Background During the parenteral nutrition (PN) compounding process, medical prescriptions must be transcribed in the pharmacy department, where there is an increased risk of medication errors. Purpose To describe the implementation of the connection between the hospital prescription program and the PN compounding program. Materials and methods From November to December 2010, an explanatory document was prepared to cover all the products used in the preparation of PN for adult and paediatric patients and the calculations performed to convert the medical prescription in the units of volume for the PN preparation. A second document was developed to collect the data issued by the electronic prescription program (Prescriplant), patient information (history number, name, service, bed, and weight), prescription information (date, time, service, prescribing physician) and information on PN (total volume, nitrogen, glucose, lipids, sodium, potassium, phosphorus, magnesium, calcium, chloride, acetate, zinc, trace elements and vitamins). From January to February 2011, an external provider (Intercath) entered this information in the PN program of the MedicalOne®parenteral database and made the necessary adjustments so that the program could automatically calculate PN. Results The Prescriplant® program was connected with the MedicalOne®parenteral program. The PN was generated automatically in the MedicalOne®parenteral program using the information obtained from the Prescriplant® program according to previous indications. Tests were performed over a month to validate the calculations made by the program, both for adult and paediatric patients. The necessary adjustments were made, and the calculations that the program did not perform well were corrected. Conclusions Connection of the Prescriplant® program with the MedicalOne®parenteral program avoids manual transcription of the hospital pharmacist and simplifies the PN compounding process.

Background Glutamine is an amino acid with several functions. It acts as a precursor of protein synthesis, regulates the transport of nitrogen between organs and tissues, and is involved in active cell replication. Several studies have found a significant increase in albumin levels in patients receiving parenteral nutrition supplemented with glutamine. Purpose The aim of this study is to compare differences in blood albumin levels between patients receiving glutamine-supplemented parenteral nutrition and patients receiving non-supplemented parenteral nutrition. Materials and methods Observational study performed from 01/01/2010 to 31/12/2010. Study population: Surgical patients who started parenteral nutrition during the study period and whose blood albumin level had been assessed. Patients were divided into two groups: 1. Glutamine group: patients receiving parenteral nutrition supplemented with glutamine for 7 days. 2. Control group: patients receiving parenteral nutrition without glutamine supplement. The authors recorded blood albumin levels at the start of parenteral nutrition and after 7 days. The authors calculated the variation in albumin levels in both groups and applied the t test to identify significant differences between groups. Data were collected from the software used to prepare parenteral nutrition (Multicomp ®) and from the application used to record clinical laboratory data (IntraLAB ®). The statistical analysis was performed using SPSS ® version 15. Results The study group comprised 30 patients and the control group 30 patients. The mean increase in albumin level was 0.457 g/dl in the glutamine group and 0.180 g/dl in the control group (p=0.003). Conclusions The authors found statistically significant variations in albumin levels in favour of the group receiving glutamine-supplemented nutrition. Further controlled studies are needed to confirm this finding.

Background Administering parenteral nutrition to preterm infants in their first hours of life improves their survival. As it is not always possible for the pharmacy department to compound individual parenteral nutrition solutions, preparing a standard starter solution for preterm children to be administered within the first 24 h after birth was arranged with the Neonatology Department. Purpose To design and implement a standard starter solution of suitable composition and stability for preterm infants, as a means of meeting their nutritional requirements during their first hours of life. Materials and methods The authors performed a literature search to determine the nutritional requirements for neonates. In order to ensure a positive nitrogen balance and to avoid protein catabolism, adequate inputs of amino acids and glucose should be administered within the first hours of life in order to provide at least 4 g/kg/day of glucose and 1 g/kg/day of amino acids. Results A standard nutritional starter solution was prepared in syringes. Each syringe contained 52.5 ml of solution (+3.5 ml of purge) comprising 1.5 g of amino acids (15 ml Primene 10%) and 3.75 g of glucose (37.5 ml of 10% glucose), with an osmolarity of 629 mOsm/l (allowing either peripheral or central intravenous administration) and a total calorie input of 21 kcal per syringe (15 kcal were non-protein). The stability of the solution was 7 days at 2-8°C, as recommended in the literature. From February 2010 (implementation) until August 2011, 840 starting syringes were prepared in the pharmacy department. Conclusions This formulation makes it possible to meet the glucose and amino acid requirements for preterm neonates within their first 24 h of life, thus preventing excessive protein loss. Its long-term stability makes it possible to store it in the Neonatology Department, thus guaranteeing its availability at times when it is not possible to prepare a parenteral solution in the pharmacy department.

Background Alterations in laboratory parameters can be associated with adverse drug reactions (ADRs). Therefore, monitoring parameters may enable early detection and treatment of ADRs. Purpose To assess the association between laboratory parameters and ADRs in Internal Medicine at a tertiary hospital. Materials and methods Prospective observational study of hospitalised patients in a section of internal medicine department during February and March 2011. Every day, a pharmacist recorded drug prescriptions and the following parameters: Na, K, Ca, serum creatinine, glomerular filtration rate (GFR), INR, glucose, haemoglobin, platelets, ALT, AST, bilirubin, GGT, alkaline phosphatase, TSH, T4 and blood digoxin. The causal association between parameters outside the reference range and drugs was analysed using the modified Karch–Lasagna scale. Results 52 patients (65.4% men) were included; median age 74 years; median hospital stay 7 days. A mean of 2.94 parameters per patient were outside the reference range. An association with drugs was observed in 25.5% of patients. Reduction in GFR, 27.0% (associated with diuretics (41.7%), ACE inhibitors (33.3%), angiotensin II receptor blockers (ARB) (16.6%) and antidiabetics drugs (8.3%)); hypokalaemia, 22.6% (associated with diuretics (50.0%), fluid without potassium (37.5%) and salbutamol (12.5%)); hyperkalaemia, 14.5% (associated with ACE inhibitors (60.0%) and ARB (40.0%)); INR out of range, 10.8% (associated with interactions (66.7%)); hyperglycaemia, 8.4% (associated with corticosteroid (66.7%) and antidiabetic drugs (33.3%)); low blood digoxin during admission, 5.3%; and others, 10.8%. No ADRs led to prolonged hospital stay. In terms of causality, ADRs were classed as possible (52.9%), probable (44.1%) and definite (2.9%). Conclusions 25.5% of alterations in laboratory parameters were probably or possibly associated with drugs. The most common alterations were as follows: decrease in GFR associated with the use of diuretics, ACE inhibitors and ARB; hypokalaemia due to diuretics; and hyperkalaemia due to ACE inhibitors and ARB. There were no severe ADRs, as these were detected early.

No abstract