Table 1

BIFA recommendations

BIFA recommendations
1.All haematological and biochemical monitoring of HPN patients should be individualised and may change with their clinical condition. The point at which patients become stable post discharge will vary.
2.Routine blood tests, including standard electrolytes, chloride, bicarbonate (as a measure of acid–base balance), calcium, magnesium, phosphate, renal and liver function tests, glucose, full blood count, ferritin and CRP should be performed monthly for the first 3 months after discharge. If stable this may then be 3–4 monthly.
3.When discharged patients should have their prothrombin time, cholesterol and triglyceride, haemoglobin A1c (HbA1c), vitamin D and B12 and folate concentrations checked. These should then be monitored at least 6 monthly.
4.Patients who are to receive long-term HPN should have baseline vitamins A and E, zinc, copper, manganese and selenium concentrations checked and then monitored 6-monthly.
5.If the CRP is significantly raised (>20 mg/L) iron can be measured with transferrin and transferrin saturation to assist interpretation of iron status. In this situation, care must be taken in the interpretation of zinc, copper, selenium and vitamins A, D and E in view of their inflammatory response.
6.When measuring zinc, copper, manganese or selenium use a trace element-free collection tube.
7.If the triglyceride concentration is elevated a fasting concentration should be repeated.
8.Urine sodium concentration is useful for assessing sodium balance in patients with a short bowel and a 24-hour urinary oxalate collection for assessing risk of renal stone formation in patients with a short bowel and colon in continuity.
  • BIFA, British Intestinal Failure Alliance; CRP, C-reactive protein; HPN, home parenteral nutrition.