Parenteral nutrition: Pediatrics Flashcards by Christopher Swims-Vernor

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

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

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

154,154, 308

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Why do neonates and young infants need more water

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

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

100ml/kg

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

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

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

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

75ml/kg

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

100ml/kg

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

120ml/kg

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

145ml/kg

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When would neonates need more water

radiant warmer, fever, diarrhea, polyuria

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What is required for a maintenance IV fluid for neonates

Dextrose 10% with electrolytes

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What qualifies as an infant

1 month to 1 year old

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What is the best way to find the fluid deficit

previous weight-current weight/(previous weight)

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What are the most common reasons for dehydration in pediatric patients

vomiting and diarrhea

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

isotonic, hypertonic, hypotonic

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What are the best indicators for dehydration in pediatrics

increased BUN, high hematocrit, low sodium bicarbonate

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

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

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

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

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

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

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What is the correction rate for hypotonic dehydration

0.5mEq/L/hr

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How is fluid replaced in pediatric patient who are hypertonic dehydration

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

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What are indications for parental nutrition in pediatrics

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

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

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

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What circumstances would a peripheral line be used, risks

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

What circumstances would a central line be used, benefits

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

What is the maximum calcium gluconate concentration for a peripheral line

10 mEq/L

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

1000 mOsm, 12.5%, 2.5%

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

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

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

55-65%

What should be the glucose administration to support protein deposition

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

What is the maximal glucose infusion rate (GIR)

12-14 mg/kg/min

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

True

What is the lowest glucose infusion rate for any pediatric patient

4mg/kg/min

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

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

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

1.5g/kg/day

What are standardized parental nutrition solutions

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

What is the max fluid intake of starter PN

80-90ml/kg/day

What is the most important advantage of pediatric formulations

Lower pH increases solubility of calcium and phosphate

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

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

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

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

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

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

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

2:1

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

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

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

What calcium product goes into TPN

calcium gluconate

What are potential symptoms due to Ca/Phos precipitates

Respiratory distress, pulmonary emboli, interstitial pneumonitis

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

mEQ/L,mmol/L

What trace element is the most important in pediatrics

Zinc`

How is heparinused in a line for pediatrics

Heparin reduces phlebitis, stimulates release of lipoprotein lipase

When should a TPN be discontinued in a pediatric patient

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

What are the limits for a peripheral parenteral nutrition solution

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

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

techinical (phlebitis, catheter occlusion), infection, metabolic

What are ways to prevent phlebits in long term PN

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

How are central line infections in long term PN

catheter removal or antibiotcs

What causes PN-associated cholestasis (PNAC)

impaired secretion of bile resulting in liver injury

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

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

What are risk factors for PNAC

prematurity and low birth weight, prolonged PN, | Soybean-based intravenous lipid emulsions, male gender

What is the treatment steps for PNAC

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

What are the pharmacologic agents that is used in PNAC treatment

Ursodiol, meteronidazole or Bactrim

What conditions cause an increase in calcium-phosphate precipitation

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

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

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

What trace elements are removed for liver dysfunction, kidney

copper and manganese, selenium and chromium