Manganese poisoning presents clinically with parkinsonian-like symptoms and psychological changes. Seizures are a rare presentation of this disease. [ncbi.nlm.nih.gov]

[…] in > 90% of all patients irrespective of age Apoptosis is present in 91% of neonates and 75% of older children / adults Ballooning or feathering degeneration is present in 91% of neonates and 86% of older children / adults Fibrosis Bridging portal - [pathologyoutlines.com]

• Splenomegaly

  We present a unique case of massive splenomegaly, hepatomegaly, and lymphadenopathy caused by lipid-laden macrophages in a 50 year old white female with short-bowel syndrome treated with long-term total parenteral nutrition. [ncbi.nlm.nih.gov]

  Components and duration of TPN Lack of enteral feeding Recurrent sepsis, particularly catheter sepsis Clinical features Children Asymptomatic at early stage Jaundice is an important sign associated with cholestasis and also a significant prognostic indicator Splenomegaly [pathologyoutlines.com]

  Delayed adverse reactions to lipid emulsions include hepatomegaly, mild elevation of liver enzymes, splenomegaly, thrombocytopenia, leukopenia, and, especially in premature infants with respiratory distress syndrome, pulmonary function abnormalities. [msdmanuals.com]

• Congestive Heart Failure

  Hypophosphatemia, hypokalemia, hypomagnesemia, body-fluid disturbances, vitamin deficiencies such as thiamine, cardiac arrhythmias, and congestive heart failure may result. [helpher.org]

• Respiratory Distress

  We recently had a case of bilateral pleural effusion and respiratory distress caused by delayed vascular injury. A 79-y-old Japanese woman was admitted to our hospital because of advanced gastric carcinoma. [ncbi.nlm.nih.gov]

  Delayed adverse reactions to lipid emulsions include hepatomegaly, mild elevation of liver enzymes, splenomegaly, thrombocytopenia, leukopenia, and, especially in premature infants with respiratory distress syndrome, pulmonary function abnormalities. [msdmanuals.com]

  The signs and symptoms of an embolism include dyspnea, shortness of breath, coughing, chest pain and respiratory distress. [registerednursing.org]

• Aspiration

  Fewer patients receiving TPN vomited or had hypoglycemia, but there was no difference noted in aspiration events or aspiration pneumonia. The CALORIES trial is a good example of the risk of "brand bias" when reading the literature. [pulmccm.org]

  He is intubated and admitted to the intensive care unit for what is found to be pneumonia, and the patient is started on total parental nutrition as he is sedated and has a history of aspiration from a prior hospitalization. [medbullets.com]

  Careless flushing can lead to aspiration of blood into the catheter tip and subsequent clotting (Riella and Scribner, 1976). [nursingtimes.net]

  Neuromuscular swallowing disorder (such as stroke, gastroparesis, motor neuron disease, multiple sclerosis) Central nervous system disorder leading to sufficient interference with the neuromuscular coordination of chewing and swallowing that a risk of aspiration [bcbst.com]

  Although parenteral nutrition is more costly than enteral nutrition and it also poses a greater risk in terms of infection, it is sometimes indicated when enteral nutrition is contraindicated for the client, when the client is at high risk for aspiration [registerednursing.org]

• Sneezing

  Try not to cough or sneeze on your work surfaces. Wash your hands thoroughly with an antibacterial soap before TPN infusion. Turn on the water, wet your hands and wrists and lather up a good amount of soap all over for at least 15 seconds. [mountsinai.org]

  If you need to cough or sneeze, move away from the clean surface. Washing your hands Wash your hands before touching any of your supplies. Turn on the water. Wet your hands and wrists. [fairview.org]

  If you ever need to cough or sneeze, move away from your work surface. Step 4. Prepare the syringe Wipe the rubber top of the saline vial with an alcohol pad. Attach the needle to the syringe. [saintlukeshealthsystem.org]

• Respiratory Insufficiency

  Ziegler [ 16 ] described the complications associated with parenteral nutrition related to excess calories inducing hypercapnia and respiratory insufficiency and increased length of ventilation, hyperinsulinemia related to excess carbohydrate, and azotemia [link.springer.com]

• Heart Failure

  On the next day, she suddenly developed severe metabolic acidosis, heart failure and deep coma. After immediate infusion of thiamine, heart failure and coma rapidly improved. [ncbi.nlm.nih.gov]

  Fall Prevention Alzheimer’s and Dementia Support My [email protected] Program Heart Failure Wound and Ostomy Care Managing Your Medicines IV Patient Teaching Prevent UTI for patients with a catheter (PDF) Educational Videos Sepsis: When an Infection Turns [medstarvna.org]

  The sequelae of refeeding syndrome adversely affect nearly every organ system and include cardiac dysrhythmias, heart failure, acute respiratory failure, coma, paralysis, nephropathy, and liver dysfunction. [g-pact.org]

  Hypophosphatemia, hypokalemia, hypomagnesemia, body-fluid disturbances, vitamin deficiencies such as thiamine, cardiac arrhythmias, and congestive heart failure may result. [helpher.org]

• Osteoporosis

  Complications may include: Clotting (thrombosis) in central access veins Frequent infections in the central-vein access lines Inflammation of the gallbladder (cholecystitis) Bone disease (osteoporosis) TPN-induced liver damage or liver failure TPN-induced [chp.edu]

  Metabolic bone disease, or bone demineralization (osteoporosis or osteomalacia), develops in some patients given TPN for > 3 months. The mechanism is unknown. Advanced disease can cause severe periarticular, lower-extremity, and back pain. [msdmanuals.com]

• Kidney Failure

  However, different formulas can be used based on test results, other disorders present, the person's age, and other factors, as for the following: For people with kidney failure when dialysis is not being used or for people with liver failure: A formula [msdmanuals.com]

• Seizure

  A 24 year-old woman developed acute hemiplegia and a seizure following accidental catheterization of the right common carotid artery and total parenteral nutrition infusion. [ncbi.nlm.nih.gov]

  DESIGN/METHODS: A case report RESULTS: A 14 year-old male with acute lymphocytic leukemia without known central nervous system involvement, bone marrow transplant, intracranial hemorrhage, posterior reversible encephalopathy syndrome, seizure, endocarditis [neurology.org]

  Other less common side effects include: changes in heartbeat confusion convulsions or seizures difficulty breathing fast weight gain or weight loss fatigue fever or chills increased urination jumpy reflexes memory loss muscle twitching, weakness, or cramps [healthline.com]

  Research output: Contribution to journal › Review Article › peer-review 2015 2013 Immunological perspectives of temporal lobe seizures Liimatainen, S., Lehtimäki, K., Kai, L., Palmio, J., Johanna, P., Alapirtti, T., Tiina, A., Peltola, J. & Jukka, P., [researchportal.tuni.fi]

• Dizziness

  Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight. Fast breathing. Shortness of breath, a big weight gain, or swelling in the arms or legs. Dizziness or passing out. Blue or gray skin color. [mskcc.org]

  Adverse reactions to lipid emulsions (eg, dyspnea, cutaneous allergic reactions, nausea, headache, back pain, sweating, dizziness) are uncommon but may occur early, particularly if lipids are given at > 1.0 kcal/kg/hour. [msdmanuals.com]

• Vertigo

  On interview, he described worsening vertigo over a few days and a new headache. His exam revealed vertical nystagmus and truncal ataxia. There was concern for hemorrhagic or ischemic etiology. [neurology.org]

• Hyperglycemia

  Abstract Adverse outcomes have been associated with hyperglycemia in patients receiving total parenteral nutrition (TPN). The relationship may be characteristic in elderly patients. [ncbi.nlm.nih.gov]

  If hyperglycemia remains uncontrolled, long-term complications can develop, such as cardiovascular disease, kidney disease and eye damage. Hyperglycemia in TPN Infusion Hyperglycemia during TPN infusion can have many causes. [livestrong.com]

  Critically Ill Patients Patients that are critically ill have a high rate of hyperglycemia when receiving TPN. [healthyeating.sfgate.com]

• Hypophosphatemia

  Refeeding syndrome and hypophosphatemia. J Intensive Care Med 2005;20(3):174-5. Tracey KJ, Legaspi A, Albert JD. Protein and substrate metabolism during starvation and parenteral refeeding. Clin Sci 1988;74:123-32. Rudman D, William PJ. [medigraphic.com]

  Hypophosphatemia, hypokalemia, hypomagnesemia, body-fluid disturbances, vitamin deficiencies such as thiamine, cardiac arrhythmias, and congestive heart failure may result. [helpher.org]

  Other than those listed below, other common complications of TPN include hypophosphatemia, hypokalemia, hyperglycemia, hypercapnia, decreased copper and zinc levels, elevated prothrombin time (if associated with liver injury), hyperchloremic metabolic [en.wikipedia.org]

   Severe electrolyte and fluid shifts that may result from refeeding after severe weight loss (PEM)  Hypophosphatemia is the hallmark of refeeding syndrome due to shift from fat to glucose metabolism.  Hypokalemia and hypomagnesemia  ↓K and ↓PO4→ [slideshare.net]

• Hypophosphatemia

  Refeeding syndrome and hypophosphatemia. J Intensive Care Med 2005;20(3):174-5. Tracey KJ, Legaspi A, Albert JD. Protein and substrate metabolism during starvation and parenteral refeeding. Clin Sci 1988;74:123-32. Rudman D, William PJ. [medigraphic.com]

  Hypophosphatemia, hypokalemia, hypomagnesemia, body-fluid disturbances, vitamin deficiencies such as thiamine, cardiac arrhythmias, and congestive heart failure may result. [helpher.org]

  Other than those listed below, other common complications of TPN include hypophosphatemia, hypokalemia, hyperglycemia, hypercapnia, decreased copper and zinc levels, elevated prothrombin time (if associated with liver injury), hyperchloremic metabolic [en.wikipedia.org]

   Severe electrolyte and fluid shifts that may result from refeeding after severe weight loss (PEM)  Hypophosphatemia is the hallmark of refeeding syndrome due to shift from fat to glucose metabolism.  Hypokalemia and hypomagnesemia  ↓K and ↓PO4→ [slideshare.net]

After this treatment, nine of the 25 patients were readmitted for recurrence of appetite loss. Two patients required additional TPN treatment, but seven immediately recovered their appetite after hospitalization without TPN treatment. [ncbi.nlm.nih.gov]

(PCI) was not associated with survival, low CA-125 within one week of GT placement was associated with improved survival (p CONCLUSIONS: Women with malignant bowel obstructions from gynecologic cancers requiring palliative GT placement had a guarded prognosis [ncbi.nlm.nih.gov]

This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients. [ncbi.nlm.nih.gov]

Additional case reports should be directed to the Epidemiology Branch, Division of Epidemiology and Surveillance, Office of Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Room 15-42, 5600 Fishers Lane, Rock- ville [cdc.gov]

The pathophysiology is postulated to be multifactorial. Diagnosis in adults is primarily by exclusion, eliminating other causes of chronic liver disease or cirrhosis, and other factors seen in critically ill or postoperative patients on TPN. [ncbi.nlm.nih.gov]

[…] and intervene as appropriate (e.g., hyperglycemia, fluid imbalance, infection) Educate client on the need for and use of TPN Apply knowledge of nursing procedures and psychomotor skills when caring for a client receiving TPN Apply knowledge of client pathophysiology [registerednursing.org]

"The pathophysiology of prolonged periods of no enteral nutrition or nothing by mouth". Newborn & Infant Nursing Reviews. 3 (2): 47–54. doi : 10.1016/S1527-3369(03)00005-9. [en.wikipedia.org]

An awareness of the factors that influence crystal solubility may prevent adverse interactions in patients who require parenteral nutrition. [ncbi.nlm.nih.gov]

This complication can be prevented by monitoring the client and adjusting the rate of the total parenteral nutrition to prevent fluid overload. [registerednursing.org]

Hand hygiene prevents the spread of microorganisms. Proper identification prevents patient errors. Compare MAR to patient wristband 4. Complete all safety checks for CVC as per agency policy. [opentextbc.ca]