Review Question - QID 103028

This patient has a central line placed and is receiving total parenteral nutrition (TPN) which can be complicated by sepsis.

Hyperglycemia in the first 1-2 days after TPN initiation is common and is associated with increased hospital complications and mortality. It is thought that this association is causal, as hyperglycemia causes impaired leukocyte function and therefore may compromise immune activity. Sudden hyperglycemia after several days of TPN warrants a thorough search for a source of infection. One of the most common complications of central lines and TPN is sepsis/infection. Whenever an infection is suspected, the management includes source control (removing and replacing lines) as well as cultures and antibiotics.

Incorrect Answers:
Answer 1: Cholelithiasis or biliary sludge are complications of TPN that can occur weeks later after TPN is started. It is a less likely complication when compared to new line placement and TPN initiation.

Answer 2: Hypocalcemia is a possible complication of multiple transfusions from citrate (in the blood products) chelation of calcium. It would be unlikely for the patient to be hypocalcemic 1 day after the procedure while receiving TPN (which has calcium in it).

Answer 3: Mesenteric ischemia presents with sudden and severe abdominal pain "out of proportion" to the exam and occurs secondary to a thrombus (usually from atrial fibrillation) or rupture of a plaque.

Answer 4: Refeeding syndrome can complicate TPN and can result in several fluid and electrolyte disorders including hypophosphatemia. Typically, patients on TPN have their labs checked daily to monitor for such changes.

Bullet Summary:
Line placement and total parenteral nutrition (TPN) are risk factors for sepsis.