P797 - INCIDENCE OF REFEEDING SYNDROME IN PARENTERAL NUTRITION: IV VITAMINS B&C VS IV THIAMINE

P797

INCIDENCE OF REFEEDING SYNDROME IN PARENTERAL NUTRITION: IV VITAMINS B&C VS IV THIAMINE

D. J. Griffith^1,2,*, S. Ardouin^1,2, L. Moorfield^1,2, H. Malhi^2,3, A. Sangera^2,4, S. C. Cooper^2,5,6

¹Nutrition and Dietetics, ²Nutrition Support Team, ³Nutrition Nurses, ⁴Pharmacy, ⁵Department of Gastroenterology, University Hospitals Birmingham, ⁶School of Infection, Inflammation and Immunology, University of Birmingham, Birmingham, United Kingdom

Rationale: Pabrinex® contains vitamins B1 (thiamine), B2, B3, B6, and vitamin C. Pabrinex® shortages began mid-2024 and are ongoing. The British Pharmaceutical Nutrition Group and the British Association of Parenteral and Enteral Nutrition, amongst others, recommended intravenous (IV) thiamine alternatively, for parenteral nutrition (PN) patients at risk of refeeding syndrome (RFS). We aimed to assess whether incidence of RFS was affected due to this change in practice.

Methods: Data were collected retrospectively between 01/02/24 – 01/03/25. This included 6 months where PN patients at risk of RFS were prescribed IV Pabrinex® and 6 months where patients were prescribed IV thiamine instead. Potassium (K), magnesium (Mg), and phosphate (PO4) were collected at baseline and for 4 days after PN started. RFS was diagnosed if K, Mg or PO4 dropped below normal after PN began. The Chi-squared test compared incidence of RFS between groups. K, Mg, and PO4 data over 5 days were analysed using repeated measures analysis or Friedman tests (dependent on normality of distribution). This audit was registered with the local audit management system.

Results: 61% (86/141) vs 58% (36/62) of patients went into RFS after PN began, when prescribed Pabrinex® or IV thiamine, respectively. There was no significant difference between incidence of RFS in patients prescribed IV Pabrinex® or IV thiamine (p = 0.813). There was no significant change in K, Mg, or PO4 over 5 days whether prescribed IV Pabrinex® or IV thiamine (p = 0.66, p = 0.49, p = 0.26, respectively).

Conclusion: Use of IV Pabrinex® compared to IV thiamine does not affect RFS incidence in PN-fed patients. This has cost-saving implications as Pabrinex® is significantly more expensive than IV thiamine. The UK is the only region to use Pabrinex®, with thiamine being used elsewhere. IV thiamine could be an appropriate permanent change across the UK.

Disclosure of Interest: None declared