Pediatric Parenteral Nutrition Flashcards
what is the maximum GIR of a pediatric patient
14 mg/kg/min
in PN, dextrose should provide between _______% kcals
40-60% kcals
in PN, fat should provide between _____% calories
20-40% kcals
providing over ____% of fat in pediatric patients can cause ketosis
60%
how much lipid is needed to prevent EFA deficiency
0.5 g/kd/day soy based lipids
what are symptoms of pediatric essential fatty acid disease
scaly rash
increased susceptibility to infection
poor wound healing
poor growth
are TNA’s recommended for neonates/infants
no
which amino acids are needed in greater amounts in infants less than 1 years old when TPN is given
tyrosine
histadine
which amino acids are needed in lesser amounts in infants less than 1 years old when TPN is given
phenylalanine
methionine
glycine
more acidic pH
which amino acid is conditionally essential in infants <1 years old as it is used for neural transmission and bile acid conjugation
taurine
why is taurine a conditionally essential amino acid in infants on PN <1 years old
it is needed for neural transmission and bile acid conjugation
why is a low pH desirable in infant PN
it increases phosphorous and calcium solubility
in infant PN , the amino acid profile is based on
human milk
preterm neonates, infants and children require how much sodium in PN
2-5 mEq/kg sodium
children over 50 kg require how much sodium in PN
1-2 mEq/kg
preterm neonates, infants and children require how much potassium
2-4 mEq/kg
children over 50 kg require how much potassium in PN
1-2 mEq/kg
preterm neonates require how much calcium in TPN
2-4 mEq/kg
infants and children require how much calcium in TPN
0.5-4 mEq/kg
children over 50 kg require how much calcium
10-20 mEq total
preterm neonates require how much phosphate in TPN
1-2 mmol/kg
infants and children require how much phosphate in PN
0.5-2 mEq/kg
infants over 50 kg require how much phosphate
10-40 mol total
preterm neonates, infants and children require how much magnesium in PN
0.3 to 0.5 mEq/kg
children over 50 kg require how much magnesium in PN
10-30 mEq total
which trace element needs to be increased in infant TPN if there is enter cutaneous fistulae or diarrhea
zinc
which trace element needs decrease in infant TPN during cholestasis
manganese
patients with cholestasis can develop _____ within the first 3 weeks of starting PN as they have difficulty excreting it from lack of bile flow
hypermanganesemia
what are symptoms of hypermanganesemia in infants/neonates
irritability
seizures
if an infant develops hypermanganesemia during PN infusion, what should be done
decrease the amount or take it out of PN
Multitrace-4 Neonatal PN MVI and Multitrace-4 Pediatric PN MVI contains all trace elements as adults EXCEPT
selenium
which trace element is NOT in multi-trace 4 PN MVI
selenium
what are the important functions of selenium for infants and children
converts thyroid to its active form
antioxidant
needed for proper enzyme and immune function
Selenium is not included in the Multi-trace MVI for infant PN and infants are at risk for deficiency. If an infant or neonate is on PN for over 1 month how should selenium be supplemented
2 mcg/kg/day
_______ deficiency is associated with microcytic anemia & neutropenia
copper
________ (along with manganese) should be eliminated or decreased in PN in children with cholestasis as it is removed by bile which is inhibited in cholestasis
copper
_____ deficiency is associated with growth failure and hair loss and loss is exponential during high GI output including diarrhea
zinc
when should zinc be added to infant PN
diarrhea, high GI output
if a child has cholestasis, how can PN be altered to be more liver friendly
reduce lipids
cycle PN
decrease copper & manganese
keep the GIR within normal limits
there is no _____ in pediatric PN MVI and there needs to be an exogenous source given for long term PN infants
iron (and selenium)
______ is supplemented with long term TPN infants to assist in fat oxidation and use
Carnitine
______ is a shuttle for long chain fatty acids that bring fatty acids across the mitochondrial membrane for beta oxidation
carnitine
when carnitine is deficient, what are the consequences
increased triglycerides
increased total bilirubin
hypoglycemia
increased All Phos
how much carnitine should be supplemented in deficiency (PN) x
v
____ improves tolerance to IV fat emulsions in children/infants
carnitine
what amino acid is added to preterm infant/infant PN to decrease pH and increase calcium/phosphorous solubility
cysteine
how can aluminum be managed in PN
choose PN components with the lowest aluminum amount
what is the max amount of aluminum per FDA guidelines
5mcg/kg/day
which types of children are at an increased risk of aluminum toxicity
renal disease (cannot excrete well from the kidneys)
hyperaluminemia is associated with
Metabolic Bone Disease
Encephalopathy
how often should trace elements be checked on children with LT PN
check in 3 months after initiation, then every 3-6 months thereafter
how often should fat soluble vitamins Be checked on children with LT PN
check in 6 months then annual thereafter if results are normal
which anthropometric measures are used to evaluate if a child is malnourished
weight
height
mid upper arm circumference
