Parenteral Nutrition Overview

Abstract

Parenteral nutrition (PN) is a life-saving intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable. The essential components of PN are carbohydrates, lipids, amino acids, vitamins, trace elements, electrolytes and water. PN should be provided via a central line because of its hypertonicity. However, peripheral PN (with lower nutrient content and larger volume) can be administered via an appropriate non-central line. There are alternatives for the compounding process also, including hospital pharmacy compounded bags and commercial multichamber bags. PN is a costly therapy and has been associated with complications. Metabolic complications related to macro and micronutrient disturbances, such as hyperglycemia, hypertriglyceridemia, and electrolyte imbalance, may occur at any time during PN therapy, as well as infectious complications, mostly related to venous access. Long-term complications, such as hepatobiliary and bone disease are associated with longer PN therapy and home-PN. To prevent and mitigate potential complications, the optimal monitoring and early management of imbalances is required. PN should be prescribed for malnourished patients or high-risk patients with malnutrition where the feasibility of full EN is in question. Several factors should be considered when providing PN, including timing of initiation, clinical status, and risk of complications.

Beneficios y riesgos asociados a la nutrición parenteral en el paciente crítico de larga estancia hospitalaria

“…Los electrolitos, aminoácidos y las vitaminas del grupo B también son importantes. 13 Estudios recientes revelaron que las complicaciones de cirugías postquirúrgicas abdominales prolongaban la estadía hospitalaria debido a que los pacientes presentaban múltiples colecciones, edema, cambios inflamatorios afectación de tejido celular subcutáneo y que el inicio de la nutrición parenteral permitía el reposo digestivo del paciente crítico. 14…”

Lipid emulsions in parenteral nutrition: does it matter?

“…ILE's as a component of PN, are key to deliver essential fatty acids and energy [13 ▪ ,14 ▪ ]. However, the optimal form of ILE in PN is controversial and has undergone further study recently [4 ▪▪ ,10 ▪▪ ].…”

Finding the sweet spot: Managing parenteral nutrition–related glycemic complications in hospitalized adults

“…Dextrose serves as the carbohydrate source in PN solutions. The monohydrate form of dextrose is commonly used in the United States and Canada and provides 3.4 kcal/g, whereas a nonhydrated form is available in Europe and provides 4 kcal/g 8 . A minimum dextrose intake of 130 g has been suggested for PN, although this is derived from carbohydrate intake in healthy patients, not acutely ill patients receiving PN 8 .…”

“…The monohydrate form of dextrose is commonly used in the United States and Canada and provides 3.4 kcal/g, whereas a nonhydrated form is available in Europe and provides 4 kcal/g 8 . A minimum dextrose intake of 130 g has been suggested for PN, although this is derived from carbohydrate intake in healthy patients, not acutely ill patients receiving PN 8 . A dose of 150 g of dextrose has been suggested as the minimum amount to include in PN prescriptions in order for the brain, renal medulla, and red blood cells to function 5 .…”

“…8 A minimum dextrose intake of 130 g has been suggested for PN, although this is derived from carbohydrate intake in healthy patients, not acutely ill patients receiving PN. 8 A dose of 150 g of dextrose has been suggested as the minimum amount to include in PN prescriptions in order for the brain, renal medulla, and red blood cells to function. 5 The American Society for Parenteral and Enteral Nutrition (ASPEN) suggests the provision of dextrose at a glucose infusion rate (GIR) of 4-5 mg/kg/ min for clinically stable patients and to limit GIR to <4 mg/kg/min for patients who are critically ill, septic, or who have traumatic injuries to decrease the risk of hyperglycemia.…”