Is PN indicated for a fistula with daily output of 600 mL?

• A. Only if the patient is malnourished
• B. Requires additional criteria beyond output
• C. Not indicated unless output falls below 500 mL/day
• D. Yes

Answer: (D)

High-output fistulas cause significant losses of fluid, electrolytes, and nutrients, so maintaining nutrition often relies on parenteral nutrition to meet energy and protein needs that the fistula impairs or cannot supply enterally. The common threshold defining high output is around 500 mL per day; a fistula losing 600 mL daily fits this category. Providing PN helps prevent malnutrition, preserves nitrogen balance, and supports healing while allowing time to control the fistula and optimize any enteral feeding that can be tolerated. In this scenario, PN is indicated to address the substantial losses and nutritional needs, even if some enteral intake is possible.