Pediatric Parenteral Nutrition

Question 1

what is the maximum GIR of a pediatric patient

Answer 1

14 mg/kg/min

Question 2

in PN, dextrose should provide between _______% kcals

Answer 2

40-60% kcals

Question 3

in PN, fat should provide between _____% calories

Answer 3

20-40% kcals

Question 4

providing over ____% of fat in pediatric patients can cause ketosis

Answer 4

60%

Question 5

how much lipid is needed to prevent EFA deficiency

Answer 5

0.5 g/kd/day soy based lipids

Question 6

what are symptoms of pediatric essential fatty acid disease

Answer 6

scaly rash
increased susceptibility to infection
poor wound healing
poor growth

Question 7

are TNA’s recommended for neonates/infants

Answer 7

no

Question 8

which amino acids are needed in greater amounts in infants less than 1 years old when TPN is given

Answer 8

tyrosine

histadine

Question 9

which amino acids are needed in lesser amounts in infants less than 1 years old when TPN is given

Answer 9

phenylalanine
methionine
glycine
more acidic pH

Question 10

which amino acid is conditionally essential in infants <1 years old as it is used for neural transmission and bile acid conjugation

Answer 10

taurine

Question 11

why is taurine a conditionally essential amino acid in infants on PN <1 years old

Answer 11

it is needed for neural transmission and bile acid conjugation

Question 12

why is a low pH desirable in infant PN

Answer 12

it increases phosphorous and calcium solubility

Question 13

in infant PN , the amino acid profile is based on

Answer 13

human milk

Question 14

preterm neonates, infants and children require how much sodium in PN

Answer 14

2-5 mEq/kg sodium

Question 15

children over 50 kg require how much sodium in PN

Answer 15

1-2 mEq/kg

Question 16

preterm neonates, infants and children require how much potassium

Answer 16

2-4 mEq/kg

Question 17

children over 50 kg require how much potassium in PN

Answer 17

1-2 mEq/kg

Question 18

preterm neonates require how much calcium in TPN

Answer 18

2-4 mEq/kg

Question 19

infants and children require how much calcium in TPN

Answer 19

0.5-4 mEq/kg

Question 20

children over 50 kg require how much calcium

Answer 20

10-20 mEq total

Question 21

preterm neonates require how much phosphate in TPN

Answer 21

1-2 mmol/kg

Question 22

infants and children require how much phosphate in PN

Answer 22

0.5-2 mEq/kg

Question 23

infants over 50 kg require how much phosphate

Answer 23

10-40 mol total

Question 24

preterm neonates, infants and children require how much magnesium in PN

Answer 24

0.3 to 0.5 mEq/kg

Question 25

children over 50 kg require how much magnesium in PN

Answer 25

10-30 mEq total

Question 26

which trace element needs to be increased in infant TPN if there is enter cutaneous fistulae or diarrhea

Answer 26

zinc

Question 27

which trace element needs decrease in infant TPN during cholestasis

Answer 27

manganese

Question 28

patients with cholestasis can develop _____ within the first 3 weeks of starting PN as they have difficulty excreting it from lack of bile flow

Answer 28

hypermanganesemia

Question 29

what are symptoms of hypermanganesemia in infants/neonates

Answer 29

irritability | seizures

Question 30

if an infant develops hypermanganesemia during PN infusion, what should be done

Answer 30

decrease the amount or take it out of PN

Question 31

Multitrace-4 Neonatal PN MVI and Multitrace-4 Pediatric PN MVI contains all trace elements as adults EXCEPT

Answer 31

selenium

Question 32

which trace element is NOT in multi-trace 4 PN MVI

Answer 32

selenium

Question 33

what are the important functions of selenium for infants and children

Answer 33

converts thyroid to its active form antioxidant needed for proper enzyme and immune function

Question 34

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

Answer 34

2 mcg/kg/day

Question 35

_______ deficiency is associated with microcytic anemia & neutropenia

Answer 35

copper

Question 36

________ (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

Answer 36

copper

Question 37

_____ deficiency is associated with growth failure and hair loss and loss is exponential during high GI output including diarrhea

Answer 37

zinc

Question 38

when should zinc be added to infant PN

Answer 38

diarrhea, high GI output

Question 39

if a child has cholestasis, how can PN be altered to be more liver friendly

Answer 39

reduce lipids cycle PN decrease copper & manganese keep the GIR within normal limits

Question 40

there is no _____ in pediatric PN MVI and there needs to be an exogenous source given for long term PN infants

Answer 40

iron (and selenium)

Question 41

______ is supplemented with long term TPN infants to assist in fat oxidation and use

Answer 41

Carnitine

Question 42

______ is a shuttle for long chain fatty acids that bring fatty acids across the mitochondrial membrane for beta oxidation

Answer 42

carnitine

Question 43

when carnitine is deficient, what are the consequences

Answer 43

increased triglycerides increased total bilirubin hypoglycemia increased All Phos

Question 44

how much carnitine should be supplemented in deficiency (PN) x

Answer 44

v

Question 45

____ improves tolerance to IV fat emulsions in children/infants

Answer 45

carnitine

Question 46

what amino acid is added to preterm infant/infant PN to decrease pH and increase calcium/phosphorous solubility

Answer 46

cysteine

Question 47

how can aluminum be managed in PN

Answer 47

choose PN components with the lowest aluminum amount

Question 48

what is the max amount of aluminum per FDA guidelines

Answer 48

5mcg/kg/day

Question 49

which types of children are at an increased risk of aluminum toxicity

Answer 49

renal disease (cannot excrete well from the kidneys)

Question 50

hyperaluminemia is associated with

Answer 50

Metabolic Bone Disease | Encephalopathy

Question 51

how often should trace elements be checked on children with LT PN

Answer 51

check in 3 months after initiation, then every 3-6 months thereafter

Question 52

how often should fat soluble vitamins Be checked on children with LT PN

Answer 52

check in 6 months then annual thereafter if results are normal

Question 53

which anthropometric measures are used to evaluate if a child is malnourished

Answer 53

weight height mid upper arm circumference