Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA.
Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
JPEN J Parenter Enteral Nutr. 2023 Nov;47(8):1021-1027. doi: 10.1002/jpen.2562. Epub 2023 Oct 6.
Use of dextrose-containing maintenance fluids prior to parenteral nutrition (PN) initiation is speculated to reduce the risk for refeeding syndrome. We aimed to assess if the use of dextrose vs nondextrose maintenance fluids before PN initiation changes electrolyte supplementation requirements and shifts during initiation.
This retrospective cohort study included patients who received nothing by mouth but received maintenance fluids ≥72 h before PN. The major end point was phosphorus supplementation over 48 h following nutrition initiation. Minor end point included other electrolyte supplementation, changes in electrolyte levels, time to discharge, and goal kilocalories per day.
Fifty-three patients between August 1, 2019, and August 26, 2020, met criteria for analysis; 60% (n = 32) used a dextrose and 40% (n = 21) used a nondextrose maintenance fluid. Baseline characteristics were similar between fluid groups except for body mass index (25.1 dextrose vs 27.5 kg/m nondextrose), sex (43.8% female vs 52.4% male), and severe malnutrition (46.9% vs 28.6%), respectively. Phosphorus (52.5 vs 50 mmol; P = 0.33) and magnesium (24 vs 22 g; P = 0.63) supplementation 48 h following nutrition initiation were similar between groups; however, potassium supplementation was lower in the dextrose group (165.0 vs 208.7 mEq; P = 0.01). No difference was observed between groups for time to discharge following nutrition initiation or time to goal kilocalories per day. After controlling for patients who were malnourished between fluid groups using linear regression, phosphorus repletion differences remained nonsignificant.
This study did not detect a difference in phosphorus supplementation between groups, even after controlling for patients who were malnourished.
在开始肠外营养（PN）之前使用含葡萄糖的维持液被推测可以降低再喂养综合征的风险。我们旨在评估在开始 PN 之前使用葡萄糖与非葡萄糖维持液是否会改变电解质补充的需求并在开始时发生变化。
这项回顾性队列研究纳入了仅接受维持液但在 PN 前至少 72 小时未进食的患者。主要终点是营养开始后 48 小时内磷的补充量。次要终点包括其他电解质的补充、电解质水平的变化、出院时间和每天的目标千卡数。
2019 年 8 月 1 日至 2020 年 8 月 26 日期间，共有 53 名患者符合分析标准；60%（n=32）使用葡萄糖，40%（n=21）使用非葡萄糖维持液。两组间的基线特征相似，除了体质量指数（葡萄糖组 25.1kg/m2，非葡萄糖组 27.5kg/m2）、性别（女性占 43.8%，男性占 52.4%）和严重营养不良（46.9% vs 28.6%）。营养开始后 48 小时内磷（52.5mmol 对 50mmol；P=0.33）和镁（24g 对 22g；P=0.63）的补充量相似，但葡萄糖组的钾补充量较低（165.0mEq 对 208.7mEq；P=0.01）。两组在营养开始后出院时间或达到每天目标千卡数的时间方面无差异。在校正了两组间存在营养不良的患者后，用线性回归分析磷补充量的差异仍无统计学意义。
即使在校正了两组间存在营养不良的患者后，本研究仍未发现两组间磷补充量有差异。
