Suggested Schedule For Minimal Monitoring Of Parenteral Nutrition

Metabolic Status

Variables

Unstable

Stable

Blood glucose

1-6 X daily

Daily

Osmolality

Daily

2X weekly

Electrolytes (Na+, K+, Cl+)

Daily

Daily

Calcium, phosphate, magnesium

Daily

3X weekly

Daily BUN increment

Daily

Daily

Urea nitrogen appearance rate

Daily

2 X weekly

Triglycerides

Daily

2 X weekly

Blood gas analysis, pH

Daily

1X weekly

Ammonia

2 X weekly

1 X weekly

Transaminases + bilirubin

2 X weekly

1 X weekly

FIGURE 18-36

Complications and monitoring of nutritional support in acute renal failure (ARF).

Complications: Technical problems and infectious complications originating from the central venous catheter, chemical incompatibilities, and metabolic complications of parenteral nutrition are similar in ARF patients and in nonuremic subjects. However, tolerance to volume load is limited, electrolyte derangements can develop rapidly, exaggerated protein or amino acid intake stimulates excessive blood urea nitrogen (BUN) and waste product accumulation and glucose intolerance, and decreased fat clearance can cause hyperglycemia and hypertriglyceridemia. Thus, nutritional therapy for ARF patients requires more frequent monitoring than it does for other patient groups, to avoid metabolic complications.

Monitoring: This table summarizes laboratory tests that monitor parenteral nutrition and avoid metabolic complications. The frequency of testing depends on the metabolic stability of the patient. In particular, plasma glucose, potassium, and phosphate should be monitored repeatedly after the start of parenter-al nutrition.

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