ASPEN ch 15 - PN formulation Flashcards
less frequently used CHO energy substrate is ___ that provides __kcal/g
glycerol; 4.3
modified a.a. formulation designed for use in _____ contains increased amts ___ and decreased amts ____
hepatic encephalopathy; BCAAs; AAA
why BCAA thought be beneficial for severe stress?
^ skel muscle catabolism
__ content higher in more concentrated products but ____ may be used to balance ratio and avoid acid base probs
acetate; chloride salts
why less use of 10% lipid now?
higher phospholipid:triglyceride ratio compared to 20%, so ^ presence free phospholipids which interfere with lipoprotein lipase activity (v lipid clearance)
what does SMOF stand for?
soybean, medium chain RG, olive oil, fish oil
SMOFlipid good for these pt:
don’t tolerate soy well, if have carnitine deficiency (MCT is carnitine independent)
causes of PNALD?
omega 6s pro-inflam, IV admin phytosterols, ox stress
ILE infusion rate should NOT exceed ___g/kg/h
0.11
why not higher ILE infusion rate?
hypertriglyceridemia, infectious complication, fat overload syndrome
fat overload syndrome characterized by:
headaches, seizures, fever, jaundice, hepatosplenomegaly, ab pain , resp distress, pancytopenia, shock
in critically ill, limit ILE to ___ g/kg/d
1
advantages of olive oil based ILE?
decreased peroxidation, lack of lymphocyte function inhibition, preserve hepatic function
use of ____ based ILE associated with faster termination of mech vent and less time to ICU discharge
olive oil and fish oil
preferred forms of calcium and magnesium in PN:
calcium gluconate and magnesium sulfate
why these forms of Ca and Mg?
less likely produce physicochemical incompatibilities compared to others
PN formulations for single vits not available for :
biotin, pantothenic acid, riboflavin, vit a, vit d, vit e
common trace elements in PN:
zinc, copper, chromium, manganese, selenium
a.a. thought to have role in intestinal integrity, immune fxn, pro synth during stress
glutamine (not actually recommended to be supplemented)
quarternary amine necessary for proper transport/metabolism of LCFA into mito for beta-ox
carnitine
ILE in 2-in-1 is administered in a ___ infusion
piggyback
advantage of TNA:
convenience, cost, more sanitary, efficient, tolerance may be better, better in fluid restricted, fat clearance better
why limit hang time ILE to max 12 hours?
cuz has potential support bacterial/fungal growth
disadvantages of TNA
larger particle size, less stable (prone to separation), compatibility and solubility of ca and na/k less, lower pH a.a., difficult visualize precipitate, some meds incompatible, > risk catheter occlusion, shorter catheter lifespan
what does ILE stand for?
injectable lipid emulsion
success in v thrombophlebitis thru addition of ____ and/or small amt ____ to PPN
heparin; hydrocortisone
technique to minimize thrombophlebitis includes use of ___ patch at venous insertion site
nitroglycerin
3 different risk levels of contamination?
low (simple closed system aseptic), medium (reconstitution to transfer or large vol PN prep), high (preparation from bulk, nonsterile ingredients or prep from sterile ingredients exposed to < ISO Class 5 standards)
what are ISO class 5 standards?
no circulating particles 0.5 micrometre or larger to exceed 100 particles/cubic food
what is in-use time?
time before which a conventionally manufactured product used to make CSP must be used once opened/punctured
Category 1 CSPs?
assigned max beyond-use-date = / < 12 hrs controlled rm temp or =/< 24 hr refrigerated
category 2 CSP?
BUD > 12 hr temp or > 24 hr fridge
what is BUD:
date/time after which CSP should NOT be stored/transported/admin and determined from date/time prep was compounded
what are ACDs
automated compounding devices
main advantage of ACD?
accuracy ^ of dosage form (also more safe)
disadvantage ACD?
cost and space
major methods used for verifying accuracy of compounding process by ACDs are ______ and _____ analysis
volumetric; gravimetric
___ used to determine whether PN formulations compounded properly
refractometry (doesn’t work w/ TNA)
why internal membrane to separte macronutr into diff chambers?
prevent Maillard rxn that alters integrity of dextrose and a.a.
advantages of using standard commercially available PN?
reduce cost, v comp time, less risk for errors, less infections, shelf stable and heat sterilized
stability in PN refers to ___ and compatibility refers to ____
degradation of nutr components that changes original characteristics (eg. maillard rxn) and ability maintain chem integrity and activity; formation of precipitates
polar regions on fat droplet create ___ charge (called ___ potential) on surface of fat drop that promotes repulsion between neighboring lipid particles of same charge
negative; zeta
factors that alter electric charge on fat drop surface include:
v in pH, addition of electrolyte salts
what is a cracked ILE?
oil phase separates from water
most critical factor influencing pH of PN formulation is _____ used
crystalline amino acid
why add cysteine hydrochloride?
although it is destabilizing, can request cuz have taurine and L-cysteine HCl can be added to ^ ca phosphate solubility
why a.a. with dextrose?
buffers acidity of dextrose
low osmolarity PN formulations (eg. PPN) pose high threat for _____ precipitation
calcium phosphate
___ indicates that fusion of fat droplets has occurred and the individual droplet size has increased
coalescence
how to reduce likelihood that ca and P will precipitate?
lower pH, ^ a.a. concentration. ^ dextrose concentration
TNA is discouraged from use in these populations:
neonatal and pediatric
^ risk of ca p precipitation cuz:
^ Ca / P concentration, CaCl use, ^ temp
risk of ____ must be considered when Ca provision < 10-15 mEq/d
metabolic bone disease
trace element contamination include:
arsenic, Al, Cr, Zn, Mn, Cu
max Al load permitted?
25mcg/L
why store in plastic instead of glass?
less Al content at expiration
pt at risk of Al toxicity:
1) significant renal dysfunction 2) high intake PN 3) Fe deficiency
why filters used now?
ca p precipitation risk minimization, v pathogenic microorgs
can’t use filters with:
ILE
if 2 in 1 used, 2 filters required:
0.22 (inline) and 1.2
inline filter can ^ incidence of ____
occlusion alarms
dextrose ____ or ____% should be used for compounding PN in fluid restriction
50; 70
