Central Parenteral Nutrition complications

    • 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.