Patterns and problems of adult total parenteral nutrition use in US academic medical centers.
OBJECTIVE
To determine the pattern of total parenteral nutrition (TPN) use in US academic medical centers because TPN in adults may be associated with complications related to excessive glucose (dextrose) administration and a respiratory quotient greater than 1.0.


METHODS
Two surveys of the University HealthSystems Consortium (n = 106, 74 members and 32 network partners using TPN) to determine TPN formulas and amounts of TPN nutrients given to 2 hypothetical abdominal trauma patients (1 man and 1 woman), each of whom weighed 70 kg.


METHODS
Amounts of dextrose, amino acids, and fat and rates of administration of TPN.


RESULTS
In the first survey, 80% (59/74) of members and 41% (13/32) of network partners of the University HealthSystems Consortium reported using TPN formulas with more than 20% dextrose; half used 25% dextrose. In the second survey, the mean (+/-SD) TPN dextrose concentrations were 190+/-43 and 170+/-45 g/L (902+/-204 and 807+/-214 mmol/L), with amino acid concentrations at 40 to 50 g/L, in the male and female patients, respectively. The amounts of amino acids and glucose given, when referred to body cell mass in the male and female patients, were equivalent. In 26% (22/86) of the institutions surveyed, the amounts of glucose given in TPN were high enough (>4.48 mg/kg per minute) to produce a respiratory quotient greater than 1.0. A standard TPN formula was derived as 4.25% amino acids, 15% dextrose, and 20% fat emulsion, at a rate to provide required calories.


CONCLUSIONS
Excessive TPN glucose administration, found in at least one fourth of US academic medical centers, suggests use of a TPN formula with no more than 15% dextrose, administered at a rate to provide no more than 4 mg/kg of glucose per minute.
Schloerb
P R
PR
Department of Surgery and the Nutritional Support Service, University of Kansas Medical Center, Kansas City 66160, USA. pschloer@kumc.edu
Henning
J F
JF
D000007:Abdominal Injuries / Q000628:therapy; D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage; D002626:Chemistry, Pharmaceutical; D003625:Data Collection; D004334:Drug Administration Schedule; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data*; D014481:United States
D000596:Amino Acids; D005217:Fat Emulsions, Intravenous; D005947:Glucose