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Content Update

May 6, 2020

Expanding Role of Novel-Source Lipid Emulsions: Use of multiple- and alternative-source intravenous lipid emulsions has increased over the last 5 years with the introduction of new products. The literature supports their potential benefit in parenteral nutrition (PN)-associated hepatic disease, a recognized complication in patients receiving long-term PN with traditional soybean oil-based products. Given the recent approvals, data remain somewhat limited, but reports thus far have been generally positive for both adult and pediatric nutritional outcomes.



Upon completion of the chapter, the reader will be able to:

  1. List appropriate indications for parenteral nutrition (PN) in adult patients.

  2. Describe the components of PN and their role in nutrition support therapy.

  3. List key elements of nutrition assessment and factors considered in assessing an adult patient’s nutritional status and nutritional requirements.

  4. List important recommendations to improve PN safety.

  5. Explain important pharmaceutical and compounding concerns with PN admixtures.

  6. Develop a plan to design, initiate, and adjust a PN formulation for an adult patient based on patient-specific factors.

  7. Describe the etiology and risk factors for PN macronutrient-associated complications in adult patients receiving PN.

  8. Describe the etiology and risk factors for refeeding syndrome, as well as measures to prevent refeeding syndrome.

  9. Design a plan to assess the efficacy and monitor for safety, as well as fluid, electrolyte, vitamin, and trace element abnormalities in adult patients receiving PN.


Malnutrition in hospitalized patients is associated with significant complications (eg, increased infection risk, poor wound healing, prolonged hospital stays, increased mortality), especially in surgical and critically ill patients.1 Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an essential part of patient care. Nutrition support therapy refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 image Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is the intravenous (IV) administration of fluids, macronutrients, electrolytes, vitamins, and trace elements for the purpose of weight maintenance or gain, to preserve or replete lean body mass and visceral proteins, and to support anabolism and nitrogen balance when the oral or enteral route is not feasible or adequate. PN is a potentially lifesaving therapy in patients with intestinal failure but can be associated with significant complications.

Desired Outcomes and Goals

The goals of nutrition support therapy include:

  • Correction or avoidance of nutritional deficiencies

  • Weight maintenance (or weight gain in malnourished patients and growing children)

  • Preservation or repletion of lean body mass and visceral proteins

  • Support of anabolism and nitrogen balance and improvement of healing

  • Correction or avoidance of fluid, electrolyte, vitamin, and trace element abnormalities

  • Improving clinical outcomes

Indications for PN Therapy

PN can be a ...

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