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Metabolic derangements in children requiring parenteral nutrition
Insights
Parenteral nutrition in hospitalized children frequently causes metabolic complications like low albumin and minerals. Many of these issues were present before treatment began, indicating underlying malnutrition.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Metabolic disorders
Background:
- Parenteral nutrition (PN) is common in hospitalized children.
- Metabolic complications of PN in pediatrics are not well-documented.
Purpose of the Study:
- To prospectively assess the frequency and nature of metabolic complications in pediatric patients receiving PN.
- To identify factors associated with these complications.
Main Methods:
- Prospective study of 201 pediatric patients receiving PN from January 1982 to December 1982.
- Weekly monitoring of serum electrolytes, minerals, liver function, and renal function tests.
- Data collected on central vs. peripheral line use and sepsis rates.
Main Results:
- High incidence of metabolic complications observed, including hypoalbuminemia, hypocalcemia, hypophosphatemia, and hypomagnesemia.
- Abnormal liver function tests in one-third of patients; renal dysfunction in 10%.
- Complications were more frequent with central line PN; sepsis rates were 3.7-4.8%.
Conclusions:
- Parenteral nutrition is associated with a high rate of metabolic complications in pediatric patients.
- Many complications appear to stem from pre-existing malnutrition, particularly evident at PN initiation.
- Peripheral PN generally resulted in fewer complications compared to central PN.
Abstract:
Intravenous alimentation is routinely used in many hospitalized pediatric patients, however, there are few reports of the nature and frequency of metabolic complications. In order to assess the frequency and nature of metabolic complications all children receiving parenteral nutrition from January 1, 1982 to December 31, 1982 were prospectively enrolled in the study. Data collection began with the institution of parenteral nutrition. Serum electrolytes, minerals, liver function tests, and renal function tests were followed weekly. A total of 201 patients received parenteral nutrition for 5378 days. Nutrition was delivered to 146 patients (4980 patient days) via a central line and 55 patients via a peripheral line (398 patient days). The sepsis rate was 3.7% in central lines used only for parenteral and 4.8% in multipurpose central lines. In general, complications were fewer in the patients supported peripherally. In patients supported centrally, hypoalbuminemia was the most commonly found abnormality followed by hypocalcemia, hypophosphatemia and hypomagnesemia, reflecting a malnourished state. One-third of the patients had abnormal liver function tests, and in half of those factors causing liver dysfunction other than parenteral nutrition were present. Abnormal renal function tests occurred in 10% of the patients. Thus, a high incidence of metabolic complications occurred in association with parenteral nutrition. Most were present during the initiation of parenteral nutrition, suggesting an abnormal metabolic state was present prior to the institution of parenteral nutrition. The frequency of low serum albumin and minerals is consistent with previous publications of the prevalence of malnutrition in hospitalized patients.