Complications and monitoring - Guidelines on Parenteral Nutrition, Chapter 11

W H Hartl, K W Jauch, K Parhofer, P Rittler, Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine, M Adolph, J Arends, K Bauer, H K Biesalski, S C Bischoff, I Blumenstein, G Bockenheimer-Lucius, H-J Boehles, U Bolder, P Brass, I Celik, A Dossett, W Druml, Ch Ebener, R Fietkau, Ch Franken, A Frewer, Ch Fusch, Ch Goeters, W Hartl, H Hauner, L Hausser, A R Heller, S Holland-Cunz, M J Hug, K W Jauch, F Jochum, M Kemen, L Kester, H Kierdorf, T Koch, B Koletzko, M Koller, I B Kopp, L Kraehenbuehl, M Krawinkel, G Kreymann, K Krohn, E R Kuse, F Laengle, R Meier, S Muehlebach, A Muehlhoefer, M J Mueller, J Ockenga, K Parhofer, M Plauth, E Pscheidl, R Radziwill, P Rittler, S Rothaermel, I Schmid, W Schregel, R-J Schulz, T Schuetz, D Schwab, M Senkal, E Shang, Z Stanga, J Stein, P Thul, K Traeger, S Verwied-Jorky, O Volk, K H Wehkamp, A Weimann, A R Zander, G Zuercher, W H Hartl, K W Jauch, K Parhofer, P Rittler, Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine, M Adolph, J Arends, K Bauer, H K Biesalski, S C Bischoff, I Blumenstein, G Bockenheimer-Lucius, H-J Boehles, U Bolder, P Brass, I Celik, A Dossett, W Druml, Ch Ebener, R Fietkau, Ch Franken, A Frewer, Ch Fusch, Ch Goeters, W Hartl, H Hauner, L Hausser, A R Heller, S Holland-Cunz, M J Hug, K W Jauch, F Jochum, M Kemen, L Kester, H Kierdorf, T Koch, B Koletzko, M Koller, I B Kopp, L Kraehenbuehl, M Krawinkel, G Kreymann, K Krohn, E R Kuse, F Laengle, R Meier, S Muehlebach, A Muehlhoefer, M J Mueller, J Ockenga, K Parhofer, M Plauth, E Pscheidl, R Radziwill, P Rittler, S Rothaermel, I Schmid, W Schregel, R-J Schulz, T Schuetz, D Schwab, M Senkal, E Shang, Z Stanga, J Stein, P Thul, K Traeger, S Verwied-Jorky, O Volk, K H Wehkamp, A Weimann, A R Zander, G Zuercher

Abstract

Compared to enteral or hypocaloric oral nutrition, the use of PN (parenteral nutrition) is not associated with increased mortality, overall frequency of complications, or longer length of hospital stay (LOS). The risk of PN complications (e.g. refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections) can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. Occuring complications are e.g. the refeeding-syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycaemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis. Efficient monitoring in all types of PN can result in reduced PN-associated complications and reduced costs. Water and electrolyte balance, blood sugar, and cardiovascular function should regularly be monitored during PN. Regular checks of serum electrolytes and triglycerides as well as additional monitoring measures are necessary in patients with altered renal function, electrolyte-free substrate intake, lipid infusions, and in intensive care patients. The metabolic monitoring of patients under long-term PN should be carried out according to standardised procedures. Monitoring metabolic determinants of bone metabolism is particularly important in patients receiving long-term PN. Markers of intermediary, electrolyte and trace element metabolism require regular checks.

Keywords: catheter infection; hyperglycaemia; hypertriglyceridemia; liver disease; refeeding syndrome.

Figures

Table 1. Effects of total PN on…
Table 1. Effects of total PN on mucosal function
Table 2. Some approaches to monitoring PN…
Table 2. Some approaches to monitoring PN effects
Table 3. Measures for the monitoring of…
Table 3. Measures for the monitoring of patients on PN (according to [53])
Table 4. Laboratory monitoring programme for patients…
Table 4. Laboratory monitoring programme for patients with long-term PN (Mayo diagram [55])
Table 5. Monitoring and clarification of patients…
Table 5. Monitoring and clarification of patients with metabolic bone diseases receiving PN (according to [54])

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