Chapter 073. Enteral and Parenteral Nutrition (Part 10)

Table 73-8 Selected Metabolic Disturbances and Their CorrectionDisturbanceCauseCorrective Action with PNHyponatremiaIncreasedtotalbodyDecrease orfreewater or decreased total body water sodium sodiumincreaseHypernatremiaOccurs commonly withIncreasefreeexcessiveisotonicor water to produce nethypertonic fluid followed by positive fluid balance diuretic administration with maintaining sodiumfree water clearance; can also and chloride balance occur with dehydration and normal total body sodiumHypokalemiaInadequate relative to needintakeUse supplementsExcessive tubular dysfunctiondiuresis,Use supplementsMagnesium deficiencyIncrease magnesiumPNMetabolic alkalosisCorrect alkalosisHyperinsulinemiaMaintain constant PN, increasepotassiumHyperkalemiaExcessive provisionReduce supplements ...
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Chapter 073. Enteral and Parenteral Nutrition (Part 10) Chapter 073. Enteral and Parenteral Nutrition (Part 10)Table 73-8 Selected Metabolic Disturbances and Their CorrectionDisturbance Cause Corrective Action with PNHyponatremia Increased total body Decrease free water or decreased total body water or increase sodium sodiumHypernatremia Occurs commonly with Increase free excessive isotonic or water to produce net hypertonic fluid followed by positive fluid balance diuretic administration with maintaining sodium free water clearance; can also and chloride balance occur with dehydration and normal total body sodiumHypokalemia Inadequate intake Use relative to need supplements Excessive diuresis, Use tubular dysfunction supplements Magnesium deficiency Increase PN magnesium Metabolic alkalosis Correct alkalosis Hyperinsulinemia Maintain constant PN, increase potassiumHyperkalemia Excessive provision Reduce supplements Metabolic acidosis Evaluate alkalosis, treat with PN acetate salt and decrease potassium Renal deterioration Evaluate patient and adjust PN as indicatedHypocalcemia Reciprocal response to Increase phosphorus repletion calcium Critical illness effect Increase calcium Severe malabsorption Supplement calciumHypercalcemia Excessive Reduce or administration or pathologic eliminate calcium (cancer, hyperparathyroidism)Hypomagnesemia Increased requirements Supplement due to diuretic use, alcoholism, magnesium malabsorption, malnutrition Critical illness Supplement magnesiumHypophosphatemia Inadequate intake Supplement relative to needs related to phosphorus malnutrition, alcohol use Increased calcium Use intake supplementsHyperphosphatemia Excessive Reduce administration or worsening phosphorus renal functionAzotemia Excessive amino acid Reduce amino infusion or worsening renal acid level but consider function renal replacement therapy if cannot provide 1 g protein per kg for prolonged periodsNote: PN, parenteral nutrition.