Enteral and parenteral nutrition

Question 1

Indications for EN/PN

Answer 1

1. Inability to support minimal fluids, energy and nutrients by mouth:
   -GI discomfort
   -intolerance
   -malnutrition
   -hypermetabolic state
   -multisystem organ failure
2. pre-post operative period

Question 2

Complications of PN

Answer 2

1. CLABSI
   -Minimize line access
   -ethanol locks
2. mechanical complications
   -occlusion
   -extravasation into pleural or pericardial space
   -venous thrombosis
   -air embolus
   3.metabolic bone disease
   -inadequate Ca, Vit D, P
   -bone dueal absorptiometry
3. hyperytiglyceridemia
   -add carnitine to help lipid mobilization
   -hold lipids 4hr or alternate every 48hr
   -avoid high GIR
4. PN associated liver disease
   RF: prolonged NPO, high omega-6 (soybean)
   dec fat 1g/kg/day
   cycle TPN
   wean PN
5. essential fatty acid deficiency
   -defi in Omega 6 and 3 (not made in human body)
   -hair loss, xerosis, poor wound healing, inc risk of infection, developmental delay
   Monitor: trien: tetraen ratio (mild>=0.05, mod >=0.2, severe>=0.4)
   Alternative lipids
   URSO