Which major complication of total parenteral nutrition requires monitoring?

• A. Infection risk
• B. Hyperglycemia and electrolyte imbalance
• C. Hyperkalemia
• D. Dehydration

Answer: (B)

Monitoring total parenteral nutrition centers on keeping metabolic stability because the continuous infusion delivers a large glucose load and essential minerals that can shift quickly. The most critical complications to watch for are hyperglycemia and electrolyte imbalances. The high dextrose content can raise blood glucose, so blood sugar is checked frequently—often every 6 hours at the start—and the rate of the PN or insulin therapy is adjusted to keep glucose in a safe range. Insulin can drive potassium, phosphorus, and magnesium into cells, which may cause hypokalemia, hypophosphatemia, and hypomagnesemia; therefore daily or more frequent electrolyte labs are necessary, and supplementation is given as needed, especially during initiation and dose changes. This metabolic focus is also tied to refeeding syndrome risk in malnourished clients, underscoring why electrolyte shifts are closely monitored. While catheter-related infection is a real concern with PN due to the central line, the priority in monitoring is ensuring glucose control and electrolyte balance to prevent life-threatening metabolic disturbances.