We have a patient having TPN during dialysis and I was wondering if anyone knows of any protocols or guidelines that we can follow. Although her blood sugar goes up during treatment, I worry about rebound hypoglycaemia after dialysis. There is insulin in the bag, but it doesn't seem to be enough and the ICU registrar (that makes up the orders) doesn't seem to know how to manage it in this situation.

We occasionally give IntraDialytic Parenteral Nutrition to severely malnourished patients. This begins with no lipids, but once it is clear the patient is tolerating the IDPN, lipids are added to the mix.
The introductory period, about 2-3 weeks, requires that we keep the patient an extra 30 minutes, to draw a post 30" blood glucose. Our nutritionists oversee the whole process. If you would like, please email me at lilrebpic@aol.com, and I will ask our dietitians if they would be willing to share info with you.