Unit 3 - Parental Nutrition 1 Flashcards
Give examples of ingredients in parenteral nutrition
Amino acids
- nitrogen
Carbohydrates
Lipids
Electrolytes
Trace elements
Vitamins
- water soluble
- fat soluble
Water
- diluent/carrier
What are the indications for parenteral nutrition?
Post-operative states where oral or tube feeding is contraindicated for more than four or five days
Short bowel syndrome
Gastrointestinal fistulae
Prolonged paralystic ileus
Acute pancreatitis
Multiple injuries involving viscera
Major sepsis
Severe burns
Inflammatory bowel disease
Who makes up a clinical nutrition team?
Important
- clinician
- dietician
- nurse
- pharmacist
- paediatric/neonatal specialists
Helpful
- biochemist
- chemical pathologist
- microbiologist
- social worker
- physiotherapist
- occupational therapist
- speech therapist
What tests can be carried out to test for malnutrition?
Simple tests
- patient height
- patient weight
Anthropometric tests
- skinfold thickness
- mid-arm circumference
Biochemical tests
- complete blood tests
- urinary output
- stool output
Which patients are “at risk” nutritionally?
Gross underweight
- BMI below 80% of standard
Gross overweight
- BMI over 10% of standard
Recent loss of 10% or more of usual body weight
Persons with a high alcohol intake
No oral intake for over 10 days
Protracted losses
- malabsorption syndromes
- short gut syndromes
- fistulae
- renal dialysis
- draining abscesses and wounds
Increased metabolic needs
- extensive burns
- infections
- trauma
- protracted fever
- hyperthyroidism
Intake of drugs with anti-nutrient or catabolic properties
- appetite suppressants
- steroids
- immunosuppressants
- anti-tumour agents
How are amino acids administered parenterally?
Amino acids solutions
- comprise a solution of crystalline L-amino acids
- provide amino acids for protein synthesis
- balance of essential and non-essential amino acids
- no excessive levels of any one particular amino acid
Which amino acids are found in human protein?
Alanine
Arginine
Asparagine
Cysteine/cystine
- children for premature babies
Glutamic acid
Glutamine
- hard to produce
Glycine
Histidine
Hydroxyproline
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
- phenylketonuria
Proline
Serine
Threonine
Tryptophan
Tyrosine
Valine
How are carbohydrates administered parenterally?
Usually a solution of glucose in water at various concentrations
- 5% to 70%
Major source of energy
- minimum requirement of 200g/day for an adult male to avoid ketosis and protein catabolism
Solutions of
- fructose
- maltose
- sucrose
- xylitol
- sorbitol
- ethanol
What is an emulsion?
A dispersion of one immiscible liquid in another as small droplet
It is thermodynamically unstable
- separate into its original state over a period of time
Barrier to instability can be produced by the use of an emulsifying agent
- mechanical barrier
- electrostatic barrier
Give examples of fat soluble vitamins that are needed in the body
Vitamin A
- retinol
Vitamin D
Vitamin E
- alpha-tocopherol
Vitamin K
What are the special characteristics of trace elements?
Withdrawal leads to a reproducible functional and/or structural abnormality
- associated with a specific biochemical change
- prevented and/or cured with the observed clinical abnormality by giving the deficient trace element
How are trace elements absorbed?
Orally obtained trace elements are absorbed usually from the gut in combination with specific carrier proteins
Generally trace elements are vital components of many of the bodies’ enzyme systems
- integral components
- metalloenzymes
- cofactors to enzymes
