Section 7 - Parenterals 3

Question 1

What is used for peritoneal dialysis?

Answer 1

Large bore catheter is placed into abdominal cavity through a “tunnel” and catheter usually has 2 Dacron cuffs to seal tunnel from microorganisms and leaks

Question 2

What are the stages of peritoneal dialysis?

Answer 2

Hookup, infusion, diffusion (fresh), diffusion (waste), and drainage

Question 3

What is used for continuous ambulatory peritoneal dialysis (CAPD)?

Answer 3

Soft catheters w/ 1 mm perforations and slots to allow fluid placement and removal

Question 4

What are some complications that can arise from catheter placement?

Answer 4

• Bladder or bowel perforation
• Hemorrhage
• Hydrothorax
• Peritonitis
• Tunnel infection

Question 5

How long does fluid remain in place during peritoneal dialysis?

Answer 5

4-6 hours (dwell time), based on patients needs

Question 6

What is the usual daily fluid use for peritoneal dialysis?

Answer 6

About 8 L, based on patients needs

Question 7

What is contained in fluid solutions for peritoneal dialysis?

Answer 7

Sodium, magnesium, calcium, and lactate in about the same concentrations found in blood

Question 8

What effect does dextrose in fluid solutions have for peritoneal dialysis?

Answer 8

Determines the amount of water that will be removed from the patient

Question 9

What are the available concentrations of dextrose for fluid solutions for peritoneal dialysis?

Answer 9

0.5, 1.5, 2.5, and 4.25%

Question 10

During peritoneal dialysis, fluid and waste exchange is controlled by ____

Answer 10

Peritoneal membrane

Question 11

What is peritoneal dialysis not effective at?

Answer 11

Removing phosphate, so antacid tablets are used as phosphate binders

Question 12

What is the most common complication of peritoneal dialysis?

Answer 12

Infection; first is gram positive from staphylococcus on skin, then gram negative, third is candida which is very hard to treat

Question 13

Who are candidates for parenteral nutrition?

Answer 13

• Severely malnourished
• Those w/ a dysfunctional GI tract for more than 5-7 days
• Post-surgical complications, severe trauma or burns, inflammatory bowel disease, chemotherapy, short-gut syndrome
• Pre-term infants

Question 14

What are the normal energy needs for adults?

Answer 14

30-50 cal/kg/day

Question 15

How can total energy requirement be estimated?

Answer 15

Resting energy expenditure (found from Harris-Benedict equation) * activity (1.1-1.3) * injury factors (1-2)

Question 16

What can excess calories from carbs cause?

Answer 16

Liver damage and high production of CO2

Question 17

What will occur if more than 5 mg/kg/minute of dextrose is given?

Answer 17

Hyperglycemia w/ high volume of diuresis

Question 18

Are parenteral nutrition solutions hypo, iso, or hypertonic and what do they typically contain?

Answer 18

• Hypertonic

- As much as 25% and 5% amino acids, so administration through a suitably large vein is required

Question 19

What are the fluid requirements for adults and for neonates?

Answer 19

• Adults = 50 mL/kg/day

- Neonates = 100-150 mL/kg/day

Question 20

How is nitrogen provided through parenteral nutrition?

Answer 20

As a mixture of amino acids

Question 21

What are the typical requirements of nitrogen?

Answer 21

0.16-0.32 g/kg/day

Question 22

How much protein provides 1 g of nitrogen?

Answer 22

6.25 g of protein

Question 23

How can nitrogen output be estimated?

Answer 23

Urinary urea nitrogen (accounts for about 85% of total nitrogen output)

Question 24

What type of nitrogen balance is desired in most cases?

Answer 24

Slightly positive, so higher intake than output

Question 25

What are the usual requirements of sodium?

Answer 25

1-2 mmol/kg/day

Question 26

What are the usual requirements of potassium?

Answer 26

1.5 mmol/kg/day

Question 27

What are the usual requirements of calcium?

Answer 27

0.15 mmol/kg/day

Question 28

What are the usual requirements of magnesium?

Answer 28

0.15 mmol/kg/day

Question 29

What are the usual requirements of phosphorus?

Answer 29

0.2 mmol/kg/day

Question 30

What should be expected w/ respect to potassium and phosphorus when anabolic state is reached?

Answer 30

Temporary drop in serum levels b/c both are intracellular electrolytes

Question 31

What are some possible complications w/ a catheter?

Answer 31

Thrombosis, occlusion, phlebitis

Question 32

What are some metabolic complications w/ parenteral nutrition?

Answer 32

• Electrolyte imbalance
• Fluid imbalance
• Acidosis, alkalosis
• Hypo and hyperglycemia
• Liver abnormalities