Parenteral nutrition blood glucose

Speerhas R, Wang J, Seidner D, Steiger E. Maintaining normal blood glucose concentrations with total parenteral nutrition Is it necessary to taper total parenteral nutrition Nutr Clin Pract 2003 18 414 16. 

Clinical and biochemical monitoring should always go hand in hand in the assessment of any form of nutritional support. In some circumstances the contribution of the laboratory may be the simple measurement of blood glucose, while in other simations the measurements and advice provided by the lab may dictate the regimen in a patient receiving parenteral nutrition. 

HONK coma occurs mostly in elderly, non-insulin dependent diabetics, and develops relatively slowly over days or weeks. The level of insulin is sufficient to prevent ketosis but does not prevent hyperglycacmia and osmotic diuresis. Precipitating factors include severe illness, dehydration, glucocorticoids, diuretics, parenteral nutrition, dialysis and surgery. Extremely high blood glucose levels (above 35 mmol/l. and usually above 50 mmol/l) accompany severe dehydration resulting in impaired consciousness. 

Hyperosmolar coma with extremely high concentrations of blood glucose (often accompanied by a concomitant hypernatremia) may occasionally be seen during the course of total parenteral nutrition, particularly if adequate monitoring is not carried out. This complication has been implicated in several fatalities of total parenteral nutrition. 

Khashu M, Harrison A, Lalari V, Lavoie JC, Chessex P. Impact of shielding parenteral nutrition from light on routine monitoring of blood glucose and triglyceride levels in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2009 94(2) Flll-5. 

Another indication of the relevance of the Maillard reaction to human nutrition and metabolism was the finding of urinary loss of bound amino acids after infusion of autoclaved sugar (glucose or finctose)—amino acid or peptide solutions. Nonutilizable amino acids were detected in the blood and urine (S38, S39). After these and other reports, parenteral solutions were sterilized by nonheat methods. 

---