Answer to Question 1
Hyperglycemia most often occurs in patients who are glucose intolerant, receiving excessive energy or dextrose, undergoing severe metabolic stress, or receiving corticosteroid medications. It can be prevented by providing insulin along with parenteral solutions, avoiding overfeeding or overly rapid infusion rates, and restricting the amount of dextrose in the solution. Although uncommon, hypoglycemia sometimes occurs when parenteral nutrition is interrupted or discontinued or if excessive insulin is given. In patients at risk, such as young infants, feedings may be tapered off over several hours before discontinuation. Another option is to infuse a dextrose solution at the same time that parenteral nutrition is interrupted or stopped. Hypertriglyceridemi a may result from dextrose overfeeding or overly rapid infusions of lipid emulsion. Patients at risk include those with severe infection, liver disease, kidney failure, or hyperglycemia and those using immunosuppressant or corticosteroid medications. If blood triglyceride levels exceed 400 milligrams per deciliter, lipid infusions should be reduced or stopped.
Answer to Question 2
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