Manual of Clinical Nutrition

Manual of Clinical Nutrition Management III- 94 Copyright © 2013 Compass Group, Inc.

PARENTERAL NUTRITION (PN): METABOLIC COMPLICATIONS (1-4)

Complication Causes Symptoms Treatments
Hyperglycemia (1-4) Trauma

Infection

Diabetes mellitus

Excessive dextrose

administration

Corticosteroids or

immunosuppressive

therapy

Elevated blood glucose

level

With persistent hyperglycemia,

provide insulin when necessary to

maintain blood glucose levels of 100

to 150 mg/dL in critically ill patients

(4,5).

In diabetic patients, the plasma goal is

140 to 180 mg/dL for the majority

of critically ill patients (2,5) and <140

mg/dL for non-critically ill patients

with random blood glucose

targeting levels <180 mg/dL (2,5).

More stringent targets may be

appropriate in stable patients with

previously tight glycemic control.

Less stringent targets may be

appropriate in patients with severe

comorbidities (5).

The rate of dextrose infusion in

parenteral nutrition (PN) should not

exceed 4 to 5 mg/kg per min (1,4).

Hypoglycemia Sudden cessation of
PN
Excessive insulin
administration

Low blood glucose level

(<70 mg/dL) (5,6)

Headache

Sweating

Thirst

Disorientation

Convulsions

Coma

If managed on insulin, decrease insulin

administration.

Give intravenous dextrose.

Avoid the abrupt cessation of PN.

Studies show that hypoglycemia is

equally prevalent in nondiabetic

patients due to stress. Taper PN

solution for 1 to 2 hours. If PN must

be discontinued quickly, 10%

dextrose should be infused for 1 or

2 hours following PN

discontinuation (1). Check the

capillary blood glucose

concentration 30 min to 1 hour after

the discontinuation of PN to identify

rebound hypoglycemia (1).

Hyperglycemic
hyperosmotic
syndrome

Dehydration from

osmotic diuresis

(type 1 diabetes

mellitus)

Poor intake of water

(occurs in elderly

patients with type 2

diabetes mellitus)

Lethargy

Stupor

Convulsions

Blood glucose level >600

mg/dL (6-7)

Serum osmolality >350

mOsm/L

Discontinue PN.

Initiate rate of half of the estimated

needs or approximately 150 to 200

g (or 100 g/day if severe

hyperglycemia) for the first 24

hours until tolerance is documented

(1).

Provide insulin to correct the blood

glucose level.

Carbohydrate administration should

not exceed a rate of 4 to 5 mg/kg

per min (1).