一位病人正透過中心靜脈導管接受全靜脈營養（TPN）。護理師發現 TPN 藥袋已空，但下一袋藥尚未由藥局送到。護理師應先掛上哪種溶液？
A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The nurse discovers the TPN bag is empty, and the next bag has not arrived from the pharmacy. Which solution should the nurse hang in the meantime?
- A10% dextrose in water (D10W)✓ 正解10% 葡萄糖水 (D10W)
- B5% dextrose in lactated Ringer's乳酸林格氏液中加 5% 葡萄糖
- CSterile water無菌水
- D0.9% normal saline0.9% 生理食鹽水
TPN 含有極高濃度的葡萄糖（通常 20-50%），會刺激胰臟分泌大量胰島素。核心風險是如果 TPN 突然中斷，體內的高濃度胰島素會導致嚴重的反跳性低血糖（Rebound Hypoglycemia）。正確答案 A 使用 10% 葡萄糖水（D10W）是標準處置，目的是提供足夠的糖分來維持血糖穩定，直到新的 TPN 袋到達。選項 D（生理食鹽水）不含糖，無法預防低血糖；選項 C（無菌水）會導致溶血且無糖。護理師必須了解 TPN 的代謝特性，並隨時準備好 D10W 作為緊急替代品，這是維持病人安全與代謝穩定的重要環節。
TPN contains a very high concentration of dextrose (usually 20-50%), which stimulates the pancreas to secrete large amounts of insulin. The core risk is that if TPN is abruptly stopped, the high circulating insulin levels can cause severe rebound hypoglycemia. The correct answer, A, the use of 10% dextrose in water (D10W), is standard practice. The goal is to provide enough glucose to keep blood sugar stable until the next TPN bag arrives. Option D (normal saline) contains no glucose and cannot prevent hypoglycemia; option C (sterile water) causes hemolysis and contains no glucose. The nurse must understand the metabolic characteristics of TPN and have D10W ready as an emergency substitute, which is an important component of maintaining patient safety and metabolic stability.
美國護理標準明確規定 TPN 空窗期必須使用 D10W 銜接。台灣臨床上，部分單位若 TPN 延誤，可能僅調慢原點滴流速或改掛 D5W，對於反跳性低血糖的警覺性與 D10W 的標準化使用程度可能因醫院而異。