Parenteral Nutrition Patients Research Articles

The Role of Total Parenteral Nutrition in Patients with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis.

Simple SummaryPatients with peritoneal carcinomatosis often develop complications which prevent them from receiving adequate oral intake. This can contribute to malnutrition, as well as increased morbidity and mortality. In such patients, total parenteral nutrition, which involves the intravenous administration of nutrients thereby bypassing the oral route, can be lifesaving. In this study, we performed a systematic review and meta-analysis of the existing literature to evaluate the effect of total parenteral nutrition on the survival of patients with peritoneal carcinomatosis. In light of the limited treatment options available, total parenteral nutrition may improve survival outcomes, but further studies are needed to conclude definitively.Peritoneal carcinomatosis (PC) is often associated with malnutrition and an inability to tolerate enteral feeding. Although total parenteral nutrition (TPN) can be lifesaving for patients with no other means of nutritional support, its use in the management of PC patients remains controversial. Therefore, a systematic review and meta-analysis was performed to evaluate the benefit of TPN on the overall survival of PC patients, in accordance with PRISMA guidelines. A total of 187 articles were screened; 10 were included in this review and eight were included in the meta-analysis. The pooled median overall survival of patients who received TPN was significantly higher than patients who did not receive TPN (p = 0.040). When only high-quality studies were included, a significant survival advantage was observed in PC patients receiving TPN (p < 0.001). Subgroup analysis of patients receiving chemotherapy demonstrated a significant survival benefit (p = 0.008) associated with the use of TPN. In conclusion, TPN may improve survival outcomes in PC patients. However, further studies are needed to conclude more definitively on the effect of TPN.

Impact of nationwide essential trace element shortages: A before-after, single-center analysis of hospitalized adults receiving home parenteral nutrition therapy.

Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages. We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods. Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%). ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.

Effect of Early Versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review.

ObjectivesThis systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults.MethodsThe literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched.ResultOn screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients’ quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group.ConclusionThe supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients’ diagnosis varied.

P-95: Quality of Life Assessment of the Home Parenteral Nutrition Patients in the Waiting List for Intestinal Transplantation in Brazil

P-95: Quality of Life Assessment of the Home Parenteral Nutrition Patients in the Waiting List for Intestinal Transplantation in Brazil

Home parenteral nutrition patients on mixed oil lipid emulsion have a higher rate of hospitalizations compare to those on soybean oil– a prospective 2-year cohort study

Mixed oil intravenous lipid emulsion (MO ILE) that contains 30% soybean oil (SO), 30% medium chain triglycerides, 25% olive oil and 15% fish oil can benefit hospitalized patients receiving parenteral nutrition (PN) but there are very few studies on its long-term use. Our goal was to evaluate the clinical outcomes of adults receiving home PN (HPN) with MO versus those receiving SO ILE over a 2-year period. This is a retrospective analysis of data collected prospectively from a cohort of patients recorded in the Canadian HPN Registry over a 2-year period. HPN patients from academic programs across Canada were entered in the Registry according to a validated protocol. For this study, demographic, nutritional, laboratory and clinical data were extracted from January 1st 2015, when MO lipid emulsion became available in Canada, to July 24th 2019. Clinical data for each patient included: number of hospitalizations, number of hospitalizations related to HPN and number of hospitalization days related to HPN, over a year; incidence of line sepsis per 1000 catheter days and mortality. Data are presented as median (1st, 3rd quartile) for continuous variables and frequency (percentage) for categorical variables. Comparisons between groups were performed using two sample t-test or Wilcoxon Rank Sum tests for continuous variables and Chi-square tests or Fisher's exact tests for categorical variables. Univariate and multiple linear regressions were also carried out. Statistical significance is set at a p-value <0.05. A total of 120 patients were included (MO n=68, SO n=52). Significant differences at baseline between the two groups were a higher use of Hickman line (62.12% vs 42%, p=0.038) and more western Canada based hospital care with MO (75% vs 42.31%, p=0.0002). The MO group had significantly more hospitalizations (p=0.001), more hospitalizations related to HPN (p=0.012) and more hospitalization days related to HPN (p=0.016) per patient per year compared to SO patients. There was no significant difference between groups for line sepsis per 1000 catheter days (MO: 0.05 (0.0, 1.0) vs SO: 0.0 (0.0, 0.22), p=0.053) or mortality. All other variables, including biochemical variables, were similar between groups. In a multiple regression analysis, the following factors were significantly associated with a greater number of hospitalizations per patient per year: use of MO, high blood glucose from the last recorded value and having died by the end of the study period. This 2-year prospective cohort study suggests an increased risk of hospitalization in HPN patients receiving MO lipid emulsion. The long-term effect of using MO lipid emulsion in HPN patients should be further evaluated using a large randomized controlled trial. THE STUDY WAS REGISTERED IN CLINICALTRIALS.GOV: (NCT02299466).

The effects of the administration of in‐hospital selenium preparation to home parenteral nutrition patients.

The effects of the administration of in‐hospital selenium preparation to home parenteral nutrition patients.

The use of the internal mammary vein for central venous access

Purpose: To describe the use of the internal mammary vein as an alternative access for central venous catheters.Methods: We performed a retrospective review of patients who underwent placement of central venous catheters via the internal mammary vein. Patient demographics, indication for venous access, technical success, catheter type, dwell time and indication for exchange or removal were recorded.Results: Placement of central venous catheters via the internal mammary vein was attempted in 11 patients including 8 children (4 males, mean age 5.7 years) and 3 adults. The most common indication was parenteral nutrition in patients with intestinal failure (7/11). Initial needle access of the vein was successful in all patients. Catheter placement was successful in 9 and unsuccessful in 2 patients due to occlusion of the superior vena cava. There were no immediate complications. A total of 20 catheters of various sizes (3–14.5 French) and lengths (8–23 cm) were either placed (n = 12) or exchanged (n = 8). The most common indications for catheter exchange were poor function and malposition (7/8). Four catheters were removed for infection and 4 were accidentally removed. The mean dwell time was 141 days (range 0–963 days) per catheter for a total of 2829 catheter days. The total mean dwell time per patient, including primarily placed and exchanged catheters, was 314 days (range 5–963 days).CONCLUSIONS: The internal mammary vein may provide a safe alternative route for patients who have lost their traditional access veins.

Plasma and Red Blood Cell PUFAs in Home Parenteral Nutrition Paediatric Patients-Effects of Lipid Emulsions.

Background: Mixed lipid emulsions (LE) containing fish oil present several advantages compared to the sole soybean oil LE, but little is known about the safety of essential fatty acids (EFA) profile in paediatric patients on long-term Parenteral Nutrition (PN). Aim of the study: to assess glycerophosfolipid polyunsaturated fatty acids (PUFA) levels on plasma and red blood cell (RBC) membrane of children on long term PN with composite LE containing fish oil (SMOF), and to compare it with a group receiving olive oil LE (Clinoleic®) and to the reference range for age, previously determined on a group of healthy children. Results: A total of 38 patients were enrolled, median age 5.56 (0.9–21.86) years, 15 receiving Clinoleic®, 23 receiving SMOF. Patients on SMOF showed significantly higher levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower levels of arachidonic acid (ARA) and Mead acid (MEAD)/ARA ratio in plasma and RBC compared with patients on Clinoleic® and with healthy children. Triene:tetraene (T:T) ratio of both groups of patients did not differ from that of healthy children-median plasma (MEAD/ARA: 0.01, interquartile rage (IQR) 0.01, p = 0.61 and 0.02, IQR 0.02, p = 0.6 in SMOF and Clinoleic® patients, respectively), and was considerably lower than Holman index (>0.21). SMOF patients showed no statistically significant differences in growth parameters compared with Clinoleic® patients. Patients of both groups showed stiffness class F0-F1 of liver stiffness measure (LSM) 5.6 (IQR 0.85) in SMOF patients and 5.3 (IQR 0.90) in Clinoleic® patients, p = 0.58), indicating absence of liver fibrosis. Conclusions: Fatty acids, measured as concentrations (mg/L), revealed specific PUFA profile of PN patients and could be an accurate method to evaluate nutritional status and eventually to detect essential fatty acid deficiency (EFAD). SMOF patients showed significantly higher EPA, DHA and lower ARA concentrations compared to Clinoleic® patients. Both LEs showed similar hepatic evolution and growth.

Outcomes associated with strong opioid use for non-cancer pain in patients with chronic intestinal failure

Rationale: Opiates have a role as a part of multimodal therapy for management of non-cancerous pain in carefully selected patients. Previous studies in intestinal failure (IF) showed that over one third of home parenteral nutrition (HPN) patients were using opioids on a regular basis. This study aim to evaluate the prevalence of opioids use in an HPN population and the outcomes associated with its use.

Are we providing adequate vitamin K to patients receiving parenteral nutrition?

Rationale: Certain patients established on long-term parenteral nutrition (PN) receive lipid free (aqueous) formulations for reasons such as liver dysfunction or intolerance to the lipid component. Certain commonly used adult IV multivitamin preparations stable in aqueous formulations do not contain any vitamin K (phylloquinone), and a vitamin K deficiency was suspected in certain home PN patients under the care of the Intestinal Failure (IF) centre.

Carotid artery intima-media thickness in adults receiving long-term home parenteral nutrition

Background and aimsNutrition regimen in parenteral nutrition (PN) patients allows for a control of diet components. This may affect the process of lipid deposition in the vascular wall and change the risk of atherosclerosis. This study aims to examine the effect of long-term PN in adults on carotid intima-media thickness. Methods and resultsThirty long-term PN patients (15 men and 15 women, mean age 64.7 ± 8.5 years) and thirty healthy volunteers (HV) (15 men and 15 women, mean age 64.9 ± 8.77 years) entered the study. Total amino acid and lipid formulation intake as well as duration of PN were calculated for PN patients. The common carotid artery intima-media thickness (CCA IMT) was examined in both groups.A lower CCA IMT (right/left mean: PN - 776 ± 121 vs HV - 848 ± 121 μm, p < 0.05; right/left maximum CCA IMT: PN - 935 ± 139 vs HV - 1024 ± 135 μm, p < 0.05) in PN patients was observed. A lower serum level of total (PN - 131.43 ± 43.12 vs HV - 209.2 ± 48.01 mg/dl, p < 0.05) and HDL (PN- 44.16 ± 12.45 vs HV - 72.57 ± 25.04 mg/dl, p < 0.05) cholesterol was reported in the PN patients. A correlation between patients’ age and CCA IMT was observed in the control group, but not in the PN patients (right/left mean CCA IMT - PN: r = 0.48, p-0.007 vs HV: p-0.073; right/left maximum CCA IMT – PN: r = 0.48, p-0.008, vs HV: p-0.073). ConclusionsLong term PN in adults is associated with lower CCA IMT. Long-term PN patients are a unique group in which carotid intima-media thickness does not correlate with the age.

Utilization of a standardized discharge checklist to improve the transition of care for patients receiving parenteral nutrition.

Guidelines recommend using discharge checklists to discharge patients receiving parenteral nutrition (PN). Transition-of-care (TOC) tools have not been extensively studied in the PN population. The purpose of this study is to evaluate the impact of a standardized PN discharge checklist on TOC for PN patients. This is an Institutional Review Board-approved, retrospective quasi-experimental study of patients discharged receiving PN between January 1, 2014, and May 31, 2018. The primary end point was the completion of a PN discharge bundle (identification of a responsible provider to monitor PN after discharge, meeting daily caloric requirement of 20-35 kcal/kg/d, cycling PN prior to discharge). Secondary end points included documentation of PN discharge checklist components, hospital length of stay, frequency of 30-day hospital encounters, cause of hospital encounters, and time to readmission. Fifty encounters were included in the pregroup and postgroup each (n= 100). There was a significant increase in completion of the TOC bundle in the postgroup (54% vs 76%, P = .035), driven by identification of a responsible provider for outpatient PN management (54% vs 82%, P = .005). Other PN discharge checklist components impacted included the following: case manager had the PN prescription for home infusion (50% vs 80%, P = .003), assessment for home glucometer (40% vs 90%, P < .001), and PN plan-of-care note documentation at discharge (18% vs 82%, P < .001). A standardized PN discharge checklist improved completion of discharge bundle.

Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota.

BackgroundWe sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN.MethodsWe used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN.ResultsFourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis.ConclusionsLess than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

Variability in Parenteral Nutrition Use in US Children's Hospitals

The variability of parenteral nutrition (PN) use for pediatric inpatients is currently unknown. In this study, we aim to determine the variability in PN use in US children's hospitals and the association of PN initiation with inpatient PN use. We performed a retrospective cohort study of children who received PN during an inpatient encounter in US children's hospitals. Hospitals were divided into tertiles based on their rates of PN use: low (<36.9 of 1000 encounters), medium (36.9-51.8 of 1000 encounters), and high (>51.8 of 1000 encounters). Multivariable regression models were developed to assess the associations between hospital PN use and time to PN initiation, PN duration, and encounter length of stay after adjustment for salient patient characteristics. The cohort included 82,142 patients receiving PN, and rates of hospital PN use ranged from 5.9 to 76.7 patients receiving PN per 1000 inpatient encounters. After multivariable adjustment, patients treated at high-use hospitals had a significantly shorter time to initiation of PN compared with low-use hospitals (incident rate ratio [95% CI]: 0.78 [0.69-0.89]; P < .001). There was no significant association between low- and medium- or high-use hospitals regarding PN duration or hospital length of stay. Large variation in PN use exists among US children's hospitals. High-use hospitals are more likely to start PN earlier but do not have longer PN duration or encounter length of stay. This variability makes PN use an ideal target for hospital quality improvement efforts to improve adherence to PN evidence-based guidelines.

The clinical potential of GDF15 as a \u201cready-to-feed indicator\u201d for critically ill adults

BackgroundCirculating growth-differentiation factor-15 (GDF15), a cellular stress marker, abruptly increases during critical illness, but its later time course remains unclear. GDF15 physiologically controls oral intake by driving aversive responses to nutrition. Early parenteral nutrition (PN) in ICU patients has overall been shown not beneficial. We hypothesized that low GDF15 can identify patients who benefit from early PN, tolerate enteral nutrition (EN), and resume spontaneous oral intake.MethodsIn secondary analyses of the EPaNIC-RCT on timing of PN initiation (early PN versus late PN) and the prospective observational DAS study, we documented the time course of circulating GDF15 in ICU (N = 1128) and 1 week post-ICU (N = 72), compared with healthy subjects (N = 65), and the impact hereon of randomization to early PN versus late PN in propensity score-matched groups (N = 564/group). Interaction between upon-admission GDF15 and randomization for its outcome effects was investigated (N = 4393). Finally, association between GDF15 and EN tolerance in ICU (N = 1383) and oral intake beyond ICU discharge (N = 72) was studied.ResultsGDF15 was elevated throughout ICU stay, similarly in early PN and late PN patients, and remained high beyond ICU discharge (p < 0.0001). Upon-admission GDF15 did not interact with randomization to early PN versus late PN for its outcome effects, but higher GDF15 independently related to worse outcomes (p ≤ 0.002). Lower GDF15 was only weakly related to gastrointestinal tolerance (p < 0.0001) and a steeper drop in GDF15 with more oral intake after ICU discharge (p = 0.05).ConclusionIn critically ill patients, high GDF15 reflected poor prognosis and may contribute to aversive responses to nutrition. However, the potential of GDF15 as “ready-to-feed indicator” appears limited.Trial registrationClinicalTrials.gov, NCT00512122, registered 31 July 2007, https://www.clinicaltrials.gov/ct2/show/NCT00512122 (EPaNIC trial) and ISRCTN, ISRCTN 98806770, registered 11 November 2014, http://www.isrctn.com/ISRCTN98806770 (DAS trial)

Efficacy of 4% tetrasodium ethylenediaminetetraacetic acid (T-EDTA) catheter lock solution in home parenteral nutrition patients: A quality improvement evaluation.

A functioning and reliable central venous access device is fundamental for home parenteral nutrition patients to administer essential nutrition. Complications of central venous access devices including occlusion, microbial colonization, and biofilm formation are problematic and sometimes life-threatening. A novel lock solution, 4% tetrasodium ethylenediaminetetraacetic acid, has properties that may reduce such complications. The aim of this study was to determine the safety, efficacy, and cost implications of implementing 4% tetrasodium ethylenediaminetetraacetic acid to prevent catheter-related complications in home parenteral nutrition patients. A pre- and post-intervention study was carried over 36 months (12 months pre; 24 months post) by the British Columbia Home Parenteral Nutrition Program in Vancouver, Canada, where 4% tetrasodium ethylenediaminetetraacetic acid was implemented for patients at high risk for central venous access device occlusion and catheter-related infection. Patients were included in the study if they had previous central venous access device complications. The outcomes evaluated were central line-associated bloodstream infection, catheter occlusion requiring thrombolytic treatment, and catheter replacements. In total, 22 out of 105 patients met the inclusion criteria. Two patients were excluded from analyses due to non-adherence and concomitant use of other lock solutions. Post intervention, 20 home parenteral nutrition patients experienced significant reduction in the central line-associated bloodstream infection rate (pre = 1.918/1000 catheter days; post = 0.563/1000 catheter days; p = 0.04) There were no occlusion events reported post intervention. For home parenteral nutrition patients, 4% tetrasodium ethylenediaminetetraacetic acid lock solution effectively reduces the risk of central venous access device complications including occlusions and catheter-related infections.

Effects of Sexual Function, Social Media Use, and Self-Efficacy on Quality of Life Among Home Parenteral Nutrition Patients.

Quality of life (QOL) of home parenteral nutrition (HPN) patients is a critical issue for functioning and survival. This study evaluates the roles of sexual function (SF), self-efficacy (SE), and the use of social media (USM) in the QOL of HPN patients. The study model investigates the independent variables USM and SF and the dependent variable QOL, and SE is a mediator variable between SF and USM. We included 203 participants with HPN who completed self-administered, validated questionnaires for QOL, SF, SE, and USM. Statistical analysis included a t-test, Sobel test, bootstrapping method, and Pearson correlations between variances. The mean HPN duration was 10.5 ± 8 years. Results show a significant correlation between QOL scores and SF (P = .001). USM was positively correlated with SE (P = .001). SE as a mediator between USM and SF was supported by significant results in the Sobel test. Patients with a stoma were significantly less sexually active and had lower SE ratings than those without a stoma. Physical changes that affect SE and boost social relationships by allowing emotional support through social networks are important factors for QOL improvement. These findings may guide health professionals in the management of HPN patients.

Telehealth and Nutrition Support During the COVID-19 Pandemic

Telehealth and Nutrition Support During the COVID-19 Pandemic

Factors Associated With Central Line-Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients.

Central line-associated bloodstream infection (CLABSI) is a potentially life-threatening complication in home parenteral nutrition (HPN) patients. We investigated potential predictors of CLABSI in a cohort of adult HPN patients METHODS: Patients managed by the HPN service at the Hospital of University of Pennsylvania on January 1, 2018, were included and followed through June 30, 2019, using existing medical records to collect demographic and clinical data. CLABSIs were adjudicated prospectively by infectious disease experts. Variables with P ≤ .2, when comparing patients with CLABSIs and those without, were included in logistic regression models. Among 114 patients, mean age was 54 ± 16 years, 78/114 were female, and BMI was 25 ± 5.6. Median experience with HPN was 516 days (range, 15-10,281), and 30 had prior CLABSI. Catheter types were peripherally inserted central catheters (83/114), tunneled (27), and implanted (4). The incidence of CLABSI was 0.89 per 1000 catheter days. One multivariate model identified ostomy/wound (odds ratio [OR], 22.0; 95% CI, 4.8-101.7), tunneled/implanted catheter (OR, 4.4; 95% CI, 1.4-13.9), and BMI < 18.5 (OR, 5.9; 95% CI, 1.4-24.2) as predictors of CLABSI. A second model identified patients with 2 potential predictors (OR, 22.9; 95% CI, 5.6-93.5) and tunneled/implanted catheter (OR, 6.7; 95% CI, 2.1-21.8) at high risk of CLABSI. Whether CLABSIrates might be reduced by more intense training in wound or catheter care (especially for those with multiple predictors), different types of catheters, or rapid treatment of malnutrition will require further study.

1042-P: Insulin Requirement during Total Parenteral Nutrition in Patients with Diabetes Mellitus

Glycemic control in patients with diabetes mellitus receiving total parenteral nutrition (TPN) can be challenging due to multiple factors. These patients often have a high burden of illness and receive medications that raise blood glucose (BG) levels. Moreover, TPN delivers a large amount of glucose directly into the systemic circulation without the benefit of incretin effect. Therefore, relatively large amounts of insulin are expected to be required for glycemic control. However, there are no studies to guide insulin dosing in patients with diabetes being started on TPN. We conducted a retrospective study including all patients with diabetes admitted to our hospital over a 1-year period who received TPN for ≥ 3 days. The goal of this study was to estimate a safe starting dose of insulin for TPN. Patients receiving enteral nutrition along with TPN were excluded. Insulin doses and blood glucose levels on the last day of TPN were used for data analysis. We found 25 patients who fulfilled our inclusion/exclusion criteria. All patients had type 2 diabetes and were receiving antidiabetic drugs before hospitalization. Mean age was 68 ± 7 years, 56% were men, 80% were White, 44% had microvascular and 44% had macrovascular complications. Mean BMI was 26.7 ± 6.7 kg/m2, systolic BP 131 ± 27 mmHg, diastolic BP 65 ± 15 mmHg, HbA1c 7.7 ± 2.3% and serum creatinine 2.7 ± 3.3 mg/dl. The mean daily BG on TPN was 212 ± 47 mg/dl. Out of 171 BG values available on the last day of TPN, 116 (68%) were &amp;gt;180 mg/dl, 4 (2%) were &amp;lt;70 mg/dl and 0 were &amp;lt;40 mg/dl. Only two patients suffered mild hypoglycemic episodes while all others remained hyperglycemic. Average total daily insulin dose was 17 ± 20 units before starting TPN and 53 ± 54 units on the last day of TPN. Patients received an average of 0.7 Units/kg total daily dose of insulin on the last day of TPN. With this dose, they had minimal risk of hypoglycemia but the glucose levels were often high. Our study shows that the majority of patients with diabetes need more than 0.7 units/kg insulin when receiving TPN. Disclosure R. Garg: None. A. Arunachalam: None. L.E. Bermudez: None. M. Ramirez: None.