Metabolic complications of home parenteral nutrition and short bowel syndrome: metabolic bone disease, hyperglycemia, dehydration, and d-lactic acidosis

Given the significant benefit of parenteral nutrition in patients who are unable to meet their nutrition needs through oral intake or enteral nutrition support, the prevalence of home parenteral nutrition (HPN) remains high in the United States. A recent study estimated that more than 25, 000 Americans (70 per million) receive HPN each year. Despite extensive training and close follow-up, HPN can be associated with significant complications including infections, catheter or access-related issues (thrombosis, occlusion, etc.), liver disease, and metabolic complications. Although the most common complication continues to be catheter line associated blood stream infections, metabolic complications have been noted to occur with a prevalence of 0.12-0.61 episodes per catheter year. This chapter reviews metabolic complications commonly associated with HPN including diagnosis and management.