Which of the following is a potential complication of parenteral nutrition?

January 9, 2026 •

4 min read

According to a 2018 study, up to 78.9% of children receiving inpatient parenteral nutrition (PN) experience some form of complication, with metabolic issues being the most common. This therapy, while life-saving, carries several significant risks that require careful management by healthcare professionals.

Quick Summary

Parenteral nutrition can lead to complications, including metabolic problems like hyperglycemia and electrolyte imbalances, infections from central venous catheters, and liver dysfunction. Long-term use can also cause metabolic bone disease and nutrient deficiencies.

Key Points

Hyperglycemia: This is a potential complication of parenteral nutrition, often caused by rapid infusion of high dextrose concentrations.
Infection: Catheter-related bloodstream infection (CLABSI) is a common and serious risk associated with the central venous catheter used for PN delivery.
Refeeding Syndrome: A potentially fatal metabolic complication in malnourished patients, characterized by severe electrolyte shifts upon re-initiation of feeding.
Liver Dysfunction: Long-term PN can cause hepatobiliary issues, including hepatic steatosis and cholestasis, due to excess caloric load and lack of enteral stimulation.
Electrolyte Imbalances: Fluctuations in potassium, phosphorus, magnesium, and other electrolytes are a frequent metabolic complication that requires close monitoring.
Catheter Occlusion: Mechanical failure, such as catheter clogging or thrombosis (blood clots), is another potential complication related to venous access.
Metabolic Bone Disease: With prolonged PN, patients can develop bone demineralization and osteoporosis due to altered metabolism.

Parenteral nutrition (PN), also known as total parenteral nutrition (TPN), provides essential nutrients directly into the bloodstream when a patient's gastrointestinal tract is non-functional. While crucial for survival in many cases, this complex medical intervention carries a range of potential complications. These issues can be categorized into metabolic, infectious, and mechanical problems, all of which require diligent monitoring and management by a dedicated healthcare team. Understanding these risks is vital for ensuring patient safety and optimal outcomes.

Metabolic Complications

Metabolic complications are some of the most frequently observed side effects of PN therapy. These issues arise from the body's altered processing of nutrients delivered intravenously, bypassing the natural digestive and regulatory systems.

Hyperglycemia and Hypoglycemia

Hyperglycemia, or high blood sugar, is a common metabolic issue, especially when the PN solution contains high concentrations of dextrose. Contributing factors can include sepsis, stress, and diabetes. Conversely, abruptly discontinuing a continuous dextrose infusion can cause rebound hypoglycemia, or low blood sugar. Both conditions can have serious health consequences if not managed promptly.

Electrolyte Imbalances

Shifts in fluid and electrolyte levels are another significant metabolic concern. Refeeding syndrome, for example, can occur in severely malnourished patients when nutritional support is initiated too rapidly. This condition causes dangerous drops in phosphorus, potassium, and magnesium as the body's cells rapidly shift from a catabolic to an anabolic state. Careful, gradual initiation of feeding and close monitoring are necessary to prevent this potentially fatal complication. Other imbalances, such as hypercalcemia or hyponatremia, can also occur and require regular lab checks.

Liver Dysfunction

Long-term PN use is frequently associated with hepatobiliary complications, which can range from mild elevations in liver enzymes to severe liver disease. Hepatic steatosis (fatty liver) can develop due to excess caloric intake, especially from dextrose and lipid emulsions, causing an increased metabolic burden on the liver. Cholestasis, a condition of impaired bile flow, can also arise from a lack of enteral stimulation, leading to gallbladder sludge and gallstones. Cycling PN and providing minimal enteral feeding when possible can help mitigate these risks.

Infectious and Mechanical Complications

Beyond metabolic issues, PN introduces risks related to the use of a central venous catheter (CVC) for prolonged periods.

Catheter-Related Infections

Infection is one of the most serious and common complications of long-term PN. The CVC can be a direct entry point for microorganisms into the bloodstream, leading to central line-associated bloodstream infections (CLABSIs). Strict aseptic technique during catheter insertion and maintenance, along with frequent monitoring, is crucial for prevention.

Mechanical Issues

Mechanical problems with the catheter can also occur. These include catheter occlusion (clogging), breakage, or accidental removal. The formation of blood clots (thrombosis) around the catheter tip is another risk, which can potentially lead to more severe complications like pulmonary embolism. Regular flushing and careful handling are necessary to minimize these risks.

Long-Term Complications

For patients on long-term PN, additional risks become more prominent.

Metabolic Bone Disease

Prolonged PN can lead to metabolic bone disease, characterized by bone demineralization and osteoporosis. Factors contributing to this include inadequate intake of calcium, phosphate, and vitamin D, lack of physical activity, and alterations in metabolic function.

Trace Element and Vitamin Deficiencies

Despite the comprehensive nature of PN solutions, deficiencies or excesses of micronutrients can occur over time. Careful monitoring and adjustment of vitamin and trace element supplementation are essential for managing this risk.

Comparison of Major Parenteral Nutrition Complications


Complication Type	Example Conditions	Primary Causes	Prevention & Management
Metabolic	Hyperglycemia, Refeeding Syndrome, Electrolyte Imbalance	Rapid infusion of dextrose, electrolyte shifts with aggressive feeding, inappropriate formula composition	Slow initiation of PN, frequent glucose & electrolyte monitoring, tailored formula composition
Infectious	Catheter-Related Bloodstream Infection (CLABSI)	Contamination during catheter insertion or use, compromised immune status	Strict aseptic technique, proper catheter care, using a dedicated PN line
Mechanical	Catheter Occlusion, Thrombosis	Fibrin sheath formation, medication precipitates, catheter kinks	Regular catheter flushing, careful handling, proper patient positioning
Hepatobiliary	Steatosis, Cholestasis, Gallstones	Excess caloric load (glucose/lipids), lack of enteral stimulation, prolonged PN duration	Avoidance of overfeeding, cycling PN, minimal enteral feeding
Long-Term	Metabolic Bone Disease, Micronutrient Issues	Imbalanced mineral intake (Ca, P, Vit D), physical inactivity, prolonged duration	Adequate supplementation, regular bone density and micronutrient monitoring

Conclusion

Parenteral nutrition is a vital medical therapy that, while life-sustaining, is associated with numerous potential complications. The most significant risks include metabolic disturbances like hyperglycemia and refeeding syndrome, serious infectious risks related to central line use, and the potential for long-term hepatobiliary and bone disease. A multi-disciplinary nutrition support team is essential for carefully balancing the PN formula, monitoring patient responses, and implementing strict infection control protocols to minimize these adverse effects. Ongoing monitoring and proactive management of these complications are key to ensuring the safety and positive clinical outcomes for patients on PN therapy.

Visit the Cleveland Clinic for more information on parenteral nutrition.

Frequently Asked Questions

Refeeding syndrome is a dangerous metabolic complication that occurs when nutritional support is initiated too quickly in a severely malnourished patient. It causes sudden and severe shifts in fluids and electrolytes, particularly low levels of phosphorus, potassium, and magnesium.

Parenteral nutrition is administered through a central venous catheter, which provides a direct entry point for bacteria into the bloodstream. This can lead to serious infections known as central line-associated bloodstream infections (CLABSIs), which are a major risk for patients on PN.

Long-term parenteral nutrition can cause liver dysfunction, including hepatic steatosis (fatty liver) and cholestasis (impaired bile flow). This is primarily due to the metabolic burden of intravenous feeding and the lack of gut stimulation.

Parenteral nutrition can cause imbalances in key electrolytes like potassium, phosphorus, magnesium, and sodium. These shifts can lead to serious complications such as cardiac arrhythmias, especially in the context of refeeding syndrome.

Yes, hyperglycemia (high blood sugar) is a very common metabolic complication of parenteral nutrition. It can be caused by a rapid infusion of dextrose, which is a component of the PN solution, particularly in patients who are critically ill, have diabetes, or are on steroids.

Stopping a parenteral nutrition infusion abruptly, especially one with a high dextrose concentration, can lead to rebound hypoglycemia (low blood sugar). This requires careful monitoring and management to prevent.

Mechanical complications include catheter occlusion (clogging) caused by medication precipitates or kinks, damage to the catheter, and thrombosis (blood clots) forming around the tip, which can obstruct blood flow.