Common TPN Complications in Hospital Pharmacy

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.