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Evaluation of the Safety of Rapid Parenteral Nutrition Titration
Author(s) -
Curry Dominick,
Giancarelli Amanda,
Vickers Donald C.
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1670
Subject(s) - hypokalemia , hypophosphatemia , medicine , hypomagnesemia , parenteral nutrition , incidence (geometry) , gastroenterology , physics , optics , magnesium , materials science , metallurgy
Background Initiation of parenteral nutrition (PN) can cause complications including hyperglycemia (HGL), electrolyte abnormalities, and refeeding syndrome (RFS). These concerns lead many to titrate over several days, but our practice is to titrate PN to goal within 8 hours. The aim of this study was to evaluate the safety of titrating PN to goal within 8 hours. Methods This was a single‐center, retrospective study of adult patients initiated on continuous PN with titration to goal rate in <8 hours. The primary composite outcome included the incidence of HGL, hypomagnesemia, hypophosphatemia, or hypokalemia within 24 hours of PN initiation. Secondary outcomes included analyses of patients with risk factors for HGL and RFS, critically ill patients, and individual components of the composite outcome. Results Three hundred forty‐two patients were included, with a primary outcome incidence of 24.6% (HGL 17.4%; hypokalemia 1.8%; hypomagnesemia 0.6%; hypophosphatemia 8.5%). The primary outcome was more common in the HGL group (34.3% vs 14.7%, P < 0.01) and in the ICU group (40.9% vs 20.7%, P < 0.01). Mean 24‐hour blood glucose > 180 mg/dL occurred more in the HGL group (27.9% vs 7.6%, P < 0.01) and in the ICU group (34.8% vs 13.8%, P < 0.01). In patients with no risk factors, the primary outcome was 11.9%. Conclusion Rapid PN titration was likely safe in patients without risk factors for HGL or RFS. Further evaluation of protocolized HGL management is needed to determine the risk of HGL in patients with HGL risk factors.