d. Calculate the electrolytes, Ca, Mg, Phos based on needs and
serum levels
e. Include carnitine, zinc, trace elements, vitamins, additional
medications
D. Complications of Parenteral Nutrition
Enteral nutrition is preferred because it is more physiologic, but also
because of complications associated with parenteral nutrition administration.
Almost 5 % of patients have catheter related problems including pneumothorax
or hemothorax on insertion. Catheter migration may occur to an inappropriate
site, such as within the heart or back into a more peripheral vein. Catheter
erosion into the pericardial space also rarely occurs. The most frequent catheter
related complication is infection, a problem that can be substantially mitigated
with careful dressing changes following a specific protocol. Usual organisms are
Staph. aureus and Staph epidermidis but also can include gram negative
bacteria and fungi. Another parenteral nutrition associated problem is
hyperglycemia. The sudden onset of hyperglycemia often indicates sepsis, but is
rarely due to overfeeding. Chromium deficiency is another rare cause of
hyperglycemia. Hyperchloremic metabolic acidosis can occur with parenteral
nutrition and is treated by using acetate as a balancing anion rather than
chloride.