PMID: 2492913Feb 1, 1989Paper

Management of glucose abnormalities in patients receiving total parenteral nutrition

Clinical Pharmacy
C M KnapkeJ M Mirtallo

Abstract

A patient who developed extreme fluctuations in serum glucose concentrations while receiving total parenteral nutrition (TPN) is described, and etiologies of hyperglycemia and hypoglycemia, as well as a rational approach to preventing and managing these disorders in patients receiving TPN, are presented. A 40-year-old white man with a 29-year history of insulin-dependent diabetes mellitus was hospitalized after he had an episode of rejection related to a cadaveric kidney transplant. During the hospitalization, his right leg was amputated because of cellulitis, and he developed septicemia with respiratory failure. A renal biopsy revealed cytomegalovirus inclusion disease, the kidney was removed, and intermittent hemodialysis was begun. Control of the patient's serum glucose concentration included four routes of insulin administration: a continuous titratable insulin infusion, subcutaneous sliding-scale insulin, insulin incorporated into the TPN solution, and intravenous bolus insulin. Further, glucose management was being coordinated by three teams: intensive care, nutrition support, and the renal service, with physicians from each service prescribing insulin therapy. The patient also received prednisone daily. The sporadic appr...Continue Reading

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