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Phar 503 > Parenteral nutrition: Pediatrics > Flashcards

Parenteral nutrition: Pediatrics Flashcards

1
Q

What is the body water of premature babies, newborn babies, and one year old babies

A

80-90%, 70-75%, 60%

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2
Q

What is the Na, CL, and osmolarity in .9%

A

154,154, 308

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3
Q

Why do neonates and young infants need more water

A

They have a higher surface area, higher metabolic rate, and higher respiratory rates

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4
Q

Using the Holiday-Segar Method how much water should be given for weights between 3-10 kg

A

100ml/kg

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5
Q

Using the Holiday-Segar Method how much water should be given for weights greater than 10kg but less than 20kg

A

100ml/kg plus 50ml/kg for every kilogram greater than 10 left over

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6
Q

Using the Holiday-Segar Method how much water should be given for weights greater than 20kg

A

100ml/kg plus 50ml/kg for every kilogram greater than 10 left over plus 20ml/kg for every kilogram greater than 20 left over

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7
Q

What is the fluid requirement for neonates who are 0-2 days old

A

75ml/kg

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8
Q

What is the fluid requirement for neonates who are 2-4 days old

A

100ml/kg

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9
Q

What is the fluid requirement for neonates who are 4-6 days old

A

120ml/kg

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10
Q

What is the fluid requirement for neonates who are greater than 6 days old

A

145ml/kg

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11
Q

When would neonates need more water

A

radiant warmer, fever, diarrhea, polyuria

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12
Q

What is required for a maintenance IV fluid for neonates

A

Dextrose 10% with electrolytes

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13
Q

What qualifies as an infant

A

1 month to 1 year old

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14
Q

What is the best way to find the fluid deficit

A

previous weight-current weight/(previous weight)

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15
Q

What are the most common reasons for dehydration in pediatric patients

A

vomiting and diarrhea

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16
Q

What is the order for types of dehydration (most common to least common)

A

isotonic, hypertonic, hypotonic

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17
Q

What are the best indicators for dehydration in pediatrics

A

increased BUN, high hematocrit, low sodium bicarbonate

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18
Q

What is the dose for 0.9% NaCl in pediatrics, what is the max dose

A

20ml/kg infused over 10-20 mins, 60ml/kg over 1 hour

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19
Q

How is fluid replaced in pediatric patients early who are hypotonic or isotonic dehydration, when does this take place

A

Replace 1/2 estimated deficit (minus bolus fluid) + 1/3 maintenance fluid, the first 8 hours

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20
Q

How is fluid replaced in pediatric patients late who are hypotonic or isotonic dehydration, when does this take place

A

Replace 1/2 estimated deficit + 2/3 maintenance fluid, next 16 hours

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21
Q

What is the correction rate for hypotonic dehydration

A

0.5mEq/L/hr

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22
Q

How is fluid replaced in pediatric patient who are hypertonic dehydration

A

Add deficit to maintenance fluid needed for 48 hours and infuse slowly over 48 hours

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23
Q

What are indications for parental nutrition in pediatrics

A

premature neonates who cannot be fed by mouth, omphalocele, gastroschisis, IBS, necrotizing enterocolitis,

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24
Q

T/F: A pediatric patient can be healthy and not be fed for 4 days before needing parental nutrition

A

Healthy infants and children who are not fed in 3 days will need parental nutrition

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25
Q

What circumstances would a peripheral line be used, risks

A

Up to 2 weeks/may result in adequate caloric intake, higher incidence of phlebitis

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26
Q

What circumstances would a central line be used, benefits

A

home use and/or greater than 2 weeks/ greater calorie intake, ideal for fluid restricted patients/ higher risk of complications/infections

27
Q

What is the maximum calcium gluconate concentration for a peripheral line

A

10 mEq/L

28
Q

What is the maximum osmolarity concentration, dextrose concentrarion, and amino acid concentration in a peripheral line for pediatrics

A

1000 mOsm, 12.5%, 2.5%

29
Q

T/F: If osmolarity of a peripheral line is to high in pediatrics electrolytes should be cut

A

False: Dextrose and electrolytes should never be cut, only amino acids

30
Q

What should be the calorie intake of carbohydrates in neonates and young infants

A

55-65%

31
Q

What should be the glucose administration to support protein deposition

A

2-3kg/mg/min per gram of protein intake

32
Q

What is the maximal glucose infusion rate (GIR)

A

12-14 mg/kg/min

33
Q

T/F: The younger the patient the more they need of everything

A

True

34
Q

What is the lowest glucose infusion rate for any pediatric patient

A

4mg/kg/min

35
Q

When is the only time insulin should be used in pediatric patients

A

When the glucose infusion rate is 4mg/kg/min and the serum glucose is greater than 250 mg/dl

36
Q

What is the minimum protein intake to prevent breakdown of endogenous tissue

A

1.5g/kg/day

37
Q

What are standardized parental nutrition solutions

A

pre-made parental nutrition solutions containing dextrose and amino acid to be used for immediate use

38
Q

What is the max fluid intake of starter PN

A

80-90ml/kg/day

39
Q

What is the most important advantage of pediatric formulations

A

Lower pH increases solubility of calcium and phosphate

40
Q

How much protein should be given in order to have optimum protein utilization

A

24 to 32 non-protein kcal for every gram of protein

41
Q

What is the minimum amount of lipids for preterm/term/infants, older children/adolescents

A

.5g/kg/day, 1.5g/kg twice a week

42
Q

What are factors that a pedatric patient may have that makes them susceptible to hypertriglyceridemia

A

premature infants, patients with sepsis, liver and/or renal disease, patient receiving fat based medications

43
Q

What is the ideal ratio of calcium to phosphorous in mEq per mMol

A

2:1

44
Q

What is the key factor that increases solubility of calcium and phosphorous

A

pH

45
Q

What are products that can be added to TPN to affect the pH, how is the pH affected when added

A

Cysteine (decreases pH), amino acid and dextrose (decreases pH), lipids (increase pH)

46
Q

What calcium product goes into TPN

A

calcium gluconate

47
Q

What are potential symptoms due to Ca/Phos precipitates

A

Respiratory distress, pulmonary emboli, interstitial pneumonitis

48
Q

When looking at solubility curve how does the calcium and phosphate need to be converted

A

mEQ/L,mmol/L

49
Q

What trace element is the most important in pediatrics

A

Zinc`

50
Q

How is heparinused in a line for pediatrics

A

Heparin reduces phlebitis, stimulates release of lipoprotein lipase

51
Q

When should a TPN be discontinued in a pediatric patient

A

3/4 or 75% enteral intake in neonates/infants, 2/3 or 67% enteral intake in children

52
Q

What are the limits for a peripheral parenteral nutrition solution

A

limit dextrose 12.5%, limit amino acid to 2.5%, limit calcium gluconate concentration to less than 10 mEq/L

53
Q

What are the complications that can come from a long-term PN

A

techinical (phlebitis, catheter occlusion), infection, metabolic

54
Q

What are ways to prevent phlebits in long term PN

A

treat with hyaluronidase, decrease with heparin, osmolarity less than 900, co-infuse with fat

55
Q

How are central line infections in long term PN

A

catheter removal or antibiotcs

56
Q

What causes PN-associated cholestasis (PNAC)

A

impaired secretion of bile resulting in liver injury

57
Q

What is an indicator for PNAC, what organ does it affect the most

A

direct bilirubin greater than 2mg/dl or direct bilirubin greater 20% total bilirubin, liver

58
Q

What are risk factors for PNAC

A

prematurity and low birth weight, prolonged PN,

Soybean-based intravenous lipid emulsions, male gender

59
Q

What is the treatment steps for PNAC

A

1) Initiate enteral feeds 2)Alterations in IV fat emulsion intake 3)Limit glucose intake 10-12 mg/kg/min 4)cycling of PN 5) Remove copper and manganese 6) give pharmacologic agents

60
Q

What are the pharmacologic agents that is used in PNAC treatment

A

Ursodiol, meteronidazole or Bactrim

61
Q

What conditions cause an increase in calcium-phosphate precipitation

A

More lipids, less dextrose, more light/temp, higher pH

62
Q

What is the maximum protein infusion rate, what is the maximum fat infusion rate

A

3-4 g/kg/day, 3-4 g/kg/day

63
Q

What trace elements are removed for liver dysfunction, kidney

A

copper and manganese, selenium and chromium

Phar 503 (25 decks)

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