COMPLICATIONS OF NUTRITIONAL SUPPORT
Diarrhea is a common problem with enteral feed-ings and may be related to either hyperosmolarity of the solution or lactose intolerance. Gastric disten-tion is another complication that increases the risk of regurgitation and pulmonary aspiration; the use of duodenal or jejunostomy tubes should decrease the likelihood of gastric distention. Complications of TPN are either metabolic or related to central venous access (Table 53–1). Bloodstream infections associated with central and peripheral venous lines remain a major concern, particularly in the patient with critical illness and immunocompromised states.
Overfeeding with excess amounts of glucose can increase energy requirements and production of carbon dioxide; the respiratory quotient can be >1 because of lipogenesis. Overfeeding can lead to reversible cholestatic jaundice. Mild elevations of serum transaminases and alkaline phosphatase may reflect fatty infiltration of the liver as a result of overfeeding.