Patient Instructions: Possible Complications of Parenteral Nutrition (PN) Administration

It is important to be familiar with the signs and symptoms of possible complications when a child is receiving parenteral nutrition (PN).

Central line-associated bloodstream infection (CLABSI)

Children receiving parenteral nutrition (PN) are at an increased risk for central line-associated bloodstream infections. It is very important to follow all steps for keeping your hands, your preparation area, PN supplies, and your child’s line clean.

Check your child’s temperature daily or more often if concerned for a fever. Children with a central line and fever will need to be admitted to the hospital for observation and antibiotics.

It is important to call your child’s healthcare team for:

Temperature of 100.4 F or higher.
Oncology patients: Fever of 101.3F or higher, OR 3 low grade temperatures between 100.4-101.2 in 24 hours (at least 2 hours apart).

Your child can still get a CLABSI while receiving antibiotics. Never assume cold symptoms are the cause of a fever. Call your child’s medical team if you have questions or concerns about symptoms or behavior.

Members of the Home PN Program will meet with you if your child is admitted with a CLABSI. We will review central line care, PN supplies, and care leading up to admission.

Electrolyte Imbalance

Electrolytes are chemicals in the body that help keep the body’s organs working. These include sodium, potassium, chloride, bicarbonate, phosphorous, magnesium, and calcium. These electrolytes are also in PN.

Your child needs the right amount of each electrolyte to keep the body working properly. The team managing your home PN will test your child’s blood to monitor electrolyte levels. They may order changes to the contents of the PN to balance the electrolytes.

If your child’s electrolytes are out of balance you may notice the following symptoms:

Cranky or crying a lot
Drowsy or sleepy
Muscle cramps or spasms
Shaking
Increased stool output
Constipation
Increased g-tube drainage
Vomiting
Increased or irregular heartbeat
Chest pain
Loss of coordination or balance

Call your child’s healthcare team if you notice any of these symptoms.

Low Blood Sugar (Hypoglycemia)

While on PN, your child may have times when there is a low level of sugar in their blood. This can happen for different reasons:

Your child’s body is making too much insulin. Insulin is a hormone in the body that controls blood sugar.
Your child’s PN was stopped too quickly. Sometimes it is necessary to slow down the rate of the PN for the last hour. This is called tapering down. The team managing your home PN would order this.
Your child may have an infection.
Your child may have gone too long without eating or getting PN.

Some symptoms of low blood sugar:

Sweating
Nausea
Weakness
Headache
Shaking
Blurred vision
Dizziness
Confusion
Seizures

If your child has any symptoms of low blood sugar, call your healthcare team immediately.

If you have a glucometer, check blood glucose when you notice symptoms and then call the healthcare team to discuss results.

High Blood Sugar (Hyperglycemia)

It is also possible for your child to have too much sugar in the blood while they are getting PN. High blood sugar may be caused by:

The body is not making enough insulin to control the blood sugar.
Some kinds of medications.
Some types of infections.
Your child is getting too much sugar in the PN.

Some things you may see if your child has high blood sugar are:

Weakness
Increased thirst
Increased urination
Headaches
Confusion
Urine glucose +2 or higher

If your child has any symptoms of high blood sugar, call your healthcare team immediately.

If you have a glucometer, check blood glucose when you notice symptoms and then call the healthcare team to discuss results.

Dehydration

Your child may become dehydrated if their body is losing more fluid than it is taking in. Some causes of dehydration are:

Severe vomiting or diarrhea
Increased ostomy or fistula output
Increased g-tube drainage
Your child is not getting enough fluids by drinking or through their IV

Some things you will see if your child is dehydrated are:

Weight loss
Tiredness
Decreased urine output
Sunken soft spot on infant’s head
Dry mouth or lips
Sunken eyes
Dark colored urine
Bad smelling urine
Cold hands and/or feet

Fluid Overload (overhydration)

Your child may become overhydrated if their body takes in more fluid than it needs or can get rid of. There are many causes such as giving the PN too fast. The causes may be different for each child.

If your child is overhydrated, you will see:

Weight gain
Increased urine output
Puffiness of eyes, face, hands, feet, and/or ankles
Headaches
Very light-colored urine
Difficulty breathing
Fast breathing

Call your child’s healthcare team to discuss symptoms or you have any concerns.

Liver Problems

Parenteral nutrition can cause liver inflammation over time. Other factors may cause liver inflammation or scarring, including:

Infections
Prolonged periods without using the stomach or GI tract for food or formula
Various medications

Risk for liver problems may increase if your child is:

Getting PN for a long time
Not getting feedings through the GI tract (mouth, stomach, intestines)
Having frequent infections
History of prematurity and receiving parenteral nutrition in the NICU

Some things you will see if your child has liver problems are:

Jaundice or yellow color to eyes or skin
Changes in blood tests such as high bilirubin level
High liver enzyme levels in the blood
Pale or white stools

The team managing you home PN will monitor liver enzymes routinely. They may order changes to the contents of the PN based on the lab results. Call your child’s healthcare team immediately to discuss symptoms or concerns.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.