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