Cimetidine and parenteral nutrition in the ICU patient

Cimetidine is often prescribed for hospitalized patients requiring intravenous nutritional support (ie, total parenteral nutrition). When administered parenterally, the drug may prevent excessive fluid and electrolyte loss in patients with short-bowel syndrome, particularly after resection. It may also help prevent anastomotic ulcers in patients following partial gastrectomy. In patients with hypersecretory disease or high-volume ostomy drainage, cimetidine is clinically useful in moderating secretions, thus reducing fluid and electrolyte loss. Cimetidine can prevent, and perhaps treat, metabolic alkalosis associated with significant losses of nasogastric aspirate. Intravenous administration of the drug to patients requiring nasogastric suction often eliminates the need for addition of hydrochloric acid to their parenteral nutrition admixtures. Cimetidine has been found to be physically compatible and chemically stable in crystalline amino acid/dextrose solutions and in crystalline amino acid/dextrose/lipid admixtures. As cimetidine is widely used in patients receiving total parenteral nutrition, it has become acceptable practice to deliver the drug via parenteral nutrition admixtures. Admixing the drug may be of particular advantage for patients with limited vascular access or for those who are fluid restricted. Cimetidine when given by continuous infusion may be more effective and require less drug per day than if administered via intermittent injection. Moreover, administration of cimetidine by continuous infusion to hyperalimentation patients has been documented to save the institution more than $22,000 a year in materials and labor costs.