Metabolic Complications of Long-Term Parenteral Nutrition
EXPERT INSIGHT
A comprehensive nutrition assessment and a periodic reassessment are necessary to ensure the PN prescription is appropriate for the patient’s current clinical status, personal goals, and lifestyle.
Glycemic Control
Hyperglycemia (blood glucose >180 mg/ dL) can occur in patients receiv- ing PN therapy with higher amounts of dextrose in their PN prescription or in those who have a history of diabetes mellitus. Hyperglycemia is also common in patients receiving long-term PN who have no prior diagnosis of diabetes.22
To prevent or reduce the risk of hyperglycemia, it is import-
ant to monitor blood glucose during PN therapy. The adjustment of PN formulations to lower the amount of dextrose and/or add insulin may allow for a patient to reach target glycemic goals. An individual’s target glycemic goal may vary based on factors such as age, clinical presenta- tion, medication use, and medical or surgical history. The typical target glucose range is between 70 and 180 mg/ dL.22 Hypoglycemia (blood glucose levels <70 mg/ dL) can occur if PN is
interrupted abruptly or if there is excess insulin in the PN prescription, and it can lead to significant complications if left untreated.7,22
To reduce
the risk of rebound hypoglycemia, a 1- to 2-hour taper down of the cycled PN infusion may be needed for an individual at high risk. Careful mon- itoring of blood glucose is necessary during transition periods until the patient’s blood glucose levels are stable.7
Hypertriglyceridemia
Lipids provide an energy source and essential fatty acids that are neces- sary for survival. In general, patients receiving long-term HPN should also receive a lipid source routinely (ie, daily, every other day, or weekly) either from oral nutrition and/or their PN prescription.23
Providing an
appropriate dosage of lipids according to the guidelines for the chosen product helps reduce metabolic complications such as hypertriglyceri- demia. The type of intravenous lipid emulsion (ILE) used will determine the appropriate dosing. Temporarily omitting ILE from the PN prescrip- tion may be indicated for an individual with a triglyceride level of greater than 400 mg/ dL.7
A clinician prescribing PN should check the product 79
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