What could possibly cause hypoglycemia and hypovolemia in a patient on TPN?

Question

I appreciate your help

Answer 1

I am assuming that you are referring to problems with the TPN itself.

A poorly prepared solution with inadequate glucose and volume are the first things to check.

Is there insulin in the TPN? There may be too much. Also true if on a sliding scale (insulin in the TPN is better). Any cause to suspect insulinomas? How about alcohol consumption (yes, even in the hospital)? Concern for sureptitious use of insulin by the patient?

Excessive diuresis or hemodialysis can cause hypovolemia. Intravascular hypovolemia could result from inadequate protein (third spacing). Diarrhea, fistulas and NG-tube suctioning can cause hypovolemia, but you're probably already tracking them...

Sepsis could cause hypovolemia, but this is less likely given the hypoglycemia.

Any other symptoms to refine the differential?


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Nick l:
True hypoglycemia can manifest in severe sepsis, but most patients end up hyperglycemic prior to/in the beggining stages of sepsis, especially in an ICU setting(e.g. http://www.medscape.com/viewarticle/507661, http://www.ccmtutorials.com/infection/sepsis/page10.htm). However, this very well could be a patient in transition. Obviously, more data would reveal a lot.

And I've used TPN on plenty of patients who weren't that sick, but were simply NPO for protracted peroids (post-op illeus, pancreatitis, enterocutaneous fistulas, diverticulitis, Ogilvie's).

Answer 2

Tickdher is pretty close with hypoalbuminemia and third spacing, but I would take exception that 'sepsis' is less likey because of the hypoglycemia. In fact, one could infer that said patient is fairly ill(i.e. requiring TPN) and in this setting persistent hypoglycemia and hypovolemia would lead one to think of sepsis or bacteremia as the most likely culprit.

Answer 3

maximum sufferers are genuinely recommended to apply marinol or to chew/consume the mj relatively than smoke. no longer possibly because of the main cancers possibility, yet because of the an infection possibility. First, smoke irritates the lungs and can reason any style of lung infections in the main cancers affected person. 2nd, because of the fact it hasnt been processed, it incorporates micro organism and fungi needless to say. maximum cancers sufferers are genuinely often on a neutropenic food plan which in specific prohibits something that hasnt been processed like clean culmination greens and herbs for that reason. Thc works nevertheless. it works lots extra effectual than the different meds used is a lot much less addictive than the different meds used. Hefty doses of anti biotics and anti fungals are given to the sufferers using genuine mj to stay away from an infection from the unprocessed substance.

Answer 4

RELATED TO TPN
Miscalculation of the total calorie need
Miscalculation of the total water need
Mis-preparation of the formula

NOT RELATED TO TPN
Fever
Adrenal problem