Metabolic Complications Occur More Frequently in Older Patients Receiving Parenteral Nutrition

Abstract

Background The European Society for Clinical Nutrition and Metabolism Guidelines for Parenteral Nutrition in Geriatric Patients state metabolic complications are more frequent in elderly patients. However, literature provides limited information about metabolic complications in older patients receiving parenteral nutrition (PN). Consequently, the purpose of this study was to compare the development of metabolic complications in older vs younger patients receiving PN. Methods Patients receiving PN from May 1, 2014, to February 7, 2017, at Cooper University Hospital were included. Metabolic complications assessed included acid‐base disturbances, hepatic complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome. Results 595 patients were included (older group [≥65 years]: n = 245, median age: 76 years; younger group [<65 years]: n = 350, median age: 53 years]. Certain characteristics were similar between groups (female, 51%; mean body mass index of 28; critically ill, 34%; central PN, 97%; median duration of PN, 7 days; mean energy provision PN, 25.4 kcal/kg/d; mean dextrose infusion rate, 2.31 mg/kg/min). Overall, metabolic complications developed in 58% of patients and occurred more frequently in older vs younger patients (65.7% vs 53.4%; P = .003). Multivariate logistic analysis demonstrated increased odds of metabolic complications in the older group (odds ratio, 1.55; 95% CI, 1.014–2.375). Conclusions Older hospitalized patients are more likely to develop a metabolic complication during their PN course than younger patients. This study heightens awareness that patients of advanced age are subject to metabolic complications; practitioners should anticipate and resolve complications in a timely manner.

Stress Hyperglycemia and Osteocalcin in COVID-19 Critically Ill Patients on Artificial Nutrition

“…The amount or glucose delivered through artificial nutrition might be another associated factor with stress hyperglycemia. It has been shown that among the metabolic complications of parenteral nutrition, hyperglycemia is one of them, and this may be especially important in older individuals [ 7 ]. Therefore, nutrition-support regimens need to minimize stress hyperglycemia and assist glucose management [ 25 ].…”

“…Among the factors associated with stress hyperglycemia, the need for parenteral nutrition (PN)—which is normally part of the nutritional therapy together with enteral nutrition (EN) in critically ill patients [ 6 ]—might be one of them, especially in older individuals [ 7 ]. Besides, several interactions between some counter-regulatory hormones, adipokines, and inflammatory cytokines produce excessive production of glucose by the liver and insulin resistance at the peripheral tissues [ 8 ].…”

New features of parenteral nutrition in home care and acute care setting for the older population

“…As might be expected from the global demographic shifts to an older age group commonly with multiple comorbidities and a greater risk of malnutrition, it is expected that more parenteral nutrition will be needed. In the USA, currently, more than 40% of patients receiving parenteral nutrition are over 65 years of age [1]. A recent 10-year retrospective review of a prospectively collected database including 55 000 Japanese medical claims in patients on parenteral nutrition reported that over 70.3% of patients receiving parenteral nutrition in this study were over 70 years of age [2].…”

“…The geriatric population is at a higher risk for metabolic complications versus a younger population when receiving parenteral nutrition [1]. This retrospective study compared the metabolic complications in the less than 65yo to those more than 65yo receiving parenteral nutrition.…”

Enteral Nutrition: Based on the Combination of Nutrison Fibre and TPF-DM with A Marine Biological-Based Active Polysaccharide Preparation

“…However, using parenteral nutrition exclusively will make it more difficult to maintain patients' nutritional status and raise the risk of problems [12][13][14][15]. Enteral nutrition (EN) is a way to provide patients with required nutrients through the gastrointestinal route [16,17]. In the early stages of neurocritical patients, enteral nutrition can better maintain the integrity of the body's tissues and organs than parenteral nutrition and has a nonnegligible impact on the prognosis of patients [18].…”