Hypophosphatemia occurs with insulin administration during refeeding by total parenteral nutrition in rats

Refeeding syndrome (RFS) is characterized by the metabolic and clinical changes that occur following aggressive nutritional supplementation in malnourished patients. Hypophosphatemia is the hallmark of RFS and is key to its prevention and treatment in clinical practice. However, the mechanism of hypophosphatemia during RFS is unclear because of the lack of an animal model. In this study,we developed a rat RFS model as a first step to clarifying the molecular mechanism. After establishing the parenteral route, rats were fasted for 5 days and refeeding was started using total parenteral nutrition. The animals were infused with a high calorie solution with or without insulin administration. Results showed that plasma phosphate levels did not decrease in rats infused with the high calorie solution alone ; in contrast, a 20% reduction compared to baseline was observed in rats administered insulin. In addition, rats infused with the high calorie solution containing added phosphate did not present with hypophosphatemia. Thus, we developed a rat RFS model with hypophosphatemia by tube feeding and insulin administration, and demonstrated the importance of phosphate in preventing refeeding hypophosphatemia

処方入力時の体表面積をベースとした注射薬オーダ上限量警告システム

雑誌掲載版処方入力時の体表面積をベースにした注射薬オーダー上限量警告システムを構築し、稼動できたがシステムの有用性について検証した。2006年5月〜8月に注射薬処方の中から上限量警告システムにかかった事例をログファイルから抽出し、警告により処方量を通常使用量に変更した薬剤、警告により処方が変更又は中止された薬剤、警告を解除した薬剤の三つに分類して行った。調査期間中の処方注射薬件数は158300件で、上限量警告システムの警告件数は742件で全体の0.47%、1日当たり平均警告件数は6.9件、平均警告解除件数は5.4件であった。上限量を超えたオーダでは入力不可警告を表示し、処方が確定できないようにした。0.47%で中止を含めて実際に処方が変更された注射薬は処方件数の0.10%で、全警告件数の21.1%で、注射薬過量投与防止プログラムによる処方チェックは医療に一定限の安全性を保証していた