Nutrition support in critically ill patients: Parenteral nutrition
- David Seres, MD
David Seres, MD
- Director of Medical Nutrition
- Associate Professor of Medicine in the Institute for Human Nutrition
- Columbia University College of Physicians and Surgeons
- Section Editors
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Parenteral nutrition (PN) support refers to the provision of calories, amino acids, electrolytes, vitamins, minerals, trace elements, and fluids via a parenteral route. Access, prescribing, monitoring, and complications of parenteral nutrition are reviewed here.
The goals, outcomes, indications, contraindications, and nutritional requirements for parenteral nutrition are discussed separately. (See "Nutrition support in critically ill patients: An overview".)
The American Society of Parenteral and Enteral Nutrition recommendations for managing shortages relevant to components of parenteral nutrition can be accessed at the following site: http://www.nutritioncare.org/Professional_Resources/Drug_Shortages_Update/.
INDICATIONS AND CONTRAINDICATIONS
The indications and contraindications for parenteral nutrition are described elsewhere. (See "Nutrition support in critically ill patients: An overview", section on 'Patient selection'.)
In order to initiate parenteral nutrition, appropriate access must be obtained and the prescription (ie, composition and infusion rate) must be determined. Guidelines suggest that when tolerance to enteral nutrition is evident, parenteral nutrition should be weaned and discontinued when >60 percent of the patients' needs are met enterally, although there are no data to support this practice . Our practice is to wean parenteral nutrition proportionate to the amount of enteral nutrition being delivered.
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- INDICATIONS AND CONTRAINDICATIONS
- - Dextrose
- - Amino acids and electrolytes
- - Lipids
- - Vitamins and trace elements
- Therapeutic vitamin and mineral supplementation
- - Glutamine
- Bloodstream infection
- Metabolic effects
- Venous access
- PERIPHERAL PARENTERAL NUTRITION
- SUMMARY AND RECOMMENDATIONS