Manual of Clinical Nutrition

Parenteral Nutrition

Manual of Clinical Nutrition Management III- 96 Copyright © 2013 Compass Group, Inc.

Complication Causes Symptoms Treatments
Hyponatremia Fluid overload

Excessive

gastrointestinal loss

Excessive urinary loss

Adrenal insufficiency

Congestive heart

failure

Syndrome of

inappropriate

antidiuretic

hormone secretion

Decreased serum Na

levels and osmolality

Irritability

Confusion

Seizures

Evaluate free-water intake and total

volume status considering disease

state and underlying causes. If the

volume is excessive (eg, free water,

intravenous fluids), decrease fluid

intake and/or adjust free-water

volume. If the volume is deficient,

increase water and Na. Adjust Na

intake as condition dictates.

Hypernatremia Dehydration
Excessive Na intake
Osmotic diuresis
Hypoglycemia
Hypocalcemia
Head trauma
Antidiuretic hormone
deficiency

Increased serum Na

level

Convulsions

Irritability

Restlessness

Coma

Evaluate for dehydration or deficit of

water or total volume. Increase free-

water or fluid intake as appropriate.

Evaluate intravenous sources and

consider decreasing Na if excessive.

Hyperphosphatemia Renal insufficiency
Excessive
phosphorous
administration

Elevated serum

phosphorous level

Decrease phosphorous in PN.

Hypokalemia Inadequate K+ intake
Diarrhea
Intestinal fistula
Anabolism
Metabolic alkalosis
K+-wasting
medications
Vomiting
Refeeding syndrome

Ileus

Cardiac arrhythmia

Correct K+ prior to starting PN^ or adjust

PN formula.

Consider additional intravenous

supplementation (8).

If refeeding syndrome occurs, modify

the delivery of energy from

carbohydrates (15 to 20 kcal/kg per

day) until electrolytes are stable (1).

Hyperkalemia Renal insufficiency
Excessive K+
administration
Medication
(spironolactone)

Cardiac arrhythmia

Paresthesias

Decrease K+ in PN (also consider

decreasing K+ from other intravenous

sources).

Provide K+ binders and antagonists.

K+ >^ 5.5 mEq may warrant an

electrocardiogram (8).