Parenteral Nutrition课件.ppt

Initiation of PN: formulation As protein associated with few metabolic side effects, maximum amount of protein can be given on the first day, up to 60-70 grams/liter Maximum CHO given first day 150-200 g/day or a 15-20% final dextrose concentration In pts with glucose intolerance, 100-150 g dextrose or 10-15% glucose concentration may be given initially ASPEN Nutrition Support Practice Manual 2005; p. 98-99 精品文档 Initiation of PN: Formulation Generally energy and protein needs can be met in adults by day 2 or 3 In neonates and peds, time to reach full support relates inversely to age, may be 3-5 days 精品文档 Initiation of PN: Formulation Dextrose content of PN can be increased if capillary blood glucose levels are consistently 180 mg/dL IVFE in PN can be increased if triglycerides are 400 mg/dL ASPEN Nutrition Support Practice Manual 2005; p. 109 精品文档 PN Administration:Transition to Enteral Feedings in Adults Controversial In adults receiving oral or enteral nutrition sufficient to maintain blood glucose, no need to taper PN Reduce rate by half every 1 to 2 hrsor switch to 10% dextrose IV) may prevent rebound hypoglycemia (not necessary in PPN) Monitor blood glucose levels 30-60 minutes after cessation 精品文档 PN Administration:Transition to Enteral Feedings in Pediatrics Generally tapered more slowly than in adults as oral or enteral feedings are introduced and advanced Generally PN is continued until 75-80% of energy needs are met enterally ASPEN Nutrition Support Practice Manual 2005; p. 109 精品文档 Medications That May Be Added to Total Nutrient Admixture (TNA) Phytonadione Selenium Zinc chloride Levocarnitine Insulin Metoclopromide Ranitidine Sodium iodide Heparin Octreotide 精品文档 Parenteral Nutrition Infusion Schedules 精品文档 Macronutrients: Amino Acids Source: Crystalline amino acids— standard or specialty Properties: 4.0 Kcal/g EAA 40–50% NEAA 50- 60% Glutamine / Cysteine Recommended intake: 0.8-2.0 g/kg/day 15-20% of total calories 精