Commonest complication of parenteral nutrition includes all except: March 2007
Ans. B: Hyperkalemia Parenteral nutrition is indicated to prevent the adverse effects of malnutrition in patients who are unable to obtain adequate nutrients by oral or enteral routes. Other indications are sho gut syndrome, high-output fistula, prolonged ileus, or bowel obstruction. Sho-term TPN may be used if a person's digestive system has shut down (for instance by Peritonitis. Chronic TPN is performed through a central intravenous catheter, usually in the subclan or jugular vein. In infants, sometimes the umbilical vein is used. Complications: Catheter complications include pneumothorax, accidental aerial puncture, and catheter-related sepsis. The most common complication of TPN use is bacterial infection, usually due to the increased infection risk from having an indwelling central venous catheter. Liver failure / reversible cholestatic jaundice, often related to Fatty liver, may occur. Two related complications of TPN are venous thrombosis and rarely priapism. Fat infusion during TPN is assumed to contribute to both. Total parenteral nutrition increases the risk of acute cholecystitis due to complete unusage of gastrointestinal tract, which may result in bile stasis in the gallbladder. Metabolic complications include the Refeeding Syndrome characterised by hypophosphataemia and other electrolyte abnormalities. Nutrients deficiency: hypoglycemia/ hypocalcemia/ hypomagnesemia are also seen. Hyperglycemia is common at the sta of therapy, and hypoglycaemia is likely to occur with abrupt cessation of TPN. Hyperosmolar dehydration is also associated with excesss of glucose. Excess fat leads to hyperchlosterolemia and formation of lipoprotein X and hyperiglyceridemia. Excess of amino acids leads to hyperchloraemic metabolic acidosis, hypercalcemia and uremia.
Hyperglycemia
Hyperkalemia
Hyperosmolar dehydration
Azotemia