1. Nutrition Shortages in a Large Academic Hospital Caitlin Curtis, PharmD, BCNSP

2. Objectives Identify appropriate patient populations for premixed parenteral nutrition Describe alternates for intravenous fluids Identify ways to spare intravenous phosphate List options for intravenous trace elements during shortages

3. Question # 1 Is there a role for premixed parenteral nutrition?

4. Question # 2 How has your institution dealt with the intravenous fluid shortage?

5. Question # 3 How does an institution go about decreasing intravenous phosphate usage?

6. Question # 4 Is the European trace element product compatible with the United States parenteral nutrition components?

7. Question # 5 How does one choose an oral “trace element” to use for the formulary?

8. References 1.Kweder S, and Dill S. Drug shortages: The cycle of quantity and quality. Clinical Pharmacology and Therapeutics. 2013:245-251. 2.Busch R, Curtis C, and Kudsk K. Use of piggyback electrolytes for patients receiving individually prescribed vs premixed parenteral nutrition. JPEN J Parenter Enteral Nutr. 2014. published online. DOI.10.1177/0148607113518583. 3.http://www.ashp.org/DocLibrary/Policy/Conservation-Strategies-for-IV- Fluids.pdfhttp://www.ashp.org/DocLibrary/Policy/Conservation-Strategies-for-IV- Fluids.pdf 4.http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Pr actice_Library/Parenteral_Nutrition_Trace_Element_Product_Shortage_ Considerationshttp://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Pr actice_Library/Parenteral_Nutrition_Trace_Element_Product_Shortage_ Considerations 5.A.S.P.E.N. Clinical Practice Committee and Nutrition Product Shortage Subcommittee. Intravenous Trace Element Shortage Survey Report, June 2014.

9. References http://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM3553 92.pdf (Fresenius Kabi “Dear Healthcare Professional” letter comparing trace element profiles between European and USA productshttp://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM3553 92.pdf http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Prac tice_Library/Parenteral_Nutrition_Electrolyte_and_Mineral_Product_Shortag e_Considerationshttp://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Prac tice_Library/Parenteral_Nutrition_Electrolyte_and_Mineral_Product_Shortag e_Considerations Clark C, Sacks G, and Dickerson R. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med. 1995; 23:1504-11.