Question

A client has been on total parenteral nutrition (TPN) for 8 weeks at home. The health care provider prescribes that the TPN be weaned by 50 mL per hour per day until discontinued. The client asks the nurse why the TPN cannot just be stopped. The nurse explains that unless the TPN infusions are tapered gradually, the client is at risk for developing which complication?

a) Hyperglycemia
b) Malnutrition
c) Hypovolemia
d) Refeeding syndrome

Answer 1

Abruptly stopping total parenteral nutrition can lead to hypoglycemia because the body's insulin production might not adjust quickly enough to the sudden change in glucose availability, consequently causing low blood sugar levels.

Step-by-step explanation:

When a client has been on total parenteral nutrition (TPN) for an extended period and is instructed to wean off the therapy by reducing the infusion rate gradually, it is essential to prevent complications. One of the risks of abruptly stopping TPN is the development of hypoglycemia. This occurs because the body's insulin production has been regulated to accommodate the high glucose levels provided by the TPN. Once the infusion is stopped suddenly, there is a risk that excess insulin will be present in the body relative to the glucose levels, leading to hypoglycemia, unlike situations with excessive insulin antagonists leading to hyperglycemia.

During insulin therapy, if hypoglycemia is very severe and persists for a longer period, it indicates that the insulin dose is more than required, and a similar case can arise when transitioning off TPN. This is why the TPN must be tapered off slowly, allowing the body to adjust its own insulin production and avoid a sudden drop in blood sugar levels that could result in hypoglycemia. Refeeding syndrome is another potential risk when re-introducing oral or enteral food after a period of malnutrition or limited intake, but it is not typically associated with the cessation of TPN.