Hakeam Hakeam, Alsemari Muhannad, Mohamed Gamal, Alshahrani Asma, Islami Muna
Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Alfaisal University, Riyadh, Saudi Arabia.
Hosp Pharm. 2023 Jun;58(3):263-271. doi: 10.1177/00185787221133711. Epub 2022 Nov 13.
Multi-chamber bag with electrolytes (MCB-E) parenteral nutrition (PN) formulations are gaining acceptance for nutritional support for safety and economic advantages. However, their use is hampered by serum electrolyte abnormalities. No data exist regarding MCB-E PN interruption due to high serum electrolyte levels. We assessed the rate of MCB-E PN discontinuation in surgical patients secondary to persistently high serum electrolyte levels. This prospective, cohort study included surgical patients (aged ≥18 years) who received MCB-E PN at King Faisal Specialist Hospital and Research Centre-Riyadh, from February 28, 2020, until August 30, 2021. Patients were followed for 30-day for the discontinuation of MCB-E PN secondary to persistent hyperphosphatemia, hyperkalemia, hypermagnesemia, or hypernatremia for two consecutive days. The association of discontinuing MCB-E PN with various factors was assessed using univariable and multivariable Poisson regression analysis. Seventy-two patients were enrolled in the study, 55 (76.4%) completed MCB-E PN, whereas 17 (23.6%) patients discontinued MCB-E PN due to a persistent hyperphosphatemia (n = 13, 18%) and persistent hyperkalemia (n = 4, 5.5%). Hyperphosphatemia and hyperkalemia were observed at a median of 9 (IQR 6-15) days and 9.5 (IQR 7-12) days of MCB-E PN support, respectively. According to adjusted multivariable analysis, developing an episode of hyperphosphatemia or hyperkalemia was associated with MCB-E PN discontinuation (RR 6.62, 1.95-22.49; = .002) and (RR 4.73, 1.30-17.24; = .018), respectively. In surgical patients receiving short-term MCB-E PN, developing hyperphosphatemia was the most frequent high electrolyte abnormality assocaited with MCB-E PN discontinuation, followed by hyperkalemia.
含电解质的多腔袋式肠外营养（MCB-E）制剂因其安全性和经济优势在营养支持方面越来越被认可。然而，血清电解质异常阻碍了它们的使用。目前尚无关于因血清电解质水平过高而中断MCB-E肠外营养的数据。我们评估了手术患者中因血清电解质水平持续过高而停用MCB-E肠外营养的发生率。这项前瞻性队列研究纳入了2020年2月28日至2021年8月30日期间在利雅得法赫德国王专科医院和研究中心接受MCB-E肠外营养的手术患者（年龄≥18岁）。对患者进行了30天的随访，观察因持续性高磷血症、高钾血症、高镁血症或高钠血症导致连续两天停用MCB-E肠外营养的情况。使用单变量和多变量泊松回归分析评估停用MCB-E肠外营养与各种因素的关联。72名患者纳入研究，55名（76.4%）完成了MCB-E肠外营养，而17名（23.6%）患者因持续性高磷血症（n = 13，18%）和持续性高钾血症（n = 4，5.5%）停用了MCB-E肠外营养。高磷血症和高钾血症分别在MCB-E肠外营养支持的中位数9（四分位间距6 - 15）天和9.5（四分位间距7 - 12）天被观察到。根据校正后的多变量分析，发生高磷血症或高钾血症发作分别与停用MCB-E肠外营养相关（风险比6.62，1.95 - 22.49；P = 0.002）和（风险比4.73，1.30 - 17.24；P = 0.018）。在接受短期MCB-E肠外营养的手术患者中，发生高磷血症是与停用MCB-E肠外营养相关的最常见的高电解质异常，其次是高钾血症。
