A nurse is preparing to discontinue long-term total parenteral nutrition (TPN) therapy for a client. The nurse should plan to discontinue the TPN gradually to reduce the risk of which of the following adverse effects?

A. Hyperglycemia is incorrect. Hyperglycemia is a risk during TPN administration, particularly if the glucose concentration is high or if the client has impaired insulin secretion. However, when discontinuing TPN, the risk shifts from high to low blood glucose, not elevated levels. B. Constipation is incorrect. Constipation is not a direct concern when stopping TPN. It may occur if oral intake is insufficient after TPN discontinuation, but it is not an acute metabolic risk. C. Diarrhea is incorrect. Diarrhea can occur if the client transitions too quickly to enteral nutrition, but it is not the primary adverse effect of abruptly stopping TPN. D. Hypoglycemia is correct. TPN contains concentrated dextrose, providing a continuous source of glucose to meet the client’s energy needs. Abrupt discontinuation removes this source, which can cause a rapid drop in blood glucose, especially in clients who have been on long-term TPN or who have impaired pancreatic function. Symptoms of hypoglycemia include shakiness, diaphoresis, confusion, tachycardia, and, in severe cases, loss of consciousness.