Glucose

• Approximately 60% of non-protein energy should be supplied as carbohydrates.
• Aim to maintain normal blood sugar levels (between 80-110 mg/dl, at least

PN cycling

• Infants at around 2 months-old can often tolerate cycling.
• Taper on by starting with one half the hourly rate for 30 to 60 minutes.
• Taper off by decreasing the hourly rate by one one for 30 to 60 minutes, then decrease the hourly rate by one fourth for 30 minutes.

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Glucose infusion rate = (PN rate (ml/hour) * Dextrose concentration (g/dL) * 1000 mg/gram)/(weight (kg) * 60 (min/hour) * 100 ml/dL)

Hyperglycemia

• Symptoms: Polyphagia, polydipsia, dehydration (typically when PN infusing)
• Generally tolerated to advance GIR by 1-2 mg/kg/minute.  Patients may not tolerate glucose infusion rate (GIR) > 15 mg/kg/minute.
• Risk factors: stress (inpatient), critically ill, diabetes, sepsis, steroid therapy
• Treatment: Decrease dextrose in PN, prolong PN cycle, add insulin to PN.
• Monitoring for hyperglycemia if GIR > 20 mg/kg/minute with either of the following tested at least twice:
  • Finger stick blood glucose during peak PN infusion
  • Urinalysis

Hypoglycemia

• Symptoms: Sweating, sleepiness, pallor, tachycardia (typically when PN stopped suddenly or tapered off).
• Risk factors: Interuptions in infusions, younbger age, Low lean mass, 
• Monitoring for hypoglycaemia when cycling off PN:
  • Check fingerstick blood glucose 1 hour after PN infusion done if symptomatic.
• Ensure patients get at least 4mg/kg/min to spare the protein catabolism.