Complication of total parenternal nutrition is -
Ans. is 'c' i.e.. Metabolic acidosis Complications of Parenteral NutritionMechanical complicationsMechanical complications may occur during central line placement. These include pneumothorax, brachial plexus injury, subclavian or carotid artery puncture, hemothorax, and chylothorax etc. Thrombosis or pulmonary embolism may occur secondary to central venous catheter use.Infectious complicationsSepsis occurs secondary to contamination of the central venous catheterMetabolic complicationsMetabolic complications can be divided into Early or nutrient related and Late or related to long term administration. Early complications include, among others, hyperglycemia, refeeding syndrome, and lipid metabolism abnormalities. Complications associated with long-term PN infusion include steatosis, cholestasis, and metabolic bone disease.Hyperglycemia-is the most common metabolic complication associated with PN administration.Hypoglycemia- Abrupt discontinuation of TPN can produce rebound hypoglycemia in patients with limited oral intake.HyperlipidemiaRefeeding syndrome -Refeeding syndrome is defined as severe electrolyte and fluid shifts that may result from refeeding after severe weight loss (protein-calorie malnutrition).In starvation, energy is derived principally from fat metabolism. TPN results in a shift from fat to glucose as the predominant fuel, and rapid anabolism increases the production of phosphorylated intermediates of glycolysis. These intermediates trap phosphate, producing profound hypophosphatemia. Hypophosphatemia is the hallmark of the refeeding syndromeand has been reported in patients being repleted both parenterally and enteral ly.Hypokalemia and hypomagnesemia also occur.The lack of phosphate and potassium lead to a relative ATP deficiency, resulting in the insidious onset of respiratory failure and reduced cardiac stroke volume. The refeeding syndrome can be life threatening if not promptly treated.Because of these risks, the rate ofTPN administration in a severly malnourished patient should be slowly increased over several days.Hepatobiliary complications -Hepatic dysfunction is a common manifestation of long-term parenteral nutrition support. It includes elevated serum transaminases and alkaline phosphatase. Steatosis, steatohepatitis, lipidosis, chloestasis, fibrosis and cirrhosis can occur. Although these abnormalities are usually benign and transient, more serious and progressive disease can develop in a small subset of patients, usually after 16 weeks of PN.Biliary complications include acalculous cholecystitis, gallbladder sludge, and cholelithiasis.Metabolic Bone disease - Including osteomalacia or osteopenia may be seen with long-term TPN. Complications of Total Parentral NutritionCatheter RelatedMetabolic complicationo Infection (Systemic sepsis, infective endocarditis)o Azotemiao Injuries due to cathetero Essential fatty acid def.* Hydrothorax, hemothorax, pneumothoraxo Fluid overload* Cardiac tamponadeo Metabolic bone ds.* Injuries to arteries & veinso Liver dysfunction* Injuries to thoracic duct, nerveso Glucose imbalance (Hyperglycemia, hypoglycemia)o Thrombotic complicationo Trace elements & vitamin deficiencyo Air embolism, catheter embolismo Electrolyte abnormalities * Hypernatremia, hyponatremia * Hyperkalemia, hypokalemia * Hyperphosphatemia, hypophosphatemia * Hypermagnesemia, hypomagnesemia * Hypercalcemia, hypocalcemia * High serum zinc, low serum zinc * High serum copper, low serum copper * Hyperchloremic metabolic acidosis
CHF
Hvpochloremia
Metabolic acidosis
Leukopenia
Miscellaneous (Fluid & Electrolyte)