Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran.Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations.Based on the patients' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support.In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals.Malnutrition is a common problem in hospitalized patients [1,2]. Surgical patients with malnutrition have around three times more postoperative complications and four times greater risk of death than well nourished patients with similar operations [3]. Metabolic support via parenteral nutrition (PN) has become an important intervention in a variety of medical and surgical conditions [4,5]. Although PN has improved patient outcomes, recent meta-analysis have raised questions about its safety and high rate of PN-associated complications [6]. Metabolic disturbances such as hyperglycemia, electrolyte abnormalities such as hypophosphatemia or hypokalemia, infection of PN catheters, liver dysfunction (presented as steatosis, steatohepatitis, cholestasis