ASPEN ch 17 - PN complications Flashcards by Angela Luo

categories of PN complications?

mechanical, metabolic, infectious

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most common complication associated with PN

hyperglycemia

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why hyperglycemia?

stress associated, excess CHO admin

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recommend target BG concentration between _____ mg/dL

140-180

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PN should be initiated at ___ of estimated energy needs for first 24 hrs

half

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CHO admin NOT exceed rate of _____mg/kg/min or ____kcal/kg/d in acutely ill

4-5; 20-25

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giving subsequent dose of insulin too soon is referred to as:

stacking

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rare reason for hyperglycemia?

chromium deficiency (makes insulin less effective)

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hyperglycemia associated with these worsened clinical outcomes:

^ risk infection, poor healing, inability gain wt

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why hypoglycemia?

excess insulin admin

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abrupt PN d/c associated with:

rebound hypoglycemia

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how to prevent rebound hyperglycemia?

1-2hr taper down of infusion

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clinical manifestation of EFAD?

scaly dermatitis, alopecia, hepatomegaly, thrombocytopenia, fatty liver, anemia

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a triene:tetraene ratio > ___ indicates EFAD

0.2

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why PN need exogenous source of fat?

hypertonic dextrose infusion causes insulin secretion and reduction in lipolysis

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__ based ILEs associated with immunosuppressive effects, exaggerated SIRS, reticuloendothelial system dysfunction

soy

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how come certain LCFA impaire immune fxn?

interfere w/ phagocytosis and chemotaxis, ^ risk for infection

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how does hypertriglyceridemia occur?

dextrose overfeeding or rapid admin rates ILE > 0.11g/kg/h

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probs of hyperlipidemia?

impaire immune response, alter pulmonary hemodynamics, ^ risk pancreatitis

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ILE intake should be restricted to < ___% energy or ___g/kg/d

30; 1

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pancreatitis due to ILE hyperlipidemia rare unless serum TG > ___mg/dL

1000

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when pro admin excess, metabolic demand of disposing of byproducts of pro metabolism ^, thus ___ can result

azotemia

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prerenal azotemia result from:

dehydration, excess pro, inadequate nrg from nonpro sources

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intolerance to protein load is characterized by____

^BUN

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crystalline a.a. prevents ___ risk

hyperammonemia

why pt receiving both PN and warfarin need close monitoring?

vit K in the preparation interacts with warfarin -->therapeutic failure

pt with hx prolonged poor diet intake should have supplemental __ and __

thiamine; folic acid

vitamin that undergo degradation after addition to PN?

vit A

trace element deficiencies that may occur?

zinc, selenium

decrease ____ dosing in pt with hepatobiliary disease cuz impairs excretion

copper; manganese

adverse effects of metabolic and physio shifts of fluid/electrolytes/vit/min in aggressive nutr support or repletion of malnourished pt

refeeding syndrome

at refeeding risk ___ days after start of support

2-5

mechanism of refeeding?

reintroduction of CHO cause insulin release which uptakes lots of gluc/lytes/min/water to cells, CHO admin increases demand for intracell P to synth ATP (v P), ^ need for thiamine/K/Mg

why liver disease common in PN?

intestinal failure

3 types of hepatobiliary disorders associated with PN:

steatosis, cholestasis, gallbladder sludge/stones

what is steatosis?

hepatic fat accumulation

steatosis presents as modest elevations of serum ___

aminotransferase

condition of impaired secretion of bile or frank biliary obstruction that occurs predominantly in children

PNAC (PN-associated cholestasis)

PNAC typically presents as:

elevated alkaline phosphates, gamma-glutamyl transpeptidase, conjugated bilirubin [ ] w/ jaundice

elevated serum ))) considered prime indictator for cholestasis

conjugated bilirubin

gallbladder stasis during PN may lead to development of _____ with subsequent ____

gallstones/sludge; cholecystitis

gallbladder stasis has more to do with ____ than PN infusion

lack of enteral stim (v CCK and impaired bile flow)

biliary sludge may progress to ____ in the absence of gallstones, referred to as ____ cholecystitis

acute cholecystitis; acalculous

infection associated with ____

cholestasis

risk factors for liver disease:

SIBO, massive resection of intestine

development of steatosis in PN primarily cuz of:

excess nrg (promote hepatic fat deposition by stim insulin release, ^ lipogenesis and v f.a. oxidation)

why dextrose-based PN containing little/no fat implicated in steatosis?

excess CHO deposit as fat, and may result in EFAD which lead to impaired lipoprotein formation and TG secretion

CHO content not exceed ____g/kg/d for adults

high lvl ___ exposure may lead to develop cholestasis

aluminum

probs of phytosterols/

inefficiently metabolized, impaire bile flow and cause sludge/stones

primary ___ deficiency associated with steatosis

carnitine

why maybe supplement choline?

conversion of methionine to choline may be less efficient when methionine given PN instead of PO

this type of PN shown reduce serum liver enzyme and conjugated bilirubin

cyclic

form of bile acid used to treat various chronic cholestatic liver diseases

ursodiol

most common form of metabolic bone disease characterized by low bone mass, compromised bone strength, deterioration of bone tissue/architecture

osteoporosis

___ is characterized by softening/bending of bones that occurs cuz bones contain osteoid tissue that failed to calcify

osteomalacia

risk factors for bone loss?

post menopause, long term PN, endocrine disease, GI disease, malignancy, meds, genetic disease, immobilization, alcohol, anorexia nervosa, roux en y

calcium supplementation in PN limited by minerals' physical compatibility with ___

inadequate ___ dose may ^ urinary Ca excretion

higher ___ doses associated ^ urinary Ca excretion

protein

correction of acidosis with ___ in PN can reduce urinary calcium excretion

acetate

cyclic or continuous more Ca losses?

cyclic

why vit D excess cause bone disease?

suppress PTH secretion and promote bone resorption

only allowed to have up to ___mcg aluminum/L

___ is a prominent manifestation of Mg deficiency

hypocalcemia

Mg deficiency results in v mobilization of Ca from bone thru these mechanisms:

^ release mg ions at bone surface in exchange for ^ bone uptake of Ca ions from serum; inhibit PTH release, so low PTH lvls for degree of hypocalcemia, functional v bone response to PTH so functional hypoparathyroidism

magnesium deficiency can lead to hypophosphatemia how?

^ P excretion

copper deficiency can impair ___ formation, causing ____

bone; osteoporosis

meds that decrease bone resorption:

bisphosphonates, raloxifene, calcitonin, estrogen, monoclonal antibody denosumab

only FDA approved med that stim bone formation

teriparatide

avoid adding ___ to reduce osteoporosis risk

heparin

most common deficiencies

selenium, linoleic acid, Zn, Cu, Chromium, fat/water sol vitamins

symptoms o hypophosphatemia:

parasthesia, muscular weakness, confusion, convulsions, coma