Glucose in parenteral nutrition: a survey of U.S. medical centers.

BACKGROUND

A previous report suggested that glucose administration in total parenteral nutrition (TPN) should not exceed 4 mg/kg/min with a respiratory quotient (RQ) >1.0. This rate would not be exceeded, in most patients, with a TPN glucose concentration of 15%. Our previous survey of hospitals, 7 years ago, of TPN composition revealed use of excessive glucose. Our purpose was to reevaluate glucose usage in TPN.

METHODS

A subset of data from 45 hospitals participating in Novation's Medication Use Evaluation program, "Parenteral Nutrition for Adults and Neonates" study, was analyzed to document glucose administration in TPN.

RESULTS

Data of 629 adult patients from 44 hospitals receiving TPN were analyzed. Of these, 30 hospitals with 478 patients had 100 patients (15.9% of the total) with TPN glucose infusion rates >4 mg/kg/min, whereas 27 hospitals, or 61%, had average TPN glucose concentrations above 15%. This could be associated with an RQ >1.0, implying increased net lipogenesis.

CONCLUSIONS

The majority of hospitals surveyed were found, as in a previous survey, to be using amounts of glucose in TPN which would be expected to be associated with an RQ >1.0, implying increased net lipogenesis.