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Monday, August 11, 2025

Intravenous nutritional products


1. Introduction

  • Intravenous nutritional products (IVNP) are sterile formulations designed to provide nutrition directly into the bloodstream via parenteral nutrition (PN).

  • Used when the gastrointestinal tract is non-functional, inaccessible, or unsafe for feeding.

  • Can be total parenteral nutrition (TPN) – providing all daily nutritional needs – or partial parenteral nutrition (PPN) – supplementing oral/enteral intake.

  • Supplied in pre-mixed or customized bags, compounded in pharmacy under strict aseptic conditions.

2. Goals of Intravenous Nutrition

  • Maintain or restore nutritional status in patients unable to meet needs orally or enterally.

  • Provide adequate calories, protein, electrolytes, vitamins, and trace elements.

  • Prevent malnutrition, catabolism, and weight loss.

  • Support wound healing, immune function, and recovery during critical illness or after surgery.

3. Components of IV Nutritional Products

A. Macronutrients

  • Carbohydrates – usually as dextrose monohydrate; primary energy source.

  • Amino acids – crystalline amino acid solutions for protein needs; may be specialized for renal, hepatic, or pediatric patients.

  • Lipids – emulsions containing triglycerides from soybean oil, olive oil, fish oil, or medium-chain triglycerides; provide essential fatty acids and dense calories.

B. Micronutrients

  • Electrolytes – sodium, potassium, calcium, magnesium, phosphate, chloride, acetate; adjusted to patient needs.

  • Vitamins – water- and fat-soluble vitamins (multivitamin preparations for injection).

  • Trace elements – zinc, copper, manganese, selenium, chromium; essential for metabolic function.

C. Additives

  • Insulin, heparin, or other medications may be added to meet individual patient requirements.

4. Formulations and Presentation

A. Customized (Compounded) PN

  • Prepared in hospital pharmacy according to individual prescription.

  • Allows precise tailoring of nutrient amounts and electrolyte balance.

B. Commercial Premixed PN

  • Ready-to-use multi-chamber bags (e.g., 2-in-1: amino acids + dextrose; 3-in-1: amino acids + dextrose + lipids).

  • Require activation/mixing before administration.

C. Lipid Emulsions

  • 100% lipid products for separate infusion or inclusion in 3-in-1 admixtures.

5. Routes of Administration

A. Central Venous Access

  • Preferred for TPN (high osmolarity solutions >900 mOsm/L).

  • Administered via central venous catheter (e.g., subclavian, jugular, PICC line).

B. Peripheral Venous Access

  • Used for PPN (lower osmolarity ≤900 mOsm/L).

  • Short-term use only; risk of phlebitis if osmolarity too high.

6. Indications

  • Bowel obstruction or severe ileus.

  • Short bowel syndrome.

  • Severe pancreatitis requiring bowel rest.

  • High-output enterocutaneous fistula.

  • Severe malabsorption or intractable vomiting/diarrhea.

  • Critical illness with contraindication to enteral feeding.

  • Postoperative nutritional support in high-risk patients.

7. Contraindications

  • Functional and accessible GI tract where enteral feeding is possible.

  • Hemodynamically unstable patients where aggressive nutrition may worsen outcome.

  • Severe metabolic instability (uncontrolled electrolyte imbalances) until corrected.

8. Potential Complications

A. Infectious

  • Catheter-related bloodstream infections (CRBSI).

B. Metabolic

  • Hyperglycemia or hypoglycemia.

  • Electrolyte disturbances (e.g., hypokalemia, hypophosphatemia, hypomagnesemia).

  • Hypertriglyceridemia.

  • Refeeding syndrome in severely malnourished patients.

C. Hepatic

  • Cholestasis, steatosis, PN-associated liver disease with long-term use.

D. Mechanical

  • Catheter malposition, thrombosis.

9. Drug and Nutrient Interactions

  • Insulin requirements may change with dextrose-containing PN.

  • Warfarin effect may be altered by vitamin K in lipid emulsions containing soybean oil.

  • Electrolyte compatibility must be monitored; calcium and phosphate can precipitate if mixed improperly.

  • Certain drugs may adsorb to IV bags or be unstable in PN admixtures.

10. Monitoring Requirements

  • Daily or frequent monitoring initially:

    • Electrolytes, renal function, liver function, glucose, triglycerides.

  • Weekly or periodic monitoring once stable:

    • Trace elements, vitamins, complete blood count.

  • Fluid balance and weight.

  • Catheter site inspection.

11. Advantages

  • Provides complete nutrition when oral/enteral feeding is impossible.

  • Customizable to individual metabolic and clinical needs.

  • Can sustain life long-term in intestinal failure (home parenteral nutrition).

12. Limitations

  • Requires sterile compounding and strict handling.

  • Invasive – central venous catheter carries infection and thrombosis risks.

  • High cost compared to enteral nutrition.

  • Does not maintain gut mucosal integrity like enteral feeding.




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