm, was developed to determine optimum parenteral and enteral nutritional support, based on calculated BCM as the reference. Flexibility to permit any nutrients, in accordance with individual patient requirements, was included. With entry of simple anthropometric values and an average stress factor equivalent to 20% greater than the Harris-Benedict energy calculation, energy and nutrients were calculated for TPN as follows: amino acids, 3.4 g/kg BCM/d; carbohydrate, 12 g/kg BCM/d; and fat for remaining energy, usually 2.3 g/kg BCM/d. The program, available on any personal computer, is available using Netscape 3.0 or higher or from Microsoft Internet Explorer 4.0, at http://epen.kumc.edu. It permits rapid calculation and display of body composition values, a standardized TPN formula, an alternate TPN prescription, enteral nutrition options, a section that explains the calculations, and a list of references. The program, http://epen.kumc.edu, provides rapid definition of the TPN or enteral prescription for adult and pediatric patients, with reduced likelihood of providing excessive glucose and energy in parenteral or enteral nutrition.

Clinical effects and adequacy of a new all-in-one dextrose-electrolyte-trace element preparation in patients on prolonged TPN

We have devised a new all-in-one dextrose/electrolyste/trace element mixture (Polyfusor DY) and tested its efficacy in clinical practice. Polyfusor DY was designed to be combined with an amino-acid preparation and to be infused with lipid in a standard total parenteral nutrition (TPN) regimen. This standard regimen was formulated to provide minimum nitrogen, energy, fluid, electrolyte, vitamin and trace element requirements for the stable patient. The adequacy of currently recommended levels of provision of trace elements was tested in patients receiving long periods of intravenous nutrition. Eleven consecutive patients were fed from 13 to 280 days using TPN prescriptions based on this standard regimen. Two patients died but the nutritional state of the remainder improved. Serum concentrations of zinc, copper, chromium and manganese remained largely within or above the reference ranges, however the selenium content of Polyfusor DY (500 nmol/l) was marginally inadequate to maintain normal biochemistry. Pharmacy compounding time for the standard TPN regimen based on Polyfusor DY was 10.6 ± 0.19 min (mean ± SEM) compared with 22.5 ± 0.30 min for non-standard TPN regimens prescribed independently by other clinicians (P < 0.001). A standard TPN regimen based on Polyfusor DY was clinically effective, in particular giving generally adequate trace element provision with a reduction in pharmacy time and costs.

Reduction of total parenteral nutrition-induced urinary calcium loss by increasing the phosphorus in the total parenteral nutrition prescription.

Hypercalciuria and negative calcium balance are potential complications of total parenteral nutrition (TPN). Dietary phosphorus has been observed to have an hypocalciuretic effect. The present study evaluates the effects of administration of increasing intravenous phosphorus (P) loads on urinary calcium excretion in TPN patients. Urinary calcium exceeded daily calcium intake by 50 mg/d when 700 mg/d P was administered, was equal to intake at 1000 mg/d P, and was 30 mg/d less than calcium intake when 1300 mg/d P was given. These findings suggest that TPN-induced hypercalciuria can be attenuated in the short-term by intravenous phosphate. Reevaluation of the phosphorus requirement in patients receiving long-term TPN should be considered.