General Principles

General Principles is a topic covered in the Washington Manual of Medical Therapeutics.

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Parenteral nutrition should be considered if energy intake cannot, or it is anticipated that it cannot, be met by enteral nutrition (<50% of daily requirements) for more than 7–10 days. This guideline originates from two intensive care unit (ICU)-focused meta-analyses citing increased complications1 and increased overall mortality2 in ICU patients receiving early parenteral nutrition (i.e., within 7 days of admission), compared with those receiving no nutrition support. Recent studies have found that critically ill patients who are unable to meet caloric goals by enteral nutrition alone for the first 8 days of hospitalization have longer durations of stay and greater mortality rates than those in whom total parenteral nutrition (TPN) is withheld for the first 8 days after admission.3

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