Monitoring pn therapy

When initiating PN, patients should have important baseline laboratory values checked to assess electrolyte status, organ function, and nutritional status (Table 100-7). Baseline laboratory monitoring should include:

• Basic metabolic panel (i.e., serum sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, and calcium), serum phosphorus and magnesium.

• Liver function, including AST, ALT, alkaline phosphatase, lactate dehydrogenase (LDH), total and conjugated bilirubin; a comprehensive metabolic panel can be ordered (i.e., serum sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, calcium, AST, ALT, alkaline phosphatase, albumin, and total bilirubin), but phosphorus, magnesium, and fractionated or conjugated bilirubin are not included on this panel and must be ordered separately.

• Serum albumin, prealbumin, and triglycerides.

• Complete blood count (including hemoglobin, hematocrit, red blood cell count, and white blood cell count), and platelets with differential.

© Thereafter, the preceding parameters and other nutritional parameters should be monitored routinely or as indicated (Table 100-7). Random capillary blood glucose concentrations also should be monitored every 6 to 8 hours when initiating PN, and regular insulin should be administered to control blood glucose concentrations as needed.

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