TPN

Question 1

Dextrose

• Provides
• Max dose:

Answer 1

• Provides: 3.4 cal/gram

- Max: 500g/day in adults

Question 2

Prolonged TPN contains

• Glutamine:
• Choline:

Answer 2

• Glutamine: protects gut epithelia lining

- Choline: protects liver from hepatic fat deposits

Question 3

Minimum daily requires for protein

Answer 3

1.0 - 1.5g/kg/day

Question 4

Alpha linoleic

Answer 4

Omega-3

Question 5

Lineloic acid

Answer 5

Omega-6

Question 6

Fat provides

• 1g of PO fat:
• 1g of IV fat emulsion

Answer 6

• 1g of PO fat: 9 cal

- 1g of IV fat emulsion: 10 cal

Question 7

Fat emulsion calories

10%:
20%:
30%:

Answer 7

10% = 1.1 cal/mL
20% = 2.0 cal/mL
30% = 3 cal/mL

Question 8

TPN electrolytes

• Never add HCO3
• Never add extra Ca
• Add ? first and last

Answer 8

• Never add HCO3: It ppt Ca++
• Never add extra Ca: It ppt PO4

=> First add PHOSphate then Last add Calcium

Question 9

Trace element include

Answer 9

• Copper, Chromium, Cobalt
• Iron, Iodine, Fluride
• Manganese, Molybdenum
• Zinc, Selenium

=> Mixing iron w/ lipids cracks the emulsion => give separately or in TPN w/o lipids

Question 10

Vit

• MVI -12
• MVI -13:

Answer 10

• MVI -12: Has all it except Vit K

- MVI -13 and Ped MVI have Vit K

Question 11

Filters from TPN

Answer 11

• Dextrose and protein TPN: 0.22 micron filter

- Lipid emulsion: 1.2 micron filter

Question 12

Monitors

Answer 12

• LFT
• Electrolytes
• Renal function
• Pre-albumin
• PT/PTT
• Nitrogen Balance

Question 13

Nitrogen Balance (NB)

• Nitrogen intake
• Nitrogen loss
• Positive NB
• Negative NB

Answer 13

• Nitro intake: Daily protein intake/6.25
• Nitro loss: Daily protein in 24H urine + 4
• Positive: is our goal; anabolic state
• Negative: muscle wasting and weight loss