Abstract

CARDONA-PERA, Daniel. XIII Lesson Jesús Culebras. Hospital pharmacists and nutritional support. From the beginning to the present day (1976-2018). Nutr. Hosp. [online]. 2023, vol.40, n.1, pp.200-212.  Epub Apr 17, 2023. ISSN 1699-5198.  https://dx.doi.org/10.20960/nh.04574.

Hospital pharmacists have been, since the 1970s, active members in nutritional support commissions [parenteral nutrition (PN) and enteral nutrition (EN)] in our hospitals, mainly in the context of sterile preparation of PN components. This presentation is an attempt to explain their role in this 42-year journey.

Without any doubt, a quality leap in pharmaceutical quality regarding PN was the step from preparation in individual vials to “all-in-one” admixtures, thereby reducing catheter infections as a result of less handling. This entailed physical-chemical studies of stability of lipid emulsions since particles ≥ 5 microns produce obstruction and lipid accumulation in pulmonary arterioles. We studied the “all-in-one” emulsions that masked a possible precipitation of inorganic phosphates with calcium-phosphate salts, which could cause microvascular pulmonary embolism. Finally, we investigated how to carry out a microbiological control of our daily preparations.

In the 1980s there was an increase in PN requests. In order to reduce preparation workload some hospitals rented external catering services whereas others rationalized the indications, supported by the enteral nutrition boom where some indications for PN changed to EN.

Three events occurred in the 1990s. First, due to an increase in PN preparations, the pharmaceutical industry designed three-chamber bags. Second, studies on hospital malnutrition were launched after verifying that malnutrition increased surgical and medical complications. Finally, the Order of June 2, 1987 regulated home enteral nutrition (HEN).

Actually, this Order was an important step to regulate HEN. However, except for the autonomous communities of Galicia and Catalonia, there was regression in the knowledge of EN among the pharmacists responsible for nutrition. As a result, since 1996 endocrinologists are the clinicians who guide HEN diets in Spain. At the same time, in the 2 aforementioned communities pharmacy departments remained responsible for HEN. Of note, pharmacy departments all over Spain contributed to develop guidelines on drug administration through nasogastric tubes and ostomies.

The newly arrived dietitians in nutritional support teams asked pharmacists for drug-food interactions at the pharmacokinetic level (absorption, metabolization, etc.).

In the first decade of the new century, the growth of patients who were candidates for PN continued. One possible cause is that older patients are increasingly being operated on. Hospital pharmacists are looking for a new identity, and we dedicate our efforts to PN drug stability. At the clinical level we followed the first patients with short bowel, since they were “a bit abandoned” in their follow-up.

In the last 10 years we have intensified our work for patients with short bowel with home parenteral nutrition (HPN), but above all in the control of ileostomies after suture failure. Also, we brought order to the drugs that are stable for PN and in “Y” with it. We also started pharmacokinetics studies in the administration of drugs in different surgical situations: bariatric surgery, total gastrectomy, etc.

In the future we will continue to ask questions about how can we improve nutritional support for our patients.

Keywords : Parenteral nutrition preparation; A history of nutritional support; Three-chamber bags; Home enteral nutrition; Drug-nutrient treatment of ileostomies.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )