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Swollen in legs, hesitant to continue with TPN for preparation for a surgery. Any thoughts?

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Practicing since : 2004
Answered : 1212 Questions
Hi there,
My mom is on tpn at home preparing for a surgery. After 3 days her legs swell up and now they are twice bigger than before... I mentioned that to the doctor, he said it's up to me, but he would recommend continuing with the tpn to ensure smooth recovery after surgery... I trust the doctor, but I'm hesitant to continue with tpn since my mother is already in fluid overload mode... Any thoughts on this? My mother is 58 years old and the surgery is to remove the tumor in the abdomen.
Posted Tue, 8 May 2012 in Bones, Muscles and Joints
Answered by Dr. Indranil Ghosh 2 hours later
Thanks for posting your query.

Total parenteral nutrition (TPN) is an extremely complex subject and this therapy should be preferably given in a hospital. However, in some circumstances (especially when prolonged therapy is required), it may be carried out at home, but under the regular supervision of your physician. It needs regular monitoring of clinical status, including body weight, hydration and blood parameters.

There may be various reasons for the swelling of the legs. These include:
1. Hypoproteinemia (Low levels of protein in blood)
2. Obstruction by any tumor in the abdomen
3. Venous clot formation
4. Cardiac problems
5. Liver problems
6. Generalized fluid overload

To be able to institute appropriate treatment, we need to first ascertain the probable cause. For this, the following investigations may be needed:
a.     Blood tests like liver function tests and kidney function tests
b.     Ultrasound of the abdomen
c.     Doppler studies
d.     Echocardiography
The treatment will be according to the cause. If it is fluid overload, we may reduce the volume of TPN and then assess the situation
I hope I have answered your query. Please accept my answer if you have no follow up queries.

Above answer was peer-reviewed by
Follow-up: Swollen in legs, hesitant to continue with TPN for preparation for a surgery. Any thoughts? 13 hours later
Thanks for your fast response. Since I skipped 2 nights of tpn for her, the swelling went away. My dilemma is this: the doctor wants her on tpn, the surgery is tomorrow, should I hook her up again right before the surgery to get her nutrition up or just leave it as is... Her surgeon might be mad at me if I don't continue with tpn...
Answered by Dr. Indranil Ghosh 5 hours later

I feel that the swelling was more because of the fluid overload from TPN (Total Parenteral Nutrition). One more day off TPN will not make much of a difference. You can safely omit it. But please weigh the risk – benefit ratio. Get back to the treating doctor as soon as possible.

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