Complications Associated with Parenteral Nutrition

Parenteral nutrition (PN) involves the intravenous administration of nutrients and serves as a life-saving strategy for patients who cannot receive enteral nutrition due to various reasons such as impossibility, non-acceptance, insufficiency, temporary contraindication to enteral access, or long-term malabsorption issues. PN solutions consist of electrolytes, macronutrients, and micronutrients infused intravenously via central vascular access devices in highly concentrated and hyperosmotic solutions to prevent fluid overload. Complications associated with PN can be categorized into metabolic, mechanical, and infectious, and their occurrence depends on factors such as the timing of PN initiation, dosage, duration, proper clinical practice for vascular access device management, and integration with enteral nutrition. Refeeding syndrome (RS) is a critical complication of PN that often goes undiagnosed due to its subtle yet potentially lethal manifestations. RS is characterized by metabolic and electrolyte changes and corresponding clinical symptoms, typically occurring shortly after reintroduction or an increase in caloric intake following a period of food absence or restriction, whether through parenteral, enteral, or oral feeding routes. To mitigate the risk of complications associated with PN, it is essential to avoid unnecessary PN use or, at the very least, minimize PN dosage and volume. Instead, oral and enteral nutrition should be preferred whenever possible as they align with physiological feeding methods. The primary objective is to meet the patient’s caloric and protein requirements to ensure adequate metabolic support, especially in critically ill patients in the intensive care unit (ICU).