Nutrition

Question 0

Estimated daily expenditure expenditure?

Answer 0

30 kcal/kg/day * weight

Question 1

Nutritional requirements for non-depleted patient? Depleted patient?

Answer 1

1 g/kg/day protein and total daily calories 20% above basal energy expenditure

2 g/kg/day with total daily calories 50–100% above basal energy expenditure

Question 2

Standard TPN?

How is fat given?

Answer 2

50% dextrose; 4.25% amino acids

fat given as separate 500 mL infusion

Question 3

How to measure Nitrogen intake?

Excretion?

Answer 3

Grams protein/6.25

Urea/2

Question 4

Patient on TPN develops fever – likely diagnosis and work up?

Answer 4

Infected catheter

#if cultures negative but fever persists – change Catherine over wire or change site
#If cultures positive or fever persists – select new catheter site and initiate antibiotics

Question 5

Electrolyte abnormalities in a metabolic coma due to TPN? Mechanism?

Answer 5

Hyperglycemic, hypoosmolar, nonketotic

Dehydration following excessive diuresis due to hypoglycemia

Question 6

Effect of TPN on liver function?

Answer 6

Transaminase and alkaline phosphatase rise

Stabilize or return to normal within 7-14 days

Question 7

Dry scaly skin on a patient with TPN – deficiency?

Answer 7

Lipids