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Selenium deficiency is associated with cardiomyopathy, skeletal muscle weakness, and immune dysfunction. It can occur in PN if selenium is omitted or with high GI losses. Copper deficiency causes anemia and neuropathy, zinc deficiency causes dermatitis, and chromium deficiency causes insulin resistance.

In short bowel syndrome with colon continuity, complex carbohydrates and soluble fiber are fermented by colonic bacteria into short-chain fatty acids (SCFAs), which provide additional energy and promote fluid/electrolyte absorption. MCTs are beneficial when colon is absent, as they are absorbed without bile salts. Long-chain fats are poorly tolerated in severe malabsorption, and lactose often worsens diarrhea. Tailoring macronutrients to bowel anatomy optimizes EN tolerance and nutrient absorption.

ASPEN/Academy guidelines define severe malnutrition in acute illness as intake <50% with rapid significant weight loss and severe exam findings. Proper classification ensures urgent intervention, correct coding, and optimal outcomes.

Ethical conflicts over PN continuation should first be addressed with open communication and ethics consultation. The team should explain risks, burdens, and lack of benefit, while respecting family emotions. Stopping PN without discussion violates trust, while transferring care or blindly agreeing ignores professional responsibility. Ethics consultations help mediate conflict, align care with patient’s values, and prevent unnecessary suffering.

The first step in PN management of hyperkalemia is to reduce or eliminate potassium salts. Additional interventions may include treating underlying renal dysfunction and using potassium-binding resins or dialysis if severe. Increasing KCl would worsen the problem. Phosphate and magnesium changes do not correct hyperkalemia.