A patient admitted to the ICU with an order for complete bowel rest is started on total parenteral nutrition (TPN). On the second day, the nurse notes that the patient has developed hypertension. The physical assessment demonstrates mild peripheral edema, neck vein distension and the presence of mild crackles and rales on auscultation of the lungs bilaterally. Which of these complications of TPN is this patient likely experiencing?

This patient has signs consistent with fluid overload. Just as with any other intravenous administration of fluids, TPN that is given too quickly will produce these clinical signs. Additionally, the patient may complain of shortness of breath or dyspnea. Hypoglycemia typically presents with the complaint of headache, the presence of a tremor or “shakiness,” cool and clammy skin, diaphoresis, blurry vision, and loss of consciousness with or without seizures. Lab values will demonstrate a very low glucose level. Infection presents with fever, chills, diaphoresis with/without pain, redness and swelling at the catheter insertion site. Pneumothorax is a complication due to placement of the central venous access line prior to the onset of TPN feedings and will likely be clinically apparent during or shortly after the procedure with the main clinical findings of abrupt onset of chest pain and shortness of breath accompanied by tachycardia and tachypnea with hypotension and hypoxia if severe.