Nutritional Support

Up to 40% of pts may be undernourished on admission to hospital, and two-thirds of all pts lose weight during hospital stay. 60% of elderly pts are malnourished at discharge. More than 376,000 people depend on TPN per year in USA.

Decreased respiratory, cardiac, and skeletal muscle mass and strength.

Up to 50% of heart failure pts are malnourished.

Decreased visceral protein mass, altered GI mucosal barrier.

Altered humoral, cell-mediated immunity.

Altered neutrophil function.

Increased pulm, thromboembolic complications.

Pts with protein-calorie malnutrition have increased risk for postop cardiac, noncardiac complications.

Increased risk for nosocomial infections and decreased wound healing.

Increased risk for multiple organ failure.

Increased length of hospital stay.

Hypoglycemia or hyperglycemia, depending on additives to TPN.

Decreased ability to secrete insulin in malnourished pts.

Kidney dysfunction and failure prevalent in cases of severe malnutrition.

Increased free fraction of certain protein-bound drugs with low albumin levels.

Vitamin B ₁₂ and/or folate deficiency, leading to anemia.

Higher rates of infection with TPN.

Excess carbohydrate administration via TPN may lead to increased CO ₂ production and increased difficulty in weaning from ventilatory support and hepatic steatosis.

Excess fat administration via TPN may lead to hyperlipidemia, decreased immune function, and reduced reticuloendothelial function.