Parenteral nutrition

Parenteral nutrition
Parenteral nutrition (PN) is
feeding a person intravenously,
bypassing the usual process of
eating and digestion. The person
receives nutritional formulae that
contain nutrients such as glucose,
amino acids, lipids and added
vitamins and dietary minerals.

 called total parenteral nutrition

(TPN) or total nutrient admixture
(TNA) when no significant
nutrition is obtained by other
routes.

 called peripheral parenteral nutrition

(PPN) when administered through vein
access in a limb, rather than through a
central vein.

History
Developed in the 1960s by Dr Stanley J.
Dudrick, who as a surgical resident in the
University of Pennsylvania, working in the
basic science laboratory of Dr Jonathan
Rhoads, was the first to successfully nourish
initially Beagle puppies and subsequently
newborn babies with catastrophic
gastrointestinal malignancies.[1] Dr Dudrick
collaborated with Dr Willmore and Dr Vars to
complete the work necessary to make this
nutritional technique safe and successful.

complication
Blood clots
Chronic IV access leaves a foreign
body in the vascular system, and
blood clots on this IV line are
common.Death can result from
pulmonary embolism wherein a clot
that starts on the IV line but breaks
off goes into the lungs

 Fatty liver and liver failure

Fatty liver is usually a more long
term complication of TPN, though
over a long enough course it is fairly
common. The pathogenesis is due to
using linoleic acid (an omega-6 fatty
acid component of soybean oil) as a
major source of calories.

 Hunger
Because patients are being fed
intravenously, the subject does not
physically eat, resulting in intense
hunger pangs. The brain uses signals
from the mouth (taste and smell), the
stomach/G.I. Tract (fullness) and
blood (nutrient levels) to determine
conscious feelings of hunger.

 Cholecystitis
Total parenteral nutrition increases
the risk of acute cholecystitis due to
complete disuse of gastrointestinal
tract, which may result in bile stasis
in the gallbladder. Other potential
hepatobiliary dysfunctions include
steatosis,steatohepatitis, cholestasis,
and cholelithiasis

 Gut atrophy.
Infants who are sustained on TPN
without food by mouth for prolonged
periods are at risk for developing gut
atrophy

other complication
Catheter complications include
pneumothorax, accidental arterial
puncture, and catheter-related sepsis.

other complication
Metabolic complications include the
refeeding syndrome characterised by
hypokalemia, hypophosphatemia and
hypomagnesemia. Hyperglycemia is
common at the start of therapy, but
can be treated with insulin added to
the TPN solution. Hypoglycaemia is
likely to occur with abrupt cessation
of TPN.