DOES STANDARDISED PARENTERAL NUTRITION PROVIDE ADEQUATE ELECTROLYTES FOR CHILDREN ON PAEDIATRIC INTENSIVE CARE?.
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All Authors
Whiteley, S.
LTHT Author
Whiteley, Sarah
LTHT Department
Medicines Management & Pharmacy Services
Non Medic
Specialist Clinical Pharmacist
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Aim Standardised parenteral nutrition (PN) is preferred over bespoke PN as it eliminates many risks and requires less resource to produce.1 Children weighing 2.5 kg-5 kg typically receive Numeta G16 and children weighing 5-20 kg typically receive Numeta G192, both containing electrolytes at fixed quantities. This audit aims to discover if these two standardised bags provide adequate electrolytes for patients on paediatric intensive care (PICU). Patients on PICU have various underlying presentations that may affect their electrolyte requirement such as acute kidney injury, diuretic requirement, or tumour lysis syndrome. While the purpose of PN is to provide nutrition,2 electrolyte requirements can direct prescribing decisions regarding which PN regimen to choose. Method This is a retrospective audit whereby all patients managed with Numeta G16 or Numeta G19 while on PICU in 2023 were included in the study. As it is possible to give both enteral and intravenous (IV) electrolyte corrections of potassium, magnesium, calcium, phosphate and sodium on PICU,3 the total number of electrolyte corrections administered whilst on standardised PN, according to the medication chart, was recorded for each patient. Where a patient was switched from a standard bag to a bespoke regimen the reason for the switch was recorded. Results Sixteen patients prescribed Numeta G16 were included. One patient required no electrolyte corrections. Patient 16 was commenced on bespoke PN initially to prescribe without potassium or phosphate due to renal failure, but later changed to Numeta G16. Three patients had to change to bespoke PN: Patient 11 changed for additional sodium requirements; Patient 16 changed to reduced lipid PN; Patient 2 changed to bespoke but no reason was documented. Thirteen patients prescribed Numeta G19 were included. All patients required electrolyte corrections. Patient 7 was started on bespoke PN without potassium or phosphate due to renal failure, but later switched to Numeta G19. They were then switched back to bespoke PN due to requiring a high number of potassium corrections. Four other patients changed to bespoke PN: Patient 1 changed for increased potassium requirements and to manage high blood glucose levels; Patient 11 changed to an adult PN standard bag due to not enough volume in Numeta G19 to meet calorie requirements; Patient 12 changed to give more phosphate due to lack of adequate intravenous access and line time to run IV phosphate separately; Patient 5 changed to reduce calcium and lipid content. The most frequent electrolyte correction given was potassium. This may be due in part to most patients being managed on diuretics. The second most frequent was magnesium, with calcium and phosphate requiring relatively few corrections. Conclusion Most patients tolerated standardised PN with 5 out of 29 patients requiring a switch to bespoke PN for electrolyte management. This shows that from an electrolyte management standpoint, standard bags are suitable for most PICU patients where administration of electrolyte corrections is possible. Further auditing to compare these findings to PICU patients on enteral feeds and a similar study of non-PICU patients on PN where electrolyte corrections aren't as practical may be useful.
Journal
BMJ Paediatrics Open