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Background and Importance In parenteral nutrition (PN), where precision and continuity are essential, shortages may have an immediate clinical impact. Automated compounding devices (ACD) ensure safety and traceability but are less flexible, increasing the risk of disruption.Aim and Objectives To analyse the decision making process regarding operational and therapeutic management of drug shortages affecting automated PN preparation, in order to support proactive and efficient future strategies.Material and Methods An observational, retrospective study (October 2022–September 2025) was carried out in a tertiary hospital. All incidents involving PN shortages elaborated by two ACD, one for the neonatal/paediatric and the other for adult population, were registered. Collected variables included logistic measures, prescription adjustments, and workflow changes in the robot compounding process.Results A total of 17 shortages of eight drugs were recorded. The affected products were calcium gluconate (n=4), adult (n=2) and paediatric amino acids (n=3), potassium acetate (n=3), vitamins (n=2), trace elements (n=1), magnesium sulfate (n=1), and glucose 70% (n=1). Shortages affected both populations, but in nine events the supply was conserved in neonatal/paediatric elaborations, and an alternative drug was looked for adult use due to specific excipient (aluminium in calcium) or concentration requirements (calcium, glucose 70%). Prescription algorithms and vademecum database changes were required in 76.5% and 52.9% of cases, respectively. Starter PN for neonates was affected by 29.4% of the shortages, and home PN by 35.3%. Robot parameter adjustments were necessary in 82.4% of cases. These included changes in product identification, vial density, codes, type of infusion line, recalibration of the flow factor by an external professional and new compounding configuration with the order of addition. Temporary manual compounding was required for adult PN (due to shortages of glucose 70%, paediatric amino acids and calcium gluconate), but not in neonatal/paediatric patients because stock was prioritised for them. Biochemical monitoring was performed for electrolyte alternatives to ensure equivalence, along with weight deviation analysis during processing for quality control.Conclusion and Relevance PN shortages have a magnified impact in automated compounding, demanding extensive pharmacist intervention to ensure continuity and safety. Our experience highlights the paradox of automation: while improving traceability and safety, it reduces adaptability, making PN services more vulnerable to supply disruptions.Conflict of Interest No conflict of interest