title: Use of Piggyback Electrolytes for Patients Receiving Individually Prescribed vs Premixed Parenteral Nutrition.
abstract: 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.
  
  
  CONCLUSIONS
  Inpatient use of premixed PN results in a significant increase in IVPB electrolyte supplementation and cost compared with individualized PN use.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Busch
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Caitlin S
authors.initials: CS
authors.lastname: Curtis
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.affiliation: Veteran Administration Surgical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison kudsk@surgery.wisc.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kudsk
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage / Q000600:supply & distribution; D004573:Electrolytes / Q000008:administration & dosage* / Q000600:supply & distribution; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage; D010288:Parenteral Nutrition / Q000191:economics / Q000379:methods*; D057947:Parenteral Nutrition Solutions / Q000737:chemistry* / Q000191:economics; D010710:Phosphates / Q000008:administration & dosage; D011189:Potassium Chloride / Q000008:administration & dosage; D017680:Potassium Compounds / Q000008:administration & dosage; D055656:Prescriptions / Q000191:economics
chemical_list: D000596:Amino Acids; D004573:Electrolytes; D057947:Parenteral Nutrition Solutions; D010710:Phosphates; D017680:Potassium Compounds; D011189:Potassium Chloride; D008278:Magnesium Sulfate; C013216:potassium phosphate; C018279:sodium phosphate
keywords: nutrition; nutrition support practice; outcomes research/quality; parenteral formulas/compounding; parenteral nutrition; reimbursement