[ Vol. 12 No. 2 ] (May - August 2011 )
Parenteral nutrition metabolic complications associated with hypercaloric PN and High dextrose concentration in PN

Y T Wang1, J L Ng2, K L Ling1, D H L Ng1
1Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
2Yong Loo Lin School of Medicine, National University of Singapore, Singapore


Parental Nutrition (PN) is an important supportive therapy but is associated with hyperglycaemia, hypertriglyceridaemia and abnormal liver function tests (LFTs). Incidences of these metabolic complications were examined.

Patients who received PN in 2006 were retrospectively analysed.  Data on blood glucose, triglyceride, LFTs and calories administered were examined. Hyperglycaemia was defined as random glucose > 10mmol/L over 24 hours. Hypertriglyceridamia was defined by levels > 2.09mmol/L. Deranged LFTs were defined as raised bilirubin, AST, ALT or ALP 1.5 times above the reference range. Hypercaloric feeding (HC) was defined as > 25 kcal/kg/day. Patients with metabolic derangements prior to PN were excluded.

182 patients [102 males, 92 females; 82% surgical, 18% medical; median age 62 years (range 16-100)] received 194 courses of PN. Hyperglycaemia, hypertriglyceridaemia and deranged LFTs were observed in 20.6% (29/141), 29.4% (47/160) and 48.6% (67/138) respectively. Hyperglycaemia correlated significantly with deranged LFTs (p = 0.05) but not with hypertriglyceridaemia (p = 0.88). HC correlated negatively with hyperglycaemia (p = 0.004). Higher percentage of dextrose in PN correlated significantly with hypertriglyceridaemia (p = 0.05) but not with hyperglycaemia (p = 0.76). Hypertriglyceridaemia correlated significantly with abnormal LFTs (p = 0.01).

In this study, hyperglycaemia, hypertriglyceridaemia and deranged LFTs were observed. The deranged LFTs might be due to hyperglycaemia and hypertriglyceridaemia. The correlation between higher percentage of dextrose and hypertriglyceridaemia and the negative correlation between HC and hyperglycaemia were probably due to alterations in PN prescription in response to the observed complication.


PENSA 2009

“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 63