Term
| What two disease states come from malnutrition? |
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Definition
- Marasmus - spares visceral protein
- Kwashiorkor - spares adipose, wasting of protein |
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Term
| What are the advantages to parenteral nutrition? |
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Definition
Easier administration
Better patient acceptance
More reliable delivery |
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Term
| What are the indications for parenteral nutrition? |
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Definition
- GI tract can't be used - obstruction, severe diarrhea, fistulas, IBD, short bowel syndrome
- Critically ill w/ non-functioning GI
- some cancers
- Severe pancreatitis
- Severe malnutrition |
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Term
| What are the characteristics of malnutrition? |
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Definition
Insufficient food and nutrition intake
Weight loss over time
Loss of muscle and fat mass
Fluid accumulation
Measurable diminished grip strength |
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Term
| Do visceral proteins have a role in nutritional assessment? |
|
Definition
- Albumin - long half life, not useful
- Transferrin - hypoxia can effect
- Prealbumin - short half life, affected by chronic syndromes
**Not good nutrition markers |
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Term
| What are the kcal and infusion rates for carbs in PN? |
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Definition
- 3.4 kcal/gram - glucose
- 4-7 mg/kg/min for adults
- 10-14 mg/kg/min for infants
**Glycerol has a higher kcal, only used in palliative care. |
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Term
| How are lipids delivered for PN? |
|
Definition
Only long chain TGs: 10 kcal/gram for 20% emulsion
** do not exceed 2.5 g/kg/d or 60%
**Do not use in patients who cannot clear lipids, or with an egg allergy |
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Term
| What are essential amino acids? |
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Definition
| Histidine, Isoleucine, Leucine, Lysine, Methionine, cysteine, phenylalanine, tyrosine, threonine, tryptophan, and valine |
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Term
| What are special considerations with proteins in infants w/ PN? |
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Definition
- need more taurine, aspartic acid, and glutamic acid
- Cysteine makes lipids unstable: give infants 2 in 1 w/ a lipid piggyback
- Carnitine supplement for 7 days |
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Term
| What are the maximum concentrations of stock solutions for PN? |
|
Definition
- Dextrose - 70%
- Lipids - 30%
- AA - 20% |
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Term
| What are essential trace elements for IV PN? |
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Definition
- Chromium
- Zinc - toxicity is a risk factor for copper deficiency!
- Copper
** Multitrace 5 has Cr, Cu, Zn, Mn, Se. Multitrace 4 does not have Se. |
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Term
| What electrolytes are added as salts to PN? |
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Definition
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Term
| What are H2 antagonists compatible with in PN? |
|
Definition
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Term
| What is ascorbic acid compatible with in PN? |
|
Definition
| Only Y site, cannot be mixed |
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Term
| What is insulin compatible with in PN? |
|
Definition
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Term
| What is octreotide compatible with in PN? |
|
Definition
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Term
| What are setrons compatible with in PN? |
|
Definition
- Granisetron - 2:1 and 3:1
- Ondansetron - Conflicting data |
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Term
| What is heparin compatible with in PN? |
|
Definition
| 2:1 up to 2,000 IU, and 3:1 |
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|
Term
| What is reglan compatible with in PN? |
|
Definition
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|
Term
| What is albumin compatible with in PN? |
|
Definition
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Term
| What is Phytonidione compatible with in PN? |
|
Definition
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Term
| What are the routes available for PN? |
|
Definition
- Peripheral: for short term use, not to exceed 900 mOsm/L. Lower concentrations and limited trace elements. Watch for thrombophleblitis!
- Central - For over 7-14 days. Through superior/inferior vena cava. Cap on K (10 mEq/h)
**Continuous - for ICU patients, watch LFTs due to lipid buildup.
**Cyclic - mobile patients |
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Term
| What are the kCal/g in macronutrients in PN? |
|
Definition
- Carbs - 3.4
- Protein - 4
- Fat - 10
- Fat (Liposyn) - 1.1
- Alcohol - 7 |
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Term
| How are fluid requirements for a PN patient determined? |
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Definition
| 1500 ml/m2 OR 1.5 *BEE (Harris benedict equation) |
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Term
| How are calorie needs calculated for a PN patient? |
|
Definition
| Use harris benedict equation OR 20-25kCal/kg |
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Term
| What are the steps in PN to determining protein requirement? |
|
Definition
A protein requirement will be given:
ex: 1.2 g/kg. If a patient weighs 70 kg = 84 g
THEN --> 84g * 4 g/kcal = 336 kcal |
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Term
| How are non-protein calories determined in PN? |
|
Definition
Total calories (from BEE) - protein calories = non-protein calories. In example: 1,108
Then: 70% dextrose and 30% lipids:
- .7 * 1,108 kcal = 775.6 kcal/3.4 kcal in dextrose = 228.1 g
- .3 * 1,108 kcal = 332.4 kcal/10 kcal in lipids = 33.2 g |
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Term
| How do you determine how many mL of each component to compound in PN? |
|
Definition
Dextrose 70, Lipids 20, AA 15 ALWAYS
So, in example:
dextrose: 70g/100mL = 228.1 g/x mL --> 325.9 mL
Lipids: 20g/100mL = 33.2g/x mL --> 166 mL
AA: 15g/100mL = 84g/x mL --> 560 mL
Total volume = 1,051.9 mL |
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Term
| What mechanical complications are associated with PN? |
|
Definition
- Asymptomatic thrombosis is somewhat common.
- Malposition
- Malfunction: Pump failure, tubing, catheter. Catheter can break |
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Term
| How can line infections be prevented in PN? |
|
Definition
| USe 70% alcohol lock, gloves, and bio patch. Appropriate antibiotic if infection takes place |
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Term
| What are metabolic and nutritional complications of PN? |
|
Definition
- Liver disease - lipid deposition. Taurine deficiency is a risk.
- Hyperglycemia and high TGs - Insulin dose 0.15-.2 units/g of dextrose for hyperglycemia 150-200
- Refeeding syndrome - too few essential nutrients such as thiamine, Mg, PO4. Alcoholics, the malnourished
- Overfeeding - glucose leads to hyperglycemia and incr CO2, resp dysfunction |
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Term
| What are long term PN complications? |
|
Definition
- Essential fatty acid deficiency - hair loss, thrombocytopenia
- Metabolic bone disease - Ca and Vit D |
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Term
| What minerals are most likely to precipitate out of a PN? |
|
Definition
Calcium and phosphate, can be life threatening
**Never add iron to lipids
** Never use Sodium Bicarb - forms CO2 gas |
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