Page 47 - Avoid Food and Drug Interactions

When is Parenteral Nutrition Appropriate?

Jay M. Mirtallo, MS, RPh, BCNSP, FASHP, FASPEN
Clinical Practice Specialist, The American Society for Parenteral and Enteral Nutrition
Professor Emeritus, The Ohio State University, College of Pharmacy, Delaware, OH

Disclosures
• In the past year I have been a speaker and consultant for Fresenius Kabi and have received honoraria and

consultant fees.
• I have also received a consultant fee from Baxter Healthcare from participation in a Technical Advisory Board

Presentation Overview/Summary
The premise that ‘no parenteral nutrition (PN)’ or ‘PN should be avoided’ has the potential to significantly deplete
the lean body mass during these periods of starvation. However, contemporary practice using cancer as the
example has demonstrated that parenteral nutrition results in similar outcomes with enteral nutrition during the
perioperative period of malnourished cancer patients, improvements in lean body mass in patients with pancreatic
cancer and longer survival in incurable cancer patients that improve their function/performance scores while
receiving home parenteral nutrition. To improve outcomes, safe practices for parenteral nutrition should be
followed which includes dosing according to ASPEN recommendations, methods to manage hyperglycemia in this
‘at risk’ population which includes the daily use of lipids as a calorie source and careful consideration of
supplemental parenteral nutrition as a means to avoid prolonged periods of inadequate energy and protein
delivery when enteral nutrition intake is limited by intolerance.

Learning Objectives
Upon completion of this session, the learner will be able to:

• Explain why PN should not be avoided
• Describe best practices for the appropriate use of PN
• Improve the safety and efficacy of PN

Key Takeaways/Fast Facts
• Guidelines for the use of parenteral nutrition in critical care and cancer do not reflect contemporary practice

such as using lower doses of calories, dextrose and methods to manage glucose.
• Dosing lipid injectable emulsions to only prevent essential fatty acid deficiency leads to excessive doses of

dextrose to meet patient energy needs and the potential for hyperglycemia.
• Functional and performance measures may be a useful means to assess the benefit of long-term parenteral

nutrition.

Learning Assessment Questions
1. (True or False) Parenteral nutrition should be avoided in critical care and cancer patients until there is
evidence of malnutrition
A. True
B. False

2. (True or False) Parenteral nutrition has no effect on outcomes in cancer patients.
A. True
B. False

3. (True or False) There is a relationship between elevated glucose (hyperglycemia) and poor outcomes in
parenteral nutrition patients.
A. True
B. False

Learning Assessment Answers:
1. Answer = False; Rationale: The role of parenteral nutrition is to prevent and/or treat malnutrition during
periods of intestinal failure. Contemporary practice does not support the concept of avoiding PN or using
‘standard nutrition’ due to the potential for depleting the lean body mass due to prolonged periods of
inadequate energy or protein intake.

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