A Prospective Comparative Study of Metabolic Effects between High and Low Osmolar Total Parenteral Nutrition

Background: Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract, used to manage and treat malnutrition.Total parenteral nutrition is indicated when there is impaired gastrointestinal function and contraindications to enteral nutrition.The three main macronutrients are lipid emulsions, proteins, and dextrose, along with a mixture of electrolytes, trace elements, vitamins, and water.Various trials and studies over the years have shown the adverse metabolic effects of TPN on patients.In our hospital, mainly two different osmolar TPN solutions (850 mOsm/kg water and 760 mOsm/kg water) are transfused.In this study, we will compare the metabolic changes in patients receiving either of these types of TPN. Materials and methods: This observational, analytical, cross-sectional study was conducted on patients admitted to the ICU of ESI-PGIMSR and ESIC Medical College, Joka, Kolkata, from November 2022 to April 2023.Results: High osmolar TPN was associated with a significantly greater incidence of hyperglycemia (p < 0.05) and elevated lipid profile (p < 0.05) as compared to low osmolar TPN.No significant difference was found in renal function outcomes.Conclusion: Low osmolar TPN is associated with fewer metabolic disturbances compared to high osmolar formulations.Clinical consideration of osmolarity in TPN formulation is crucial for minimizing adverse metabolic effects.