Manual of Clinical Nutrition

Parenteral Nutrition

Manual of Clinical Nutrition Management III- 95 Copyright © 2013 Compass Group, Inc.

Complication Causes Symptoms Treatments

Azotemia Dehydration
Renal insufficiency
Excessive protein
administration or
inadequate
nonprotein energy

High blood urea nitrogen

level

Increase administration of free fluid.

Reduce amino acid dose.

Patients with impaired renal or

hepatic disease may require dialysis.

Hypophosphatemia Alcoholism

Intractable vomiting

Inadequate intake

Refeeding syndrome

Vitamin D deficiency

Hyperparathyroidism

Anorexia

Muscle weakness

Paresthesias

Long bone pain

Coma

Respiratory distress

Increase phosphorus in PN solution

based on individual medical needs

(4).

If refeeding syndrome occurs, modify

the amount of energy provided by

carbohydrates (15 to 20 kcal/kg per

day) until electrolytes are stable (1).

Cholestasis
Disuse of
gastrointestinal
tract
Overfeeding
Long-term use of PN
Excessive use of
intravenous fat
emulsions (IVFE)

Elevated total bilirubin

level >2 mg/dL (1)

Elevated alkaline

phosphatase level and

gamma-glutamyl

transpeptidase level

Reduce total energy provided.

Decrease dextrose to <5 mg/kg per

min.

Decrease IVFE to <1 g/kg per day (1).

Consider cyclic PN infusion.

Steatosis

(hepatic
accumulation)

Overfeeding

Essential fatty acid

deficiency

Elevated

aminotransferase level

Consider cyclic PN infusion.

Decrease total energy provided.

Balance dextrose energy with energy

from fat.

Decrease dextrose to <5 mg/kg per

min.

If essential fatty acid deficiency occurs,

treat with lipid infusions.

Hypomagnesemia Malabsorption
Massive small bowel
resection
Acute pancreatitis
Prolonged nasogastric
suction
Intestinal fistula
Vomiting
Refeeding syndrome

Muscle weakness

Depression

Apathy

Nausea

Vomiting

Irritability

Vertigo

Ataxia

Muscle tremor

Hypocalcemia

Hypoparathyroidism

Increase Mg in PN.

Provide additional intravenous

supplementation (4,7).

If refeeding syndrome occurs, modify

the delivery of energy from

carbohydrates (15 to 20 kcal/kg per

day) until electrolytes are stable (1).

Hypermagnesemia Excessive Mg
administration
Renal insufficiency

Drowsiness

Weakness

Nausea

Vomiting

Cardiac arrhythmia

Hypotension

Decrease Mg in PN.