In many respects, the perfection of the technique for total intravenous alimentation is one of the most significant advances in clinical nutrition of recent years.1,2 The efficacy of the technique in promoting growth and maintaining positive nitrogen balance as well as in markedly reducing the mortality of selected pediatric disorders can no longer be questioned. Despite these obvious benefits, the improper use of the technique can often be hazardous. Infection, particularly fungemia, is certainly the most common complication associated with the technique,3 but metabolic abnormalities are also being reported in increasing numbers—eg, acidosis,4 hyperammonemia,5,6 deranged plasma amino acid patterns,7,8 hypophosphatemia,9 and essential fatty acid deficiency.10
We believe that the complications of the technique, both those related to presence of the catheter (eg, infection) and those related specifically to the infusate or to infusion of the nutrient solution under conditions in which the