1. Underfeeding - Using peripheral TPN when it is inadequate
2. Overfeeding - Excess carbohydrate can lead to fatty liver, CO2
accumulation and hyperglycemia. Excess protein can lead to azotemia.
3. Non-use of the gut may lead to hepatic cholestasis, gallbladder disease,
and GI mucosal atrophy (which may be linked to bacterial translocation). If
not contraindicated, enteral nutrition even at minimal levels is encouraged.
4. Central venous catheter complications include pneumothorax, bleeding,
venous thrombosis, and sepsis. Patients with impaired host defenses are
especially prone to catheter-related bacterial and fungal infections.
5. Metabolic complications (in approximate order of frequency):
hyperglycemia, hypophosphatemia (refeeding syndrome), hypokalemia,
hypoglycemia, hypomagnesemia, hypernatremia, hyperphosphatemia,
thrombocytopenia due to heparin in TPN, alkalosis, acidosis, liver
abnormalities, vitamin deficiency, trace element deficiency and lipid
complications.
6. Long term therapy with lipids can cause hepatomegaly, jaundice due to
central lobular cholestasis, splenomegaly and thrombocytopenia. Failure to
supplement lipids can lead to essential fatty acid deficiency.
