A nurse is caring for a client whose current bag of total parenteral nutrition (TPN) has finished infusing, and the next bag is not yet available. Which of the following fluids should the nurse prepare to administer?

Total parenteral nutrition contains high concentrations of glucose, which stimulates the pancreas to secrete significant amounts of insulin. Abrupt cessation of this hypertonic solution can lead to a rapid drop in blood glucose levels, resulting in rebound hypoglycemia. Maintaining a consistent dextrose source is critical until the next TPN bag is prepared. Rationale: A. Dextrose 10% in water (D10W) is the appropriate fluid to administer because it provides enough glucose to prevent rebound hypoglycemia when TPN is unavailable. The patient's pancreas is primed to release high levels of insulin in response to the TPN; without a continued dextrose source, the patient's blood sugar will plummet. D10W serves as a temporary bridge to maintain glycemic stability. B. 0.9% sodium chloride is an isotonic solution that provides volume and electrolytes but contains no glucose. Administering this fluid alone would fail to prevent the severe hypoglycemia that occurs when the high-glucose TPN infusion is suddenly stopped. While it is useful for many clinical situations, it is inappropriate as a substitute for TPN in a patient requiring glucose maintenance. C. 0.45% sodium chloride is a hypotonic solution used for cellular dehydration and does not contain the calories or sugar necessary to counteract the patient's high insulin levels. Using this solution when TPN runs out would leave the patient vulnerable to symptomatic hypoglycemia and potential neurological complications. It is an inadequate substitute for the high dextrose concentration required by the patient's current metabolic state. D. Lactated Ringer's is a balanced crystalloid solution used for fluid resuscitation and electrolyte replacement, but it contains negligible amounts of carbohydrate. It cannot maintain the blood glucose levels of a patient who has been receiving hypertonic TPN. The nurse must prioritize a dextrose-containing solution to avoid the life-threatening consequences of a sudden cessation of parenteral nutrition support.