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Bhattarai and Kashyap, 2016)

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Contraindications & Precautions Absolute Contraindications Inborn errors of proline metabolism Hyperprolinemia type I & II Severe metabolic disorders preventing proper amino-acid utilization Hypersensitivity to amino-acid solutions (exceptionally rare) Relative Contraindications Severe hepatic impairment: Reduced amino-acid clearance risk of imbalance Renal failure: Risk of elevated BUN adjust total amino acids Sepsis or hemodynamic instability: PN may need staged introduction Fluid/electrolyte disturbances : Correct abnormalities before PN initiation Refeeding syndrome risk: Initiate PN slowly in malnourished patients Precautions Monitor for amino-acid imbalance or hyperaminoacidemia