The rudiments of TPN
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Transcript of The rudiments of TPN
Total Parenteral Nutrition
Total Parenteral Nutrition
Total Parenteral Nutrition (TPN)Feeding technique (veins)HyperalimentationBypasses the GI tractThe alimentary tract cannot or should not be usedMetabolic requirements for protein are substantially
increased (extensive burns).Gastrointestinal absorption of protein is impairedProvide fuel, energy and nutrients through the bloodstream
Total Parenteral NutritionTotal Parenteral Nutrition (TPN)
Main Fuels Protein (amino acids) Carbohydrate (glucose) Lipids (fat)
Nutrients Vitamins Minerals Electrolytes
Water (H2O) 25-40 ml/kg/day
Total Parenteral NutritionComponents
Proteins Building blocks 1.5g/kg/day Amino Acids
Organics compounds consist of proteins Carbon, hydrogen, oxygen and nitrogen
Essential amino acids – body can’t produce Non-essential amino acids – produce in the body
Total Parenteral NutritionEssential Amino Acids1. Histidine2. Isoleucine3. Leucine4. Lysine5. Methionine6. Phehylalanine7. Threonine8. Tryotophan9. Valine
Non-Essential Amino Acids
1. Alanine 2. Arginine
3. Aspartic Acid 4. Cysteine 5. Glutamic Acid 6. Glutamine 7. Glycine 8. Proline 9. Serine 10. Tyrosine 11. Aspargine 12. Selenocysteine
Total Parenteral NutritionComponents
Carbohydrates
-Dextrose (glucose)
- 4g/kg/day (daily requirements)
- CONCENTRATION PER LITER
- 25.00 - 35.00 g
- (850 - 1190 calories)
Total Parenteral NutritionComponents
Lipids (fat)
- 1g/kg/day (daily requirements)
- 1/3 of energy (non-protein)
- prevents fatty acids deficiency
- provides more concentrated calories
- disadvantage
- pancreatitis
- immunosuppression
- increase in CO2 production
Total Parenteral NutritionVitamins
Fat soluble- Vitamin A (retinol, retinoic acid, 1mg or 300 USP units)
- Vitamin D (cholecalciferol, 5mg or 200 USP units)
- Vitamin E (tocopherol, 10mg or 10 USP units)
-Vitamin K (phytonadoine, 70mg)
Water Soluble - Vitamin C (ascorbic acid, 100mg)
Total Parenteral NutritionVitamins
Water Soluble B Complex
B1 (thiamine, 3 mg) B2 (riboflavin, 3.6 mg) B3 (niacin, 40mg) B5 (pantothenic acid, 10mg) B6 (pyridoxine, 4 mg) B7 (biotin, 50 mcg) B9 (folic acid, 400 mcg) B12 (cyanocobalamin, 5mcg)
Total Parenteral NutritionTrace Elements
Given in small concentrationsMicro nutrientsDietary mineralsTrace metals
Zinc 3-5mg Co-factor of 70 enzymes Maintain normal growth Skin hydration
Total Parenteral NutritionTrace Elements
Copper 1.2-2mg Maintain normal rate of red and white blood cell formation
Prevents leukopenia, neutropenia & anemia
Manganese 0.3- 0.5 mg Prevents nausea & vomiting, dermatitis, weight loss, hair loss
Total Parenteral NutritionTrace Elements
Chromium 12-20 mg Prevents
Impaired glucose tolerance Ataxia (lack of voluntary coordination of muscles) Peripheral neuropathy Confusion Hepatic encephalopathy
Total Parenteral NutritionTrace Elements
Selenium60 – 100 mcgPrevents
Muscle pain Tenderness
Total Parenteral NutritionElectrolytes
Sodium25 – 35 mEqWater distribution controlMaintain normal fluid balance
Potassium30 – 40 mEqCellular activity (tissue synthesis)
Total Parenteral NutritionElectrolytes
Magnesium 5 – 8 mEq Absorbs carbohydrates and proteins
Calcium 5 – 8 mEq Bone & teeth development Clotting
Total Parenteral NutritionElectrolytes
Phosphate 13 – 15 mEq Minimizes the threat of peripheral parestheses
Chloride 35 – 45 mEq Maintains osmotic pressure Acid-base equilibrium
Total Parenteral NutritionElectrolytes
Acetate Varies due to amino acid source Prevent metabolic acidosis
Total Parenteral NutritionReferences:
http://www.Rxlist.com. Retrieved 02/14/2014. http://www.merckmanuals.com. Retrieved 02/14/2014.
