Mechanical complications:
PTx, HTx
subclavian and carotid a puncture
brachial plexus inj
thoracic duct inj
chylothx
air embolism
Metabolic complications:
fluid overload
hypertriglyceridemia
hypercalcemia
hypoglycemia
hyperglycemia
PE, subclavian v. thrombosis
Infectious complications
Hepatobiliary complications
elevated LFTs
steatosis, steatohepatitis, cirrhosis, lipidosis, cholestasis
cholelithiasis, acalculous cholecystitis in Pts receiving >3 wk.
In presence of cholestasis: Avoid copper and manganese in the CPN to prevent liver and basal ganglia damage.
Give a 4 wk trial of metronidazole and ursodeoxycholic acid.
Metabolic bone disease is observed in Pts receiving long-term >3 months CPN.
Radiological evidence of demineralization in Asx Pts.
Bone pain, bone Fx, osteomalacia or osteopenia
Action: remove vit D from CPN formulation, if PTH and 1,25-hydroxy vit D are low; reduce protein to <1.5 g/kg/day (amino acid can cause hypercalciuria); maintain Mg status since Mg is necessary for renal conservation of calcium, and also necessary for normal PTH action; provide PO calcium supplements of 1 - 2 g/day; and consider biphosphanate Tx to decreae bone resorption.