Parenteral Nutrition

When children are having such horrible vomiting that they can't keep anything down or they such bad diarrhea that everything goes right through them, intravenous (IV) fluids are often used to make sure they don't become dehydrated or lose too much of their salts (like sodium or potassium). 

That can help for a day or two, but if the illness or condition lasts longer, the child begins to use up his or her calories that provide the energy for the body's function--and the body begins to rob the muscle and tissues of its protein to use that as a source for the energy for the body's metabolism. That's known as negative nitrogen balance, because the protein's nitrogen isn't being replaced.

IV nutrition is designed to replenish what the body needs when regular or tube feedings can't be used. And in those situations ( or after a severe accident or major surgery), the body often needs extra protein and calories, at least for a little while. So the IV feedings (also known as total parenteral nutrition, TPN) or hyperalimentation) have to be adjusted daily in the beginning and regularly after that to make sure they deliver the

  • fluid
  • protein, sugar, essential fats
  • salts (sodium, potassium, chloride, bicarbonate)
  • calcium, magnesium, phosphorus and other minerals
  • vitamins

the body needs. TPN has to be critically balanced and carefully administered.

  • Too little and a deficiency can develop.
  • Too much and the liver, kidneys and other tissues can be affected
  • These children are tremendously susceptible to  infections that can enter through the IV tubing and connections
  • The IV tubing can clot which can prevent the nutrition from getting where it needs to go, or the clot can dislodge and cause strokes and other complications

Often, the TPN can be weaned as the child begins to eat and absorb or as he or she becomes stable enough so that tube feedings can replace the IV nutrition.