Abstract

Background: Total parenteral nutrition (TPN) provides full nutrition support to critically ill patients with an impaired digestive tract. Patients who receive TPN support are at higher risk for complications such as hyperglycemia. In our study, we aim to assess the prevalence of hyperglycemia induced by TPN and identify its risk factors in hospitalized adult patients.Methods: Patients who received TPN between January 2012 and December 2017 at University of Pittsburgh Medical Center—St. Margaret hospital were retrospectively screened. TPN-induced hyperglycemia was confirmed whether blood glucose was ≥180 mg/dL at any point, from the time of TPN initiation until 1-day post TPN termination. Characteristics of the hyperglycemia and the nonhyperglycemia groups were analyzed to predict potential risk factors.Results: A total of 197 patients were screened, 55 were excluded (1 died, 37 diabetic, and 17 had elevated blood glucose before TPN), and 142 patients were included, 42 of them (29.6%) developed hyperglycemia following TPN administration. Duration of TPN, surgical indications, and obesity were significantly higher in the hyperglycemia group. Additionally, age and steroids use were independent predictors of hyperglycemia in TPN patients after applying multivariable logistic regression model on our sample.Conclusions: Hyperglycemia is common after TPN. Risk factors assessment may help optimizing glycemic control in higher risk individuals to improve their outcomes. These include patients with obesity, surgical indication of TPN, and longer duration of TPN.

Highlights

  • Total Parenteral Nutrition (TPN) is an essential lifesaving tool that infuses dextrose, amino acids, lipids, electrolytes, vitamins, and minerals intravenously

  • Out of the remaining 159 patients, we identified and excluded 17 cases that had an elevated blood glucose value greater than 180 mg/dL during the 3-day period before Total parenteral nutrition (TPN) administration

  • We found that the odds of getting hyperglycemia for steroids takers who receive TPN are 585% higher than the odds among nonsteroids takers (OR = 6.85, 95% CI: 1.09– 43.5, P = 0.04)

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Summary

Introduction

Total Parenteral Nutrition (TPN) is an essential lifesaving tool that infuses dextrose, amino acids, lipids, electrolytes, vitamins, and minerals intravenously. TPN is associated with multiple metabolic complications.[3] Hyperglycemia, defined as blood glucose value greater than 180 mg/dL or 10 mM per the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines, is one of the metabolic complications that is common among adult patients receiving. Total parenteral nutrition (TPN) provides full nutrition support to critically ill patients with an impaired digestive tract. Patients who receive TPN support are at higher risk for complications such as hyperglycemia. We aim to assess the prevalence of hyperglycemia induced by TPN and identify its risk factors in hospitalized adult patients. Risk factors assessment may help optimizing glycemic control in higher risk individuals to improve their outcomes These include patients with obesity, surgical indication of TPN, and longer duration of TPN

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