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21 Cards in this Set
- Front
- Back
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Hyperglycemia
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high blood glucose
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Glucosuria
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glucose in urine
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hepatic steatosis
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fatty liver
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effects of excessive carbs during parenteral nutrition
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hyperglycemia
glucosuria hepatic steatosis excessive CO2 production cholestasis |
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cholestasis
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flow of bile blocked/ decreased
affects the liver impaired bile flow bc of the absence of nutrients in the intestine to stimulate bile secretion from the liver. Excess glucose, amino acid or lipid infusion. |
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dextrose concentration
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5 to 70% Usual PN: ~25%
• Fluid-restricted or pts with higher needs: 35% • Respiratory insufficiency/diabetes: use less? • Peripheral administration: 5 to 10% |
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requirements of fat emulsion
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10,20,or 30% emulsions of soybean or safflower oil
• 2 to 4% kcals from linoleic acid to prevent EFA deficiency it’s water for the most part • Maximum: 2.0 to 2.5 g fat/kg BW/d • <60% kcals from fat • Septic pts: 1 g/kg BW/d (maximum • Hypertriglyceridemia may occur high blood lipids • LCFA may suppress immune system • Impair neutrophil function • Decrease endotoxin clearance • Decreased complement synthesis • No >1 g/kg limit for pts with immunological problems |
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components of fat emulsion
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Long chain fatty acids from soy/safflower oil. If you’re allergic to these things it’s still ok. Peanut oil since it’s industrialized is ok if you’re allergic to peanuts
Glycerol Egg phospholipid: can’t have other fats if you take this |
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concentrations of fat emulsions and the factor to use
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10% fat: 1.1 kcals/ mL
20% fat: 2.0 kcal/mL 30% fat: 3.0 kcal/mL |
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contraindications for fat emulsions
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• Allergy to eggs
• Hypercholesterolemia/hypertriglyceridemia • Acute pancreatitis with hyperlipidemia |
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nutrients in parenteral nutrition
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dextrose
amino acids fat emulsion electrolytes vitamins and minerals |
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what 4 things are mixed together when administering PN?
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AA, dextrose, electrolytes, & MVI mixed together
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in administering PN, what's something to keep in mind with lipids?
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often given separately, fats are provided for 12 hours, then taken off for 12 hours. or provided for 4 hours, & taken off for 4 hours, etc.
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Guidelines of administering PN, & how much to increase by
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start with 1L of solution on the first day
increase by .5-1L/d to final volume gradually increase rate to provide total |
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Things to keep in mind when transitioning to oral/ TF
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transition as soon as possible, yet gradually.
Titrate TPN rate w oral/TF intake. do not stop TPN abruptly |
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Benefits of cyclic infusion
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TPN solution volume in 12-18 hrs.
not continuous= more freedom insulin levels are also more natural because they go up and down most common in children |
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PN catheter related complications
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infection
venous thrombosis Cardiac arrhythmias: if catheter goes too far down, it can puncture the heart or the lungs Myocardial perforation Air embolism Pneumothorax/Hemothorax lung can collapse Catheter embolism: catheter gets left in the body Arterial puncture Improperly positioned tip oral health (poor care, pathogens, aspirations of oral secretions, aspiration pneumonia) |
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metabolic complications of PN
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Fluid imbalances
Electrolyte/mineral imbalances Hyperglycemia: if you give too much dextrose and not enough insulin. Also caused by sepsis, stress, corticosteroids. Treated w insulin, slow initiation and advancement, & IV Fat solution. Instead of dextrose you give fat. If you give too much fat you compromise immune system Hypoglycemia: due to abrupt discontinuation of parenteral nutrition, insulin is overdosed. Treat w tapering solutions & use 10% dextrose and check the glucose Cholestasis Increased LFTs: LFT is liver function test. High LFT results indicate liver cell damage, may be due to excessive calories Refeeding syndrome GI atrophy intestinal villi atrophy. Prevent by early transition to oral feeding. Or treat by trickle or trophic feed (could be enough to help the GI tract and prevent atrophy). Good w tiny premature babies bc GI tracts not developed. give mL an hour to start GI tract |
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what is refeeding syndrome
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o Occurs in first days of feeding a patient who has been NPO for an extended period
o Characterized by hypokalemia (low K), hypophosphatemia(low phosphorus), hypomagnesmia (low magnesium) as electrolytes shift into the cells o May involve hemolytic anemia, respiratory distress, cardiac arrhythmias(heart can stop), tetany (don’t lift their arms, can’t keep their head up) |
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dextrose content
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glucose
amino acids fat emulsions electrolytes vitamins and minerals |
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main source of kcals
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dextrose monohydrate
3.4 kcal/g max not exceeding 5mg/kg/min minimum 1 mg/kg/min |
