Gastroenterology & Nutrition | Parenteral Nutrition

Common Problems at Initiation of PN

The Most Common Problem

The most common problem is insufficient provision of energy due to fluid restriction mandated by disease state or by orders that specify gradual increases in dextrose concentration in PN solutions.

Biochemical Concerns

Hyperglycemia

If urine dipstick > 1+, then check blood glucose. If blood glucose > 250 mg/dl, then reduce dextrose infusion rate.

Hypoglycemia

Rare problem. May occur with interruption of PN in patients with marked undernutrition or severe liver disease with liver synthetic dysfunction. Restart glucose infusion promptly.

Hypophosphatemia

Measure serum phosphorus q d for 3 days in patients with marked undernutrition. Increase phosphorus content or decrease glucose infusion rate if serum phos < 1.

Unnecessary Precautions

Some authorities recommend gradual increases in amino acid concentration to reach eventual goals. These slow increases appear unnecessary since no known metabolic adaptations occur to alter metabolism of IV amino acids.