Glucose in Parenteral Nutrition: A Survey of US 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.