Total Parenteral Nutrition in Clinical Practice: The Pharmacist’s Role in Prescribing Support, Preparation, and Risk Management
Abstract
Background: Total parenteral nutrition (TPN) is a critical intervention for patients unable to meet nutritional needs via the gastrointestinal tract. It delivers macronutrients and micronutrients intravenously, bypassing digestion and absorption, but carries significant risks requiring multidisciplinary oversight.
Aim: To review the pharmacist’s role in prescribing support, preparation, and risk management of TPN, emphasizing clinical indications, mechanisms, administration, adverse effects, contraindications, monitoring, and toxicity.
Methods: A comprehensive literature review was conducted, synthesizing evidence-based guidelines and clinical studies on TPN formulation, administration strategies, and safety considerations.
Results: TPN is indicated in conditions such as bowel obstruction, high-output fistulas, severe malabsorption, and prolonged NPO status. Its mechanism involves intravenous delivery of carbohydrates, amino acids, lipids, electrolytes, vitamins, and trace elements, tailored to patient-specific needs. Administration requires central venous access and strict aseptic technique. Adverse effects include catheter-related complications, infections, metabolic disturbances (e.g., refeeding syndrome, dysglycemia), and hepatobiliary dysfunction. Contraindications include functional GI tract, irreversible neurological injury, and critical instability. Monitoring protocols emphasize frequent assessment of electrolytes, renal function, and glucose. Toxicity risks arise from overfeeding, trace element accumulation, and oxidative damage. Pharmacists play a pivotal role in compounding stability, compatibility checks, and interdisciplinary coordination.
Conclusion: TPN is a high-risk, lifesaving therapy requiring individualized prescriptions, vigilant monitoring, and collaborative care to optimize outcomes and minimize complications.
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Copyright (c) 2025 Bejad Muteb Saad Alotaibi, Ali Hasan Ali Gharawi, Adel Ali Alshehri, Abdulrahman Saleh Alanazi, Abdullah Shaya Hamad Aldossari, Ali Ibrahim Abdullah Faqeeri, Fayez Fayadh Helal Alanazi, Mohammed Ali Mohammed Alsahli, Mohammed Muqbil Alqahtani, Rahma Turki Hassan Alshamrani, Saud Nasser Salem Alotaibi, Hussain Habib Al Abdullah
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