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Specific indications
High-dose chemotherapy or radiation therapy.
Infants = 90 - 100
Calories Children = 70 - 100
Adults = 40
kcal/kg/day Adolecents = 40 - 55
Adults = 28 - 30
Trace elements
Trace elements are metabolic cofactors essential for
the proper functioning of several enzyme systems.
In patients with renal impairment, selenium,
chromium, and molybdenum may be omitted.
In patients with severe hepatic disease, manganese
and copper may be withheld.
Special populations: Pulmonary disease
The goal of nutritional therapy in these
patients is to provide adequate
carbohydrate calories to meet energy needs,
but not to produce unacceptably high levels
of CO2.
Increase the proportion of calories supplied
by fat and to restrict the administration of
carbohydrate to 4 mg/kg/min. Protein needs
should be estimated at 1.5 g/kg/day.
Special populations: Diabetes
Disadvantages
Not used in nutritionally deplicted patients
Not used in volume-restricted patients
Does not usually increase patient’s weight
May cause phlebitis
Total Parenteral Nutrition
Provided via central line due to
hyperosmolarity (1800-3000 mOsm/L)
Administered at rates not to exceed
200mL/hr
Dextrose 20%-70% is administered as
calorie source
Used for prolonged periods in malnutrition
states: months to years
Total Parenteral Nutrition
Reverses starvation and achieves tissue
synthesis, repair, and growth
All TPN solutions must be filtered: 0.2-
micron filter is used for dextrose and
amino acid solutions; a 1.2-micron filter
must be used for lipids
Must have a dedicated lumen
Total Parenteral Nutrition
Advantages
Long term use
For patients with large caloric and nutrient needs
Provides calories, restores nitrogen balance and
replaces essential vitamins, electrolytes and
minerals
Promotes tissue synthesis, wound healing, and
normal metabolic function
Allows bowel rest and healing
Nutritionally complete
Total Parenteral Nutrition
Disadvantages
Ma require a minor surgical procedure to
Hyperchloremic acidosis
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