TPN...Do you need to taper it down ?

There is a general belief that PN formulations require tapering.

Rebound hypoglycemia is rarely seen but is often discussed in the clinical setting .

The risk is very low, even in patients with diabetes mellitus, as they are somewhat “protected” by inherent insulin deficiency.

Stopping PN is the same as stopping an independent insulin drip; remember, the half-life of regular

insulin is only 5 minutes (although, somewhat longer if the patient is in renal failure).

A taper down of PN is not needed, especially if the patient is receiving another dependable source of carbohydrate.

If a particular patient is prone to hypoglycemia, tapering PN over 1–2 hours before discontinuation is justified and can avoid this problem.

Eisenberg PG, Gianino S, Clutter WE, et al. Abrupt discontinuation of cycled parenteral nutrition is safe.

Dis Colon Rectum, 1995; 38 (9):933-939.

Krzywda EA, Andris DA, Whipple JK, et al. Glucose response to abrupt initiation and discontinuation of total parenteral nutrition.

J Parent Enteral Nutr, 1993;17:64-67.

Nirula R, Yamada K, Waxman K. The effect of abrupt cessation of total parenteral nutrition on serum glucose: a randomized trial.

Am Surg, 2000;66(9):866-869.

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