Few reports have been published examining the impact of a nutrition support service on avoiding serious metabolic complications in hospitalized patients receiving total parenteral nutrition (TPN). We report a high frequency of metabolic abnormalities, with 33% of patients having at least one laboratory value outside the normal range during their course of TPN. Nonetheless, only 13 abnormalities in 11 patients were associated with adverse clinical symptoms in 2747 courses of TPN over 7 years (0.47%). Data were obtained by retrospective analysis of a prospectively maintained nutrition support team database. This report is offered as a standard of care to be attained. Copyright © 2001 American Society for Parenteral and Enteral Nutrition.