背景：肠外营养（PN）液可来于自动装置混合配制的个体化处方或商业化预混溶液。我们医院曾经只用个体化处方PN，但由于氨基酸短缺，暂时转换为预混溶液。通常，对于器官功能正常患者，预混溶液所含电解质水平低于个体化配方。我们旨在量化静脉额外补充电解质（IVPB）对接受个体化配方和预混PN液成人患者的使用情况，同时量化其在治疗花费上的差异。

　　方法：我们对接受PN患者在氨基酸短缺前和短缺时经静脉补充电解质进行了对比。经IVPB补充的电解质：氯化钾，10和20mEq；硫酸镁，2g和4g；磷酸钾，7.5和15mmol；磷酸钠，7.5和15mmol。

　　结果：在各个阶段，每日PN配方差异无统计学意义（个体化比预混：14.7±3.9比14.0±2.6）。在预混PN阶段，每日获得的总IVPB电解质显著多于个体化PN阶段（7.03±3.8比13.8±6.8；P＜0.0001）。与接受个体化PN的患者相比，接受预混PN的患者由于补充额外的IVPB电解质而使其每30天需要额外花费11855.74美元。

　　结论：与使用个体化PN相比，使用预混PN导致IVPB电解质补充量和花费均显著增加。

JPEN J Parenter Enteral Nutr. 2015;39(5):586-90.

Use of Piggyback Electrolytes for Patients Receiving Individually Prescribed vs Premixed Parenteral Nutrition.

Busch RA, Curtis CS, Leverson GE, Kudsk KA.

University of Wisconsin School of Medicine and Public Health, Madison.

University of Wisconsin Hospital and Clinics, Madison.

Veteran Administration Surgical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.

BACKGROUND: Parenteral nutrition (PN) is available as individualized prescriptions frequently prepared with an automated compounding device or as commercially prepared premixed solutions. Our institution exclusively used individualized PN until an amino acid shortage forced a temporary switch to premixed solutions. In general, premixed solutions contain lower electrolyte levels than individualized formulations prescribed for patients with normal organ function. We aimed to quantify supplemental intravenous piggyback (IVPB) electrolyte use in adult patients receiving individualized and premixed PN and to quantify any effect on difference in the cost of therapy.

METHODS: We compared use of supplemental IVPB electrolytes administered to patients receiving PN during consecutive periods prior to and during the amino acid shortage. Electrolyte IVPBs tabulated were potassium chloride, 10 and 20 mEq; magnesium sulfate, 2 g and 4 g; potassium phosphate, 7.5 and 15 mmol; and sodium phosphate, 7.5 and 15 mmol IVPB.

RESULTS: There was no statistical difference in the number of PN formulations administered per day during each period (14.7 ± 3.9 vs 14.0 ± 2.6, individualized vs premixed, respectively). Total IVPB electrolytes prescribed per day increased significantly from the individualized PN period to the premixed PN period (7.03 ± 3.8 vs 13.8 ± 6.8; P < .0001). The additional IVPB electrolyte supplementation required in patients receiving premixed PN was associated with an additional $11,855.74 cost per 30 days of therapy compared with those who received individualized PN.

CONCLUSION: Inpatient use of premixed PN results in a significant increase in IVPB electrolyte supplementation and cost compared with individualized PN use.

KEYWORDS: nutrition; nutrition support practice; outcomes research/quality; parenteral formulas/compounding; parenteral nutrition; reimbursement

PMID: 24390715

PMCID: PMC4081483

DOI: 10.1177/0148607113518583