Re-feeding syndrome is a specific problem that occurs after nutrition has
been started for extremely malnourished patients. Carbohydrate is utilized along
with phosphorus (PO4) to rebuild energy stores leading to hypophosphatemia.
Providing adequate PO4 can prevent subsequent congestive heart failure and
respiratory distress syndrome.
Liver dysfunction is seen as a complication of parenteral nutrition
particularly in children after several months of therapy. The complication is
multifactorial but recent studies suggest that this complication can be prevented
or treated with restriction of soy based lipid formulations to 1gm/kg/day or
replacement by a fish oil emulsion which has not been approved for use in the
US. Another complication is acalculous cholecystitis, which some patients rarely
develop while on parenteral nutrition.
VI. MONITORING ADEQUACY OF NUTRITION
Laboratory monitoring of parenteral nutrition should initially include daily
electrolytes, Mg, PO4 and ionized Ca. Serum triglycerides should be checked
with each increase in lipids. After a few days of stable values, these items are
checked twice a week. Liver enzymes, bilirubin, alkaline phosphatase and CBC
are checked every other week.