Introduction The aim of parenteral nutrition (PN) is to meet the body’s needs while avoiding complications of deficiency and toxicity.1Trace elements (Cu, Zn, Se) play an important role in many of the body’s functions including metabolism, immunity and enzymes.1ESPGHAN/ ESPEN guidelines recommended that levels of trace elements should be checked at the commencement and frequently after starting PN.1Our aim was to review the current practice in our tertiary paediatric hospital.
Method In-patients receiving PN were identified from the pharmacy database. All records from patients receiving PN on two randomly allocated days in December and January were analysed for demographic data and diagnosis. From the laboratory database we looked for Zinc (Zn), Copper (Cu) and Selenium (Se) levels at the commencement and 4–8 weeks after starting PN. We excluded patients with no available data on the start of PN.
Results 72 patients receiving PN were identified on the two days. Data were available for 63 patients and 9 others were excluded as data was not available on starting PN. The 63 patients with available results were aged 1–16 years, median age of 4.5 years. 36 were males. Overall; Trace Elements (TE) were checked in 26/63 (41.2%) (Table1). TE results were available before or within one week of starting PN in 18/63 (28.5%). Thirteen had TE follow up. Table 3 shows the levels of TE within one week of starting PN and the follow up results. 5 patients had low initial Zn, Cu and Se. These were patients with Tufting enteropathy, early onset inflammatory bowel disease (IBD), one patient with IPEX, one patient with Intestinal obstruction and one with missing records. The latter two in addition to another patient with HLH also had low levels on follow up. Out of the whole cohort of 63, 27 (43%) patients have an underlying gastrointestinal disorder, 20 (74%) of whom had levels checked initially and 9 (33%) had levels done on follow up.
Conclusion Unfortunately determination of TE level is frequently missed in our institution. Although figures from the gastroenterology department were better than other departments, we recommended use of a proforma to be filled by the clinician before starting PN. We recommend TE to be checked at least once every 3 months for those with normal levels and once a month for those with low levels. A re-audit is planned later in the year.
Disclosure of interest None Declared.
Koletzko B, et al. J Pediatr Gastroenterol Nutr. 2005;41(Suppl 2)
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