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PN Evidence Compared to Guidelines

© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. Energy Older PN Studies Recent PN Studies Current Guidelines1,2
Dextrose 19.1 NPC/kg -40 kcal/kg ~17-28 kcals/kg 20-30 kcal/kg
Not reported 4-5 mg/kg/min
Protein 2.5-3 mg/kg/min4
Lipid Source 150:1 Kcal:Nitrogen (estimated) 1.2-2.0 g/kg
Glycemic Control Soybean oil 0.7-1.2 g/kg No clear consensus
190-300 mg/dL Soybean or MCT:LCT 140-180 mg/dL
<180 mg/dL

NPC=Nonprotein calories

1. Singer P.Clinical Nutrition(2019);38 :(2019) 48-79.
2. McClave S. JPEN (2016); 40(2):159–211.
3. ASPEN. Appropriate Dosing for Parenteral Nutrition: ASPEN Recommendations. January 2019. http://www.nutritioncare.org/PNDosing
4. Doig G. JAMA.2013;309(20):2130-2138.

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© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. PN and Liver Dysfunction

• Myth: PN should be avoided because of risk of hepatotoxicity
• Evidence:

o Elevated LFT’s seen within 2-4 weeks of PN initiation1
o Elevations are usually mild and resolve over time1,2
o Most often aspartate aminotransferase, alkaline phosphatase and bilirubin 1

• Risk Factors2:

o Overfeeding with dextrose or lipid
o Pro-inflammatory lipids (high n6:n3)
o Lack of enteral stimulation
o Infection

1. Clarke PJ. JPEN.(199):15:54-59. 68
2. Gabe SM. Frontline Gastroentero. (2010);1:98–104.

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