Avoiding Patient Harm With Parenteral Nutrition During Electrolyte Shortages

Area of Science:

• Clinical Nutrition
• Metabolic Disorders
• Gastroenterology

Background:

• Gastrointestinal dysmotility and significant fluid losses necessitate parenteral nutrition (PN).
• Acetate salts are crucial PN additives for electrolyte and acid-base balance.
• Shortages of PN components can pose risks to patient management.

Purpose of the Study:

• To report a case of non-anion gap metabolic acidosis in a patient receiving PN due to an acetate salt shortage.
• To describe strategies used to manage severe metabolic complications during this PN component shortage.

Main Methods:

• A patient with gastrointestinal dysmotility requiring PN experienced significant drainage losses.
• PN was administered, and upon shortage of acetate salts, electrolytes were replaced with chloride and phosphate salts.
• Metabolic acidosis was managed with sodium bicarbonate and intravenous fluid adjustments (lactated Ringer's solution).

Main Results:

• The patient developed non-anion gap metabolic acidosis after 11 days of acetate-free PN.
• Acidemia progression was prevented through timely administration of sodium bicarbonate and fluid replacement.
• The patient's metabolic derangements were successfully managed despite the PN component shortage.

Conclusions:

• Parenteral nutrition component shortages necessitate vigilant patient monitoring.
• Creative therapeutic interventions are essential to prevent serious harm during PN supply disruptions.
• This case highlights the importance of adaptable clinical strategies in managing complex nutritional support.