Original ArticlesStrategies for Parenteral Nutrition Weaning in Adult Patients With Short Bowel SyndromeDiBaise, John K. MD, FACG; Matarese, Laura E. MS, RD, LDN, FADA, CNSD; Messing, Bernard MD; Steiger, Ezra MD, FACS, CNSPAuthor Information *Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, AZ †Intestinal Rehabilitation and Transplant Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA ‡Hepatogastroenterology and Nutrition Support Department, Hôpital Lariboisière, Paris, France §Intestinal Rehabilitation Program, Nutrition Support and Vascular Access Department, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH Reprints: John K. DiBaise, MD, Mayo Clinic Scottsdale, Division of Gastroenterology and Hepatology, 13400 East Shea Blvd., Scottsdale, AZ 85259 (e-mail: [email protected]). Received for publication January 5, 2006; accepted February 9, 2006 Journal of Clinical Gastroenterology: May 2006 - Volume 40 - Issue - p S94-S98 doi: 10.1097/01.mcg.0000212679.14172.33 Buy Metrics Abstract The development of parenteral nutrition (PN) was an important, life-saving advance in the care of patients with short bowel syndrome (SBS). Nevertheless, its long-term use is often associated with complications. Therefore, it is desirable, when possible, to wean SBS patients to an oral diet. Given the complexity of PN weaning and the lack of published guidelines, the purpose of this article is to describe strategies of PN weaning and illustrate important clinical considerations during the weaning process. Patient education and motivation are key factors in successful PN weaning. The patient should have clearly defined care protocols and understand the importance of each aspect of the weaning program. Other factors likely to influence weaning success include the length and health of the remnant bowel, the presence of a colon, and the degree to which bowel adaptation has occurred. It is imperative that daily oral fluid and caloric intake goals are met prior to initiating PN weaning and that the patient receives an optimized dietary and medication plan. During weaning, the most practical measures for assessing adequate hydration and nutritional status are oral intake, stool and urine output, serum electrolytes and visceral proteins, and body weight. PN reductions can be made by either decreasing the days of PN infusion per week or decreasing the PN infusion volume equally across all days of the week. Use of recombinant human growth hormone, with or without glutamine, may play a role in facilitating the PN weaning process. Copyright © 2006 Wolters Kluwer Health, Inc. All rights reserved.