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TPN discontinuation complications

TPN is usually slowed or discontinued prior to anesthesia, primarily to avoid complications from excessive (hyperosmolarity) or rapid decrease (hypoglycemia) in infusion rates in the busy operative arena. That said, because abrupt discontinuance may lead to severe hypoglycemia, TPN must be turned down gradually.

According to Miller (Chapter 35), Dr. Michael F. Roizen has adopted the following: “Infusion of TPN or enteral nutrition is reduced beginning the night before surgery, and a 5% or 10% dextrose solution is substituted preoperatively. If serum glucose, phosphate, and potassium concentrations (measured preoperatively) are abnormal, they are restored to within normal limits. Strict asepsis is maintained. Conversely, one should continue infusing the TPN solution by using a pump system or enteral nutrition while strictly maintaining its normal rate and asepsis, administering all fluids through a different intravenous site, and performing a rapid-sequence induction of anesthesia (for those who received enteral nutrition).”