Parenteral Nutrition
Hypophosphatemia
reported to occur in 30% of patients receiving IV nutrition;
due to enhanced uptake into cells associated with enhanced glucose uptake.
The consequences of hypophosphatemia include respiratory weakness, hemolysis, and impaired oxygen release from oxygen.
These may be particularly prominent when serum PO4- falls below 1.0 mg/dL.
Mx
Phosphate supplement in diet
The most dangerous metabolic complication, hyperglycemia, is most commonly caused by too rapid initiation of the infusion. This complication is best prevented by initiation of the infusion of 40-60 ml per hour and slowly increasing the rate at 20 cc/hour every 24 hours, while monitoring the patient's glucose levels. Patients with normal glucose tolerance may manifest glycosuria for the first 48 hours of parenteral nutrition. Before initiating insulin, one must verify that the glucose level is high, and that glycosuria is not secondary to a reduced renal threshold for glucose.
Key point:
Sudden onset of hyperglycemia or glucose intolerance in a patient receiving TPN should lead to a suspicion of sepsis.
Dumping syndrome
Dumping syndrome after gastric bypass surgery is when food gets “dumped” directly from your stomach pouch into your small intestine without being digested. There are 2 types of dumping syndrome: early and late. Early dumping happens 10 to 30 minutes after a meal. Late dumping happens 1 to 3 hours after eating. Each has slightly different symptoms.
Dx
Hydrogen breath Test
Barium Fluroscopy
Gastric Emptying studying ( Radionuclide scintigraphy)
Folic Acid
Good source : liver
also in green vegetables and nuts