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Parentral nutrition

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an introduction to parentral nutrition

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Parentral nutrition

  1. 1. Parentral nutrition. An introduction Dr. S. K. MOHAN S3 unit VMMC & SJH, NEW DELHI
  2. 2. NUTRITION • Nutrition is the provision to obtain essential nutrients necessary to support life & health. • Nutrients are the substances that are not synthesised in our body sufficiently and therefore must be supplied.
  3. 3. • Oral, entral, parenteral
  4. 4. Enteral nutrition Indicated for patients who have a functioning GI system but cant accept / ingest orally
  5. 5. Parenteral nutrition • Includes IV infusion of nutrients in an elemental form, that bypasses the usual process of digestion.
  6. 6. Indications of parenteral nutrition. • Inadequate – oral/ enteric nutrition for at least 7- 10 days. • Partial/ complete GI dysfunction. • Pre- existing severe malnutrition. • Massive small bowel resections, prolonged ileus, high output fistulas. • Severe burns • Pre/ post operative buildup.
  7. 7. Types of parenteral nutrition • 1.Peripheral (partial) parentral nutrition
  8. 8. Total parenteral nutrition • Provides complete nutritional support. • A large amount of nutrients in a hypertonic solution is infusing via a centrally placed venous access. • Normally incudes – carbohydrates, proteins, lipids, as major share
  9. 9. Contents • 1. Carbohydrates • Mainly dextrose. • Commercially available in diff. concentrations -5% to 70%. • Supplies calories – 3.4 Kcal/gm. • Prevents catabolism and have N2 sparing effect.
  10. 10. • 2. Lipids. • Iv fat emulsion which provides a dense source of Calories(9Kcal/gm.) • Contains long chain triglycerides – combination of soya and sun flower oils • Disadv-causes immune suppression, modulate inflammatory responses.
  11. 11. • 3. proteins. • Provide up to 2-3 gm/kg/day proteins in form of amino acids. • Normal protein :fat: glucose ratio for PN is 20:30:50. • Low protein formula with CRF and hepatic failure.
  12. 12. Fluid and electrolytes Normal adult requirements;- Fluid-30-40 ml/kg Na+/ k+ kg.-1-2 mEq/kg Ca+-10-20 meq/kg 8-20 mEq of Mg Trace metals[Zn, Cu, etc]
  13. 13. Types of TPN • 1. TPN without lipids ( 2 in 1 solutions) • Calories from amino acids -20-25% • Calories from dextrose-75- 80 %
  14. 14. • TPN with lipids( 3 in 1 solution) • Amino acids-20-25% • Lipids-20% • Dextrose-55-60%
  15. 15. • Systems of PN delivery:- Multiple bottle vs 3 in 1 system • Duration of delivery. continuous vs cyclical
  16. 16. Initiation of TPN • Examine and establish nutritional requirement, indications, route access of patient • Should be initiated slowly @ 50% of the goal in first day, 75% in 2nd day and 100% in 3-4 th day. • Prevent fluid over load, refeeding syndrome, hyper glycemia, hypertriglyceridemia
  17. 17. Refeeding syndrome • -severe fluid electrolyte imbalance in severely malnourished pateints under going refeeding • Starving patients- less carbohydrates-uses fat- sudden change causes increased insulin secreation- HYPOKALEMIA. Cardiac arrhythmia HYPOPHOSPHATEMIA. Renal, hepatic failure HYPOMAGNESEMIA.
  18. 18. Monitoring nutritional support • Monitor vital, fluid balance, weight. • Local care, change delivery systems. • RBS q6h, electrolytes, RFT, LFT, INR, albumin.
  19. 19. Termination of TPN • Gradual termination with starting of oral / enteral feeding. • Decrease infusion rate by 50 % for 2-3 hrs and stop/ add D10 After stopping TPN. • OR stop when patient can take 60% of total energy need enteraly.
  20. 20. Complications of TPN • MECHNICAL • Due to improper cvp placement • Venous thrombosis.
  21. 21. • INFECTIVE • Intestinal side effects – due to atrophy • Catheter related infections
  22. 22. • METABOLIC • Volume over load, hyper-hypo- glycemia, tryglyceridemia, refeeding synd. • Hepatic complications- fatty liver, NASH, cholestasis, -lithiasis. • Bone demineralisation, essen. Fatty acid deficiency.
  23. 23. Thank you… skm25.

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