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PHM 604- Nutrition and Cirrhosis > Parenteral Nutrition (TPN) > Flashcards

Parenteral Nutrition (TPN) Flashcards

1
Q

Indications for TPN

A 
GI tract dysfunction from malabsorption, obstruction, or dysmotility
Adjunctive treatment for cancer
Pancreatitis
Critically ill
Perioperative
Hyperemesis
Eating disorders
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2
Q

Features of central TPN

A

Provides “complete” TPN, osmolality of components generally exceeds 900 mOsm/L

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3
Q

Who to choose peripheral TPN in

A

No significant malnutrition
Have good peripheral vascular access
Can tolerate large volumes of fluid (2.5-3L/day)
Need 5-14 days of parental nutritional support

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4
Q

Steps to initiating TPN regimen

A 
Establish vascular access
Calculate macronutrient requirements
Evaluate electrolyte needs
Evaluate trace element and vitamin needs
Evaluate fluid requirements
Determine insulin need
Review compatibility
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5
Q

Daily requirement of sodium and potassium

A

1-2 mEq/kg

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6
Q

Daily requirement of chloride and acetate

A

PRN to balance acid/base status

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7
Q

Daily requirement of calcium

A

10-15mEq

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8
Q

Daily requirement of magnesium

A

8-20 mEq

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9
Q

Daily requirement of phosphate

A

20-40 mMol

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10
Q

What happens if there’s a vitamin shortage?

A

Don’t use pediatric product in adults and vice versa; if vitamins are completely out, attempt to give individual vitamins

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11
Q

Trace element needs

A

Deficiency syndromes generally occur with un-supplemented, long-term parenteral nutrition; requirements vary on the basis of the patient’s clinical condition

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12
Q

Increased fluid requirements: environment

A

Radiant warmer
Increased ambient temperature
Excessive sweating

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13
Q

Increased fluid requirements: GI losses

A

Diarrhea, vomiting
Ostomy or fistula drainage
NG tube suction

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14
Q

Increased fluid requirements: urinary losses

A

Glycosuria, diuretics, diabetes insipidus

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15
Q

Increased fluid requirements: miscellaneous

A

Hyperthyroid, hyperventilation, phototherapy

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16
Q

Decreased fluid requirements: environment

A

Heat shields, high humidity

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17
Q

Decreased fluid requirements: diseases/conditions

A

HF, ESRD/CKD, SIADH, hypoalbuminemia with starvation, humidified air via mechanical ventilation

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18
Q

Usual fluid requirements

A

30-40ml/kg/day or 1ml/kcal/day

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19
Q

Calcium phosphate compatibility: amino acid concentration

A

Increases pH, decreases solubility

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20
Q

Calcium phosphate compatibility: amino acid product composition (pH or PO4 content)

A

Important to evaluate a change in amino acid product to determine if solubility will be impacted

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21
Q

Calcium phosphate compatibility: calcium and PO4 concentrations

A

Increasing the concentration of calcium and/or PO4 decreases solubility

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22
Q

Calcium phosphate compatibility: calcium salt

A

Gluconate less dissociated than chloride

NEVER ADD CACL TO A TPN BAG

23
Q

Calcium phosphate compatibility: dextrose concentration

A

Lowers pH, increases solubility

24
Q

Calcium phosphate compatibility: pH of formulation

A

Low pH favors the presence of monobasic calcium phosphate (aka more soluble)

25
Q

Calcium phosphate compatibility: temperature

A

Inverse solubility (increase temp, decrease solubility)

26
Q

Calcium phosphate compatibility: order of mixing

A

ADD PHOSPHATE BEFORE CALCIUM

27
Q

Medication administration in TPN criteria

A

Compatibility and stability have been established
Clinically effective as a continuous solution
Drug dosage is stable (can’t titrate up!)
TPN infusion rate is stable

28
Q

TPN components

A

Protein, carbs, lipids

29
Q

Protein conversion

A

4 kcal/g

6.25g protein=1g nitrogen

30
Q

Most common carb source

A

Dextrose

31
Q

Dextrose conversion

A

3.4 kcal/g

32
Q

Glycerol conversion

A

4.3 kcal/g

33
Q

Lipids (IVFE) are available as what product?

A

Oil suspensions in an aqueous medium (so basically an emulsion)

34
Q

Emulsifying agent in IVFE

A

Egg phospholipid –> avoid in patients with an egg allergy

35
Q

Lipid emulsions are also a source of what vitamin?

A

Vitamin K, which can interfere with warfarin!

36
Q

Oil in a lipid emulsion

A

Soybean oil (IVLE)–> avoid in patients with a soybean allergy

37
Q

Lipid conversion

A

9 kcal/g

38
Q

Lipid emulsions: monitoring

A

Monitor for infusion reactions, especially on the first dose

Hypertriglyceridemia

Hepatic toxicity (PNALD) with chronic TPN

39
Q

Refeeding syndrome

A

Rapid, severe depletion of potassium, magnesium, and phosphate in starved patients

40
Q

Refeeding syndrome treatment

A

Aggressive supplementation of lytes plus thiamine 50-100mg/day

41
Q

The more nutritionally depleted a patient is, what does that do to the rate of administration?

A

The rate decreases

42
Q

TPN complications: economic

A

It’s very expensive; labor intensity, frequency of monitoring and management of complications contribute to cost

43
Q

TPN complications: mechanical

A

Pneumothorax, thrombosis, thrombophlebitis (PPN)

44
Q

TPN complications: infectious

A

Line sepsis/fungemia, increased bacterial translocation

45
Q

TPN complications: metabolic

A

Electrolyte abnormalities, hyper/hypoglycemia, hypertriglyceridemia, fluid overload, osteoporosis/osteomalacia

46
Q

TPN complications: GI tract

A

Hepatobiliary (PNALD)

47
Q

How often to monitor fluid and weights during TPN

A

Daily

48
Q

How often to monitor glucose during TPN

A

q1-6h

49
Q

How often to monitor electrolytes during TPN

A

daily-three times a week

50
Q

How often to monitor LFTs during TPN

A

1-2x/week

51
Q

How often to monitor visceral proteins during TPN

A

1-2x/week

52
Q

How often to monitor CBC, PT/PTT during TPN

A

1-2x/week

53
Q

How often to monitor protein turnover during TPN

A

weekly

54
Q

How often to monitor lipids during TPN

A

weekly

PHM 604- Nutrition and Cirrhosis (6 decks)

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