Hyperammonemia as an adverse effect in parenteral nutrition

Nutritional support is an essential element in the aggregate care of the chronic disease and/or critical patient. Many a times, the patients’ nutritional status has been a major predictor for the outcome and prognosis of diseases. Since 1967, assisted nutrition, mainly as total parenteral nutrition (TPN) to provide the necessary calories from carbohydrates, proteins, and lipids and also to furnish selected minerals, electrolytes, and essential vitamins, has been administered intravenously through a central venous catheter to the extremely sick patients who cannot obtain their required nutrition through enteral route. The advantage of parenteral nutrition is that it can be customized for individual requirement, though a standard solution could still be used. Though studies have clearly proven the superiority of the assisted nutrition in the betterment of the outcome of these patients, TPN is certainly associated with adverse effects and complications. Of all the complications associated with TPN, we will focus on hyperammonemia which could be a complication related to the type and quantity of the amino acids present in the TPN (Ghadimi et al. Pediatrics 48:955–965; 1971). List of Abbreviations ALT Alanine aminotransferase ASPEN American Society for Parenteral and Enteral Nutrition AST Aspartate aminotransferase BCAT Branched-chain aminotransferase EAA Essential amino acids EDTA Ethylenediaminetetraacetic acid fMRI Functional magnetic resonance imaging GI Gastrointestinal HE Hepatic encephalopathy IEM Inborn errors of metabolism LBW Low birth weight OTC Ornithine transcarbamoylase (ornithine carbamoyltransferase) PCT Proximal convoluted tubule PN Parenteral nutrition *Email: unnikrishnanpk@yahoo.com Diet and Nutrition in Critical Care DOI 10.1007/978-1-4614-8503-2_159-1 # Springer Science+Business Media New York 2014