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Complications Of TPN                      

It can be broadly classifised into 3 categories.

  1. Mechanical.        
  2. Infectious.            
  3. Metabolic.
  1. Mechanical Complications.
    1. Arise either due to wrong placement of catheter or due to maintenance of venous access.
    2. Development of pneumo, hydro, hemo, or chylothorax, Cardiac temponade. Q
    3. Injury to subclavian artery or brachial plexus.
    4. Malposition of catheter leading to arrhythmias.
    5. Air embolism or catheter embolism.
    6. Thrombophlebitis or thrombosis of SVC.
    7. Slipping of catheter, or hub detachment.
    8. In order to avoid these complications following steps should be taken:
    9. Catheter position must be confirmed by X-ray before hypertonic solution is infused.
    10. Minimal handling of the catheter
    11. Daily check arm of the patient for edema. Q
  2. Infection: Catheter sepsis is confirmed if;
    1. The catheter tip and blood cultures are positive for the same organism.
    2. Fever disappears/ decreases within 24 hrs of catheter removal.
    3. No other source of infection is identified.
    4. One of the earliest sign of systemic sepsis is sudden development of glucose intolerance (with or without temp increase), in a pt. who previously has been maintained on TPN.
    5. Sepsis is more likely with double or triple lumen tube.
  3. Metabolic Complications In TPN  

Nutrient Excess



Hyperglycemia, Polyuria (*)+polydipsia ± Hyperosmolar non ketotic hyperglycemia

Amino acids

Hyperammonia in patients with liver disease, Azotemia in liver failure      


Hypercalcemia, Pancreatitis, renal stones



Vitamin D

Hypercalcemia, Osteopenia, long bone pains

Nutrient Deficiency


Neutropenia, Anaemia, Scorbutic bone lesions, decreased ceruloplasim, Microcytic anaemia.


Nasolabial and perineal acrodermatitis, Alopecia, decreased cell function, decreased alkaline phosphatase.


Glucose intolerance, Peripheral neuropathy.


Myalgia, Cardiomyopathy, Decreased glutathion peroxidase.


Amino acid intolerance, tachycardia, techypnoea, central scotoma, irritability, decreased uric acids.

Essential fatty acids

Eczymoid dermatitis, alopecia

Vitamin A (#)

Night blindness, Decreased dark field adaptation.


Dermatitis, alopecia, hypotonia.


Wernick’s encephalopathy


*  Normal rate of glucose utilization in a normal adult is =   0.4-1.2 g/kg/hr.


#  Requirement of Vit. E. is directly proportional to dietary fat.

Hypophosphatemia: Develops if phosphorus has not been added in amount adequate to meet the requirements for the metabolism of infused glucose and amino acids. The result is an extra vascular to intracellular shift of phosphate.

  1. Signs and symptoms: paresthesia, confusion, convulsion and death.
    1. Associated with Hypophosphatemia is a reduction in erythrocytic 2,3-diphosphoglycerate leads to increased affinity of Hb for oxygen hence, less O2 is released to peripheral tissue.
    2. Early metabolic problem specially in elderly and debilitated patients including fluid overload producing CHF and glucose overload leading to stimulation of insulin secretion which causes intracellular shift of Phosphorus and potassium with resultant depletion of phosphorus and potassium leading to arrhythmias, cardiopulmonary function and neurological symptoms. Q
    3. To avoid these complications TPN should be started slowly and monitored carefully.
    4. Late metabolic complications include cholestatic liver disease with bile sludging and gall stones. Q
    5. The exact cause of liver disease is not understood but appears to be linked to the lack of enteral nutrition, the disease is less likely if some enteral feeding is continued.
    6. Hyperosmolar non-ketotic hyperglycemia develops either if the hypertonic solutions are administered too rapidly or if the patient has impaired glucose tolerance.
    7. This is particularly common in latent diabetics and in patients following severe surgical stress or trauma.
    8. Treatment of the condition consists of volume replacement, administration of insulin, electrolyte abnormality to be corrected.
  2. Complications Of TPN (Summary)





First 24 hrs.

Fluid overload




Refeeding syndrome

Cephalad displacement.


First 2 weeks

Cardio-pulm. Failure

Hyper osmolar non-ketotic             

Electrolyte imbalance

Acid-base imbalance

Catheter induced sepsis

Catheter extrusion


Air embolism

After 3 months

Essential fatty acid def.

Zn, Cu, Cr, Se, Mo, def.

Iron def.

Vit. Def.

TPN induced liver disease.

TPN induced metabolic bone                              

Catheter induced sepsis.

# or tear in catheter.


Displacement of catheter hub with blood loss or air embolism

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