Tasty Morsels of Critical Care Tasty Morsels of Critical Care 051 | Parenteral nutrition
Sep 6, 2021
Delve into the complications and metabolic issues of Parenteral Nutrition, including misconceptions about sepsis and risks of line-related infections. Explore the challenges of overfeeding and liver complications, along with the delicate balance between carbohydrates and lipids in nutrition bags.
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When To Use Parenteral Nutrition
- Use parenteral nutrition when enteral feeding cannot be established around day 5–7 of inadequate intake.
- Start earlier in practice for surgical patients if the gut is unlikely to tolerate enteral feeding.
Infection Versus Refeeding Risks
- Central access for PN raises line-related infection risk but PN itself may not directly increase sepsis risk.
- Refeeding syndrome risk is prominent with PN due to sudden calorie and insulin shifts after prolonged underfeeding.
Metabolic Effects And Overfeeding
- PN can cause metabolic disturbances like non-anion gap metabolic acidosis and CO2-generating overfeeding.
- Excess glucose (>4 mg/kg/min) drives lipogenesis and increased CO2, which may impair weaning from ventilation.