avoid infusion within the first 24 hours following head trauma. Monitor blood glucose closely as early hyperglycaemia has been associated with poor outcomes in patients with severe traumatic brain injury. Dilution or addition to parenteral nutrition admixtures must take place in controlled and validated aseptic conditions. GlucoBoost Glucose Gel from Ennogen Healthcare is a 40% Glucose Oral Gel that is widely used in the NHS.

Before adding a substance or medication, verify that it is soluble and/or stable in water and that the pH range of the glucose solution is appropriate. Additives known or determined to be incompatible with glucose as a diluent should not be used. The instructions for use of the medication to be added, including information on storage, must be consulted. If < 2.0 mmol/l after initial feed or if still hypoglycaemic on 1hly feeds, treat with IV Glucose as belowGlucose 40% w/v is for administration by intravenous infusion following appropriate dilution or incorporation in to a parenteral nutrition admixture.

Infection and sepsis may occur as a result of the use of intravenous catheters to administer parenteral formulations, poor maintenance of catheters or contaminated solutions. If the baby has an ongoing requirement of ≥120 ml/kg/day of milk / 10% glucose to maintain normoglycaemia, refer to the guideline for refractory hypoglycaemia Refeeding severely undernourished patients may result in the refeeding syndrome that is characterized by the shift of potassium, phosphorus, and magnesium intracellularly as the patient becomes anabolic. Thiamine deficiency and fluid retention may also develop. Careful monitoring and slowly increasing nutrient intakes while avoiding overfeeding can prevent these complications. The above effects do not only result from the administration of electrolyte-free fluid but also from glucose administration.

Objectives

Use of an in-line filter is recommended during administration of all parenteral solutions where possible.

Clinical evaluation and periodic laboratory determinations may be necessary to monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient or the rate of administration warrants such evaluation. The occurrence of septic complications can be decreased with heightened emphasis on aseptic technique in catheter placement, maintenance, as well as aseptic technique in nutritional formula preparation.Particular caution is advised in patients at increased risk of water and electrolyte disturbances that could be aggravated by increased free water load, hyperglycaemia or possibly required insulin administration (see below). As indicated on an individual basis, vitamins and trace elements and other components (including amino acids and lipids) can be added to the parenteral regimen to meet nutrient needs and prevent deficiencies and complications from developing. If signs of pulmonary distress occur, the infusion should be stopped and medical evaluation initiated. Solutions containing glucose should be used with caution, if at all, in patients with known allergy to corn or corn products.