What condition can occur if Total Parenteral Nutrition (TPN) is stopped suddenly?

Appeared in: NORCET 10 Prelims-2026

Explanation

Total Parenteral Nutrition (TPN) solutions are rich in dextrose, which stimulates the pancreas to produce high levels of insulin.
When TPN is stopped abruptly, the constant supply of glucose is removed, but the circulating insulin levels remain high.
This excess insulin rapidly drives glucose from the bloodstream into the cells, causing a sharp drop in blood sugar, a condition known as rebound hypoglycemia.
Symptoms include weakness, sweating, shakiness, confusion, and increased heart rate.

Option A: Hyperglycemia (high blood sugar) is a risk associated with starting TPN too quickly or infusing it at too high a rate, not stopping it.
Option C: Hypernatremia (high sodium) is an electrolyte imbalance and not the primary, acute complication of suddenly stopping TPN.
Option D: Dehydration is not the immediate risk. The most acute danger is a metabolic one (hypoglycemia), not a fluid volume deficit.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Total Parenteral Nutrition (TPN) Discontinuation as background academic context rather than a clinical decision trigger.
A nurse's primary responsibility when discontinuing TPN is to prevent rebound hypoglycemia, which can be life-threatening.
Never stop a TPN infusion abruptly. Always follow protocol for gradual tapering. If the line fails or the bag runs out unexpectedly, immediately hang a dextrose solution (e.g., D10W) at the same rate.
Patient safety depends on vigilant blood glucose monitoring during and after TPN therapy, especially during weaning.

How to Approach the Question

First, identify the core concept: the physiological effect of suddenly stopping TPN.
Recall the composition of TPN. It is a hypertonic solution with a high concentration of glucose.
Consider the body's hormonal response to a constant high-glucose infusion. The pancreas will increase insulin production to maintain homeostasis.
Now, apply cause and effect. What happens if the cause (high glucose infusion) is suddenly removed? The effect (high insulin production) will temporarily persist.
Evaluate the options based on this physiological mismatch: high insulin without a glucose source leads to a rapid drop in blood sugar (hypoglycemia). Eliminate the other options by identifying when they would occur (e.g., hyperglycemia on initiation, dehydration from osmotic diuresis).

Concept Tested & Keywords

Concept Tested: Complications of Total Parenteral Nutrition (TPN) Discontinuation
Stem keywords: Total Parenteral Nutrition, TPN, stopped suddenly
Lead-in keywords: What condition

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 207-209

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 106-108

Practise the full NORCET 10 Prelims-2026

Attempt every question from this paper in a timed mock, then review the full solution for each one.