[Prescription and preparation of parenteral nutrition at Spanish hospitals]. / Prescripción y elaboración de nutrición parenteral en los hospitales españoles.

OBJECTIVE: To identify habits related to prescription and preparation of parenteral nutrition in Spain and their adequacy to current recommendations. METHOD: A questionnaire was administered in order to collect information about the characteristics of diets used at each hospital and the way they were prepared. The questionnaire was available through the web page of the Spanish Society of Hospital Pharmacy. RESULTS: Forty five hospitals answered the questionnaire. More than 90% of the hospitals reported that they used diets with a fixed or standard composition and 66.6% reported that they bought diets available in the market with a defined composition. Fifty seven point five per cent of the hospitals always prepared "all in one" parenteral nutrition and 37.5% prepared them only for adults. A 5% provided the lipids separately, both for adults and for children. Forty five per cent of the hospitals reported that they did not use organophosphates as source of phosphate. Almost 60% alternate the introduction of vitamins and trace elements. Differences were also found regarding the type of lipids provided and the use of filters. Most hospitals used multi-layer bags and photoprotection. CONCLUSIONS: There is quite a lot of diversity in the patterns of prescription and preparation of parenteral nutrition in our country. Further consensus documents should be written about these topics.

[Non-glucose carbohydrates in the parenteral nutrition of patients with systemic inflammatory response syndrome]. / Hidratos de carbono no-glucosa en la nutrición parenteral de pacientes con síndrome de respuesta inflamatoria sistémica.

OBJECTIVE: To compare tolerance of two sources of isocaloric intake (fructose-glucose-xylitol mixture [FGX] versus glucose) in parenteral nutrition for patients with systemic inflammatory response syndrome (SIRS). DESIGN: Open, prospective, cohort and randomized study. SETTING: Intensive Care Unit. SUBJECTS AND METHODS: Two groups of patients admitted in ICU: acute pneumonia with sepsis, and necro-hemorrhagic pancreatitis. Criteria of exclusion were: diabetes, previous hypertriglyceridemia, renal failure with serum creatinine > 3 mg/dL on admission in ICU, or hyperbilirrubinemia > 2.5 mg/dL. Parenteral nutrition (TPN), consisting of 1.4 g AA + Lipids 1.3 g + carbohydrates 4 g/kg/d, (either glucose or FGX at random) was administered. Basal levels and days 1st, 4th and 10th plasma glucose, triglycerides, cholesterol, uric acid were determined, and blood venous gases as well. Capillary glycemia was measured every 6 hours and insulin given if glucose levels rose above 180 mg/dL. STATISTICS: Fisher's exact test; Student t-test; Mann-Whitney test. Data as mean and SD. RESULTS AND CONCLUSIONS: During 48 months, 119 patients admitted in the ICU (72 with pneumonia and 47 with pancreatitis) were included. In pneumonia, tolerance was similar with both intakes; glycemia was kept at the same level in both, but the amount of insulin given was significantly more in those patients fed on glucose (p < 0.05). Nevertheless, resting blood glucose and triglyceride levels were higher in pancreatitic patients, and more insulin was required. Those on FGX had lower triglyceride plasma levels (p < 0.05) and less insulin was given throughout the study. Glycemia was kept lower though no statistical significance was reached (p < 0.1). No hyperuricemia nor lactic acidosis was found.

[Influence of foods on the absorption of antimicrobial agents]. / Influencia de los alimentos en la absorción de los antimicrobianos.

Understanding the interaction between foods and antimicrobial agents is an aspect of therapy which may have an important clinical repercussion, which is why it must not be forgotten. This study reviews the interactions of foods with the anti-microbial agents which occur at the level of absorption, considering the mechanisms involved. The food-drug interaction can cause an increase, a decrease, or a delay in the bio-availability of the anti-microbial agents; foods may have no affect on the absorption of the anti-microbial agents, or they may improve the gastrointestinal tolerance. The Food and Drug Administration's bioequivalency criteria for considering whether or not there is an alteration in absorption have an orientative function, as generally all studies are conducted on healthy volunteers, but in clinical practice one must consider the physiological and pathological condition of the patient. The composition of the diet as well as the volume of liquid administered are other aspects which should be considered, as these may exert a different effect depending on the type of drug. After ingesting fatty foods, there is an increased absorption of albendazole, griseofulvin, itraconazole, and mebendazole. All foods but especially carbohydrates reduce the absorption of isoniazide. Among the anti-HIV drugs, the following must be administered on an empty stomach: didanosine, indinavir zalcitabine , and zidovudine ; lamivudine can be administered either on an empty or on a full stomach, because although food delays the absorption, it does not affect the amount absorbed; the absorption of stavudine is not affected by foods; ritonavir should be administered together with tile meals, and saquinavir must be administered after ingestion of food. It is advisable to administer clarithromycin together with foods, and azythromycin on an empty stomach; the same holds true for perfloxacin and rifabutine as for lamivudine.

[Description of a computer program and results of its application to the follow up of enteral nutrition]. / Descripción de un programa informático y resultados de la aplicación del mismo al seguimiento de la nutrición enteral.

Computerization has been introduced little by little in the different activities which take place in a department of pharmacy, due to the fact that it means an increased agility of the tasks to be performed as well as an improvement of the care and managerial quality. In our hospital, the department of pharmacy makes up enteral nutrition units, and it participates in the follow up and control of the patients with this type of nutrition through a computer program designed for this purpose. The objective of the present study is to describe this computerized program as well as the results obtained by its application. The enteral nutrition computer program is made up of two data bases which are indexed between each other: that of daily follow up of the enteral nutrition prescriptions, and that of the follow up of the patients who have been given this nutritional support. In this way it allows us to obtain identification labels and consumption listings. During a two year period a total of 632 enteral nutrition treatments were given. The department with the greatest number of prescriptions was internal medicine (187, 29.5%). The polymeric diets were the most frequently used (435, 68.7%). The have mainly been used as a supplement to a hospital kitchen diet (149, 41.8%). The oral administration was the most frequent route of administration (331, 52.4%). The main reason for not implementing the nutrition was refusal by the patient (114, 38%). The computer program allows greater agility of the circuit which in our hospital generates the preparation of the enteral nutrition formulations, which are made up in the Department of Pharmacy, and given the large number of variables which this implies, this means a quality guarantee in the preparation and follow up of the patients with enteral nutrition.

[Metabolic role of glutamine and its importance in nutritional therapy]. / Papel metabólico de la glutamina y su importancia en la terapia nutricional.

The advances in the field of nutritional support have made certain nutrients very relevant, which, although they have been known for a long time, at present represent an important chapter in nutrition, entering into what is known as "nutritional pharmacology". Among these nutrients is glutamine, an amino acid classified as non-essential, but which in certain circumstances may become to be considered as an "essential nutrient". In the present review, a review is made of its metabolic role, synthesis and degradation, metabolic routes and functions under normal conditions as well as under critical conditions. It is known that glutamine stimulates the synthesis and inhibits the degradation of proteins, it is an important vehicle for the transport of nitrogen and carbon within the tissues, it stimulates the synthesis of hepatic glycogen, it is an energy source for cell division, for the growth of different cells of rapid replication, such as enterocytes, colonocytes, and fibroblasts, as well as for other cells of the immune system, such as lymphocytes and macrophages. Thus its role in the maintenance of structure, in metabolism and function of the intestinal mucosa, and in dysfunctions of the immune system. In parenteral nutrition, at present there are no preparations which include it, given the stability problems which it presents, although attempts have been made to resolve this, using different possibilities, such as di-peptides. However, in enteral nutrition, the diets tend to include it, although in a small proportion. Nevertheless, having recognized its beneficial role in a certain type of patients, at present there are diets which contain glutamine in higher doses, with the object of attempting to cover the increased demands of glutamine which shall arise in these situations. The inclusion of glutamine in nutritional therapy is supported by multiple studies which reflect the beneficial effect of this nutrient, both in enteral nutrition as in parenteral nutrition.

[Preparation of and stability studies on enteral modular diets at the Pharmacy Service]. / Elaboración y estudios de estabilidad de dietas modulares enterales en el Servicio de Farmacia.

It is generally admitted fact in daily medical practice in some patients who require to be fed artificially, the treatment must always be directed, whenever possible, through "enteral route". There are patients whose nutritional needs cannot adapt to the standardized diets available in the market. In these cases it is necessary to draw up individualized diets for them, planned derived from the modules. It is equally known that there is always a problem to obtain, at the available means in the pharmaceutical services, established modular diets. It is described in this report a method of planning a modular enteral diets, physic-chemically stable and contaminating bacteria free. It is also detailed the election of adequate emulsion and stabilizer and the final concentration of each of these in the diets of different composition quali and quantitatively.