105: Pumping Up Our Patients With Intestinal Failure

Introduction: Children with short bowel syndrome (SBS) and intestinal failure (IF) require long-term parenteral support and are at high risk of electrolyte abnormalities and dehydration. We present a 6-year-old ex-34 week female with SBS-IF secondary to jejunoileal astresia, s/p small bowel resection, s/p STEP procedure, with poor weight gain, requiring intravenous fluids (IVF) and parenteral nutrition (PN) since birth. Patient’s anatomy is: 35cm small bowel, no ileocecal valve, full colon in continuity. She transferred to our hospital after multiple admissions to other hospitals with significant for metabolic acidosis (CO2 10 mmol/L), hypocalcemic clinical tetany (Calcium 7.4 mg/dL), and acute kidney injury in the setting of PN being discontinued for three months. Upon transfer to our hospital and after ongoing correction of her electrolytes and acidosis, she was discharged home on daily IVF with weekly monitoring of her electrolytes and IVF adjusted accordingly. She had ongoing electrolyte abnormalities at home including low potassium (range 3-3.6 mmol/L), CO2 (range 12-22 mmol/L), calcium (range 7.9-9.3 mg/dL) and magnesium (range 1.3-2.0) despite receiving large amounts of electrolytes and being increased weekly in her IVF and orally. Parent reported that she was eating well by mouth (regular diet + nutritional supplements) and complained about high urine output overnight. Parent denied any vomiting or diarrhea as well as any missed days of IVF. Stool tests for malabsorption were significant for fat malabsorption and severe pancreatic insufficiency and she was started on pancreatic enzymes. Urine electrolytes revealed high urine potassium suggesting renal loss and she was referred for renal evaluation. Previous renal evaluation had revealed no renal losses. The ongoing electrolyte abnormalities that did not respond to increases of electrolytes in her IVF led us to obtain pump reports to ensure the IVF was being run as ordered. Methods: Two pump reports at separate time intervals were obtained from the pump manufacturer through patient’s home care companies (two separate companies). The reports show dates and times the pump was accessed, turned on, turned off, and volume of fluid run through the pump daily. Results: The first pump report revealed that patient’s IVF were given for 14/22 days (63.6% compliance). Importance of compliance with daily IVF as ordered was reinforced with the patient’s parent. Despite this, the second pump report a few months later revealed that patient’s IVF were given for 2/81 days (2.5% compliance). Conclusion: When patients are demonstrating ongoing electrolyte abnormalities and/or unexplained poor weight gain that is not consistent with the electrolytes/calories being ordered in IVF/PN, pump reports can be useful to check compliance with IVF/PN administration. The utility of obtaining routine pump reports in patients on home IVF/PN to assess compliance needs to be further assessed in future studies.