Common TPN Complications in Hospital Pharmacy
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Questions and Answers

What are some common line complications associated with TPN therapy?

  • Liver dysfunction, hepatomegaly, and hyperammonemia
  • Fluid overload, electrolyte abnormality, and acid-base imbalances
  • Bacterial contamination, thrombosis, and catheter malposition (correct)
  • Metabolic complications, hyperglycemia, and trace mineral deficiency

    • How can hyperglycemia be managed during TPN therapy?

  • Discontinuing TPN therapy immediately
  • Reducing the frequency of blood glucose monitoring to avoid over-treatment
  • Monitoring blood glucose often, adjusting insulin dose in the TPN solution, and giving subcutaneous insulin (correct)
  • Increasing the concentration of dextrose in the TPN solution

    • What is a potential treatment for hypoglycemia during TPN therapy?

  • Adjusting the TPN solution to decrease insulin content
  • Infusion of 5 or 10% dextrose for 24 hours before resuming TPN via the central venous catheter (correct)
  • Decreasing the frequency of blood glucose monitoring
  • Discontinuing TPN therapy for 48 hours

    • How should abnormalities of serum electrolytes and minerals be corrected during TPN therapy?

    <p>By modifying subsequent infusions or beginning appropriate peripheral vein infusions if correction is urgently required</p> Signup and view all the answers

    How can vitamin and mineral deficiencies be prevented during TPN therapy?

    <p>By ensuring correct administration of TPN solutions</p> Signup and view all the answers

    What are some ways to avoid line complications during TPN therapy?

    <p>Placing catheters by experienced physicians, consistently following strict protocols for aseptic line care, and patient monitoring</p> Signup and view all the answers

    What is the most common cause of volume overload in patients receiving TPN?

    <p>High daily energy requirements</p> Signup and view all the answers

    Which adverse reaction to lipid emulsions is particularly likely if given at > 1.0 kcal/kg/h?

    <p>Dyspnea</p> Signup and view all the answers

    What is the suggested treatment for temporarily or permanently slowing or stopping lipid emulsion infusion to prevent adverse reactions?

    <p>Arginine supplementation</p> Signup and view all the answers

    What is the potential consequence of delayed or persistent elevations of liver enzymes in patients receiving TPN?

    <p>Progressive fibrosis</p> Signup and view all the answers

    What is the suggested correction for hyperammonemia in infants receiving TPN?

    <p>Arginine supplementation</p> Signup and view all the answers

    What can be caused or worsened by prolonged gallbladder stasis in patients receiving TPN?

    <p>Cholelithiasis</p> Signup and view all the answers

    What is the suggested treatment for gallbladder complications in patients receiving TPN?

    <p>Cholecystokinin treatment</p> Signup and view all the answers

    What is the suggested intervention to stimulate contraction of the gallbladder in patients with gallbladder complications?

    <p>Stopping glucose infusion several hours a day</p> Signup and view all the answers

    What is the primary cause of temporary hyperlipidemia in patients receiving TPN?

    <p>Liver failure</p> Signup and view all the answers

    What is the known treatment for metabolic bone disease in patients receiving TPN for more than 3 months?

    <p>Discontinuing TPN temporarily or permanently</p> Signup and view all the answers

    What is the first step in the general management of poisoning?

    <p>Initial stabilization</p> Signup and view all the answers

    Which of the following is not a part of enhancing poison elimination in the general management of poisoning?

    <p>EMESIS</p> Signup and view all the answers

    How is the diagnosis of poisoning usually made in unconscious or uncooperative patients?

    <p>Based on circumstantial or third party evidence</p> Signup and view all the answers

    What type of information can be included in the clinical history for diagnosing poisoning?

    <p>Information obtained from family, friends, law enforcement, medical personnel, and observers</p> Signup and view all the answers

    Which point does a seasoned clinician usually take into account to arrive at a conclusion in diagnosing poisoning?

    <p>Clinical history</p> Signup and view all the answers

    What provides valuable clues to help narrow the differential diagnosis in poisoned patients?

    <p>Clinical examination</p> Signup and view all the answers

    What is the first step in the general management of poisoning?

    <p>Ensure airway is clear so that breathing and circulation are adequate</p> Signup and view all the answers

    Which of the following odors may point towards exposure or poisoning by hydrogen sulfide or mercaptans?

    <p>Rotten eggs</p> Signup and view all the answers

    What does the observation of urine passed by a poisoned patient give a clue about?

    <p>Type of poison ingested</p> Signup and view all the answers

    Which of the following is an example of a vital organ recording in a poisoned patient?

    <p>Observation of body temperature</p> Signup and view all the answers

    What is the characteristic odor associated with exposure or poisoning by naphthalene or camphor?

    <p>Mothballs</p> Signup and view all the answers

    In the general management of poisoning, what does 'Hasten toxicant elimination' refer to?

    <p>Administering treatment to expedite removal of toxic substance from the body</p> Signup and view all the answers

    What should be the initial focus in the assessment and correction of life-threatening problems in a poisoned patient?

    <p>(ABCD) - Airways, Breathing, Circulation, Disability</p> Signup and view all the answers

    'Initial stabilization' in the treatment of systemic poisoning begins with which aspects?

    <p>(ABCD) - Airways, Breathing, Circulation, Disability</p> Signup and view all the answers

    'General management of poisoning' includes which concept related to limiting further absorption of toxicant?

    <p>'Remove unabsorbed material'</p> Signup and view all the answers

    'Skin Marks' may indicate which aspect of poisoning?

    <p>'Dermal manifestations'</p> Signup and view all the answers

    Study Notes

    Complications of TPN Therapy

    • Common line complications associated with TPN therapy include infections, occlusions, and thrombosis.
    • Hyperglycemia can be managed during TPN therapy by adjusting the dextrose content, using insulin, and monitoring blood glucose levels.
    • Potential treatment for hypoglycemia during TPN therapy includes administering dextrose or glucose.
    • Abnormalities of serum electrolytes and minerals should be corrected during TPN therapy by adjusting the electrolyte content and monitoring serum levels.
    • Vitamin and mineral deficiencies can be prevented during TPN therapy by ensuring adequate supplementation.

    Avoiding Line Complications

    • Ways to avoid line complications during TPN therapy include using proper insertion and care techniques, monitoring for signs of complications, and rotating the injection site.

    Adverse Reactions to Lipid Emulsions

    • The most common cause of volume overload in patients receiving TPN is excessive infusion of lipid emulsions.
    • Infusing lipid emulsions at a rate > 1.0 kcal/kg/h can lead to adverse reactions, particularly pancreatitis.
    • Temporarily or permanently slowing or stopping lipid emulsion infusion can prevent adverse reactions.

    Liver Enzyme Elevations

    • Delayed or persistent elevations of liver enzymes in patients receiving TPN can lead to liver damage.

    Hyperammonemia

    • The suggested correction for hyperammonemia in infants receiving TPN is to reduce the protein content of the TPN solution.

    Gallbladder Complications

    • Prolonged gallbladder stasis in patients receiving TPN can cause or worsen gallbladder complications.
    • The suggested treatment for gallbladder complications is to stimulate contraction of the gallbladder using cholecystokinin or other medications.

    Metabolic Bone Disease

    • Temporary hyperlipidemia in patients receiving TPN is primarily caused by the infusion of lipid emulsions.
    • The known treatment for metabolic bone disease in patients receiving TPN for more than 3 months is to supplement with calcium and vitamin D.

    General Management of Poisoning

    • The first step in the general management of poisoning is to assess the patient's airway, breathing, and circulation (ABCs).
    • The diagnosis of poisoning is usually made in unconscious or uncooperative patients by analyzing serum and urine samples.
    • The clinical history for diagnosing poisoning can include information about the time and amount of toxin exposure, symptoms, and medical history.
    • A seasoned clinician usually takes into account the patient's symptoms, medical history, and laboratory results to arrive at a conclusion.
    • The patient's physical examination and laboratory results provide valuable clues to help narrow the differential diagnosis.
    • The initial focus in the assessment and correction of life-threatening problems in a poisoned patient is to stabilize the patient's vital signs.
    • Initial stabilization in the treatment of systemic poisoning begins with assessing the patient's airway, breathing, and circulation (ABCs).
    • Limiting further absorption of toxicant is a key concept in the general management of poisoning.
    • 'Hasten toxicant elimination' refers to the use of methods to enhance the elimination of toxins from the body.
    • Skin marks may indicate injection sites or other routes of exposure to toxins.
    • A characteristic odor of garlic or rotten eggs may point towards exposure or poisoning by hydrogen sulfide or mercaptans.
    • The observation of urine passed by a poisoned patient can give a clue about the type of toxin ingested.
    • Vital organ recordings, such as ECG, can provide valuable information in a poisoned patient.
    • The characteristic odor associated with exposure or poisoning by naphthalene or camphor is a pungent, sweet smell.

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    Test your knowledge of common complications associated with Total Parenteral Nutrition (TPN) in a hospital pharmacy setting, including line complications, metabolic complications, and hepatic complications. Explore ways to prevent these complications.

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