title: Abrupt discontinuation of cycled parenteral nutrition is safe.
abstract: OBJECTIVE
  Abrupt discontinuation of total parenteral nutrition (TPN) has been recommended but is not widely practiced because of fear of hypoglycemia.
  
  
  METHODS
  To determine whether hormonal counterregulatory mechanisms prevent hypoglycemia, we studied 12 patients (10 with inflammatory bowel disease, of which 6 received dexamethasone) after both abrupt and tapered discontinuation of 3:1 TPN solution in a clinical research facility. Venous blood was drawn before reduction of TPN rate in the tapered group or 15 minutes before and at abrupt discontinuation in the abrupt group and every 15 minutes for 1.5 hours.
  
  
  RESULTS
  Glucose decreased from 152 +/- 56 (baseline) to 100 +/- 22 mg/dl 90 minutes after gradual discontinuation of TPN, compared with 135 +/- 45 to 96 +/- 15 mg/dl at 90 minutes after abrupt discontinuation, with no significant differences in mean glucose values. Mean epinephrine, norepinephrine, insulin, glucagon, growth hormone, cortisol, symptom score, and vital signs were not statistically different between the two groups.
  
  
  CONCLUSIONS
  Hypoglycemia does not occur after abrupt discontinuation of TPN. The same changes in counterregulatory hormones were seen whether discontinuation was tapered or abrupt. In stable patients, TPN solutions can be abruptly discontinued.
authors.affiliation: Section of Colon & Rectal Surgery, Jewish Hospital at Washington University, St. Louis, Missouri 63110, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Eisenberg
authors.forename: S
authors.initials: S
authors.lastname: Gianino
authors.forename: W E
authors.initials: WE
authors.lastname: Clutter
authors.forename: J W
authors.initials: JW
authors.lastname: Fleshman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004837:Epinephrine / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010289:Parenteral Nutrition, Total / Q000009:adverse effects
chemical_list: D007328:Insulin; D013006:Growth Hormone; D005934:Glucagon; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine