Despite increasing advances in total parenteral nutrition, a lot of partly serious side effects have been seen. This includes among other things the lactic acidosis after high amounts of carbohydrates or the deficiency and excessive expenditure respectively, of thiamine in carbohydrate metabolism. Metabolic changes in bone system, especially with long term parenteral nutrition are reported by american groups. Cholestasis is often caused by intravenous feeding. In patients with malnutrition a carefully balanced supply of calories and phosphate should be offered. Without misuse of TPN, the rate of complications is very low.
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