In the older person with a nonfunctioning gastrointestinal tract, parenteral nutrition may be unavoidable. All patients receiving parenteral nutrition must be monitored closely for adverse effects. For short-term intravenous nutritional repletion, peripheral parenteral nutrition may be used. Low osmolality nutritional preparations, with a low risk of toxicity to soft tissue, are best suited for this purpose. There is a paucity of data regarding the safety and efficacy of most peripheral parenteral nutritional products for periods exceeding 14 days. Thus, where longer periods of intravenous feeding are required, total parenteral nutrition through a large central vein is indicated. Standard total parenteral formulations comprising 25% dextrose, 5% amino acids, electrolytes, and trace elements in optimal amounts are suitable for use in most patients. During prolonged parenteral nutrition, lipid emulsion supplements should be added to prevent deficiency of essential fatty acids.
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