Impact of pharmacist-led electrolyte management on inpatient parenteral nutrition: A retrospective cohort study

Purpose Parenteral nutrition is often initiated for patients who are unable to meet enteral nutritional needs to avoid complications associated with nutritional and electrolyte deficiencies. Electrolyte abnormalities frequently persist despite intravenous administration of micronutrients. There is a paucity of literature demonstrating the effects pharmacists have on electrolyte management for patients receiving parenteral nutrition. Methods This was a single-center, retrospective cohort study aiming to evaluate the effect of pharmacist-led electrolyte management on inpatient parenteral nutrition outcomes. The intervention group encompassed patients who received inpatient parenteral nutrition on or after January 1, 2022, when pharmacists were managing electrolyte additives for parenteral nutrition. The control group encompassed patients who received parenteral nutrition before November 1, 2021, who were managed by dietitians or physicians. The primary outcome was a composite of the percentage of abnormal sodium, potassium, chloride, magnesium, and phosphorous laboratory values. Results Sixty-four patient encounters were included in both groups. The results showed a significant reduction in the proportion of abnormal electrolyte values favoring the intervention group (13.3% vs 24.2%; P < 0.0001). Additionally, pharmacist involvement led to more frequent electrolyte repletion when necessary (16.4% vs 11.2%; P = 0.0151) and an absence of critical electrolyte values (0% vs 0.3%; P = 0.0183). No significant differences were observed with hospital length of stay, parenteral nutrition duration, cardiac adverse events, or mortality. Conclusion Pharmacist-led electrolyte ordering in parenteral nutrition was associated with substantially fewer electrolyte abnormalities but no difference in arrhythmias, deaths, or hospital length of stay. Further research is needed to explore electrolyte-relevant outcomes for patients receiving parenteral nutrition.