Nutrition Shortages in a Large Academic Hospital

Caitlin Curtis, PharmD, BCNSP

Objectives

• Identify appropriate patient populations for premixed parenteral nutrition

• Describe alternates for intravenous fluids

• Identify ways to spare intravenous phosphate

• List options for intravenous trace elements during shortages

Question # 1

• Is there a role for premixed parenteral nutrition?

Question # 2

• How has your institution dealt with the intravenous fluid shortage?

Question # 3

• How does an institution go about decreasing intravenous phosphate usage?

Question # 4

• Is the European trace element product compatible with the United States parenteral nutrition components?

Question # 5

• How does one choose an oral “trace element” to use for the formulary?

References

1. Kweder S, and Dill S. Drug shortages: The cycle of quantity and quality. Clinical Pharmacology and Therapeutics. 2013:245-251.

2. Busch R, Curtis C, and Kudsk K. Use of piggyback electrolytes for patients receiving individually prescribed vs premixed parenteral nutrition. JPEN J Parenter Enteral Nutr. 2014. published online. DOI.10.1177/0148607113518583.

3. http://www.ashp.org/DocLibrary/Policy/Conservation-Strategies-for-IV-Fluids.pdf

4. http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Practice_Library/Parenteral_Nutrition_Trace_Element_Product_Shortage_Considerations

5. A.S.P.E.N. Clinical Practice Committee and Nutrition Product Shortage Subcommittee. Intravenous Trace Element Shortage Survey Report, June 2014.

References

• http://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM355392.pdf (Fresenius Kabi “Dear Healthcare Professional” letter comparing trace element profiles between European and USA products

• http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Practice_Library/Parenteral_Nutrition_Electrolyte_and_Mineral_Product_Shortage_Considerations

• Clark C, Sacks G, and Dickerson R. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med. 1995; 23:1504-11.