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Chapter 073. Enteral and Parenteral Nutrition (Part 10)

Table 73-8 Selected Metabolic Disturbances and Their Correction Disturbance Cause Corrective Action with PN Hyponatremia Increased total body Decrease or free water or decreased total body water sodium sodium increase Hypernatremia Occurs commonly with Increase free excessive isotonic or water to produce net hypertonic fluid followed by positive fluid balance diuretic administration with maintaining sodium free water clearance; can also and chloride balance occur with dehydration and normal total body sodium Hypokalemia Inadequate relative to need intake Use supplements Excessive tubular dysfunction diuresis, Use supplements Magnesium deficiency Increase magnesium PN Metabolic alkalosis Correct alkalosis Hyperinsulinemia Maintain constant PN, increase potassium Hyperkalemia Excessive provision Reduce supplements . | Chapter 073. Enteral and Parenteral Nutrition Part 10 Table 73-8 Selected Metabolic Disturbances and Their Correction Disturbance Cause Corrective Action with PN Hyponatremia Increased total body water or decreased total body sodium Decrease free water or increase sodium Hypernatremia Occurs commonly with Increase free excessive isotonic or hypertonic fluid followed by diuretic administration with free water clearance can also occur with dehydration and normal total body sodium water to produce net positive fluid balance maintaining sodium and chloride balance Hypokalemia Inadequate intake relative to need Use supplements Excessive diuresis tubular dysfunction Use supplements Magnesium deficiency Increase PN magnesium Metabolic alkalosis Correct alkalosis Hyperinsulinemia Maintain constant PN increase potassium Hyperkalemia Excessive provision Reduce supplements Metabolic acidosis Evaluate alkalosis treat with PN acetate salt and decrease potassium Renal deterioration Evaluate patient and adjust PN as indicated Hypocalcemia Reciprocal response to phosphorus repletion Increase calcium Critical illness effect Increase .