Snapshot A 30-year-old female has been hospitalized for the past 7 days with a severe flare in her Crohn's disease. She has not been able to tolerate enteral feeding, and has not eaten since her hospital admission. The treatment team would like to initiate total parenteral nutrition (TPN) to provide nutritional support. Introduction All nutrition is provided intravenously, bypassing the normal GI tract processes of eating and digestion Depending on the TPN solution used, may be given either peripherally or centrally (central line or PICC) Components: water dextrose/glucose (or other energy-providing carbohydrate) amino acids lipids minerals vitamins Mechanical pump delivers nutrition intravenously - may be utilized as an inpatient or at home; specific volumes/amounts and composition vary based on the patient's age, status, comorbid conditions, etc and should be calculated for each individual patient Monitoring - regularly evaluate: body weight CBC/electrolytes/BUN glucose intake/output liver function tests Indications Use for patients without a functioning GI tract or who have disorders that necessitate complete bowel rest bowel obstruction short bowel syndrome gastroschisis prolonged diarrhea high-output fistula Crohn's disease/ulcerative colitis congenital GI anomalies necrotizing enterocolitis cancer patients Complications Complications related to central venous access OR metabolic abnormalities: Refeeding syndrome Catheter-related sepsis Blood clots/pulmonary embolism Hypo-/hyperglycemia (monitor plasma glucose levels) Fatty liver/liver failure Electrolyte abnormalities Volme overload Osteoporosis/osteomalacia Hunger pangs Gallbladder complications - cholelithiasis, sludge, cholecystitis