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Parenteral Nutrition

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List appropriate indications for the use of parenteral nutrition (PN) in adult patients.

  2. Describe the components of PN and their role in nutrition support therapy.

  3. List the elements of nutrition assessment and factors considered in assessing an adult patient's nutritional status and nutritional requirements.

  4. Explain the pharmaceutical and compounding issues with PN admixtures.

  5. Develop a plan to design, initiate, and adjust a PN formulation for an adult patient based on patient-specific factors.

  6. Describe the etiology and risk factors for PN macronutrient-associated complications, including hyperglycemia, hypoglycemia, hyperlipidemia, and azotemia, in adult patients receiving PN.

  7. Describe the etiology and risk factors for the refeeding syndrome.

  8. Describe the etiology and risk factors for liver complications and metabolic bone disease in adult patients receiving PN.

  9. Design a plan to monitor and correct fluid, electrolyte, vitamin, and trace element abnormalities in adult patients receiving PN.

  10. Design a plan to assess the efficacy and monitor the safety of PN therapy.

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KEY CONCEPTS

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  • Image not available. Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is the intravenous (IV) administration of fluids, macronutrients, electrolytes, vitamins, and trace elements for the purpose of weight maintenance or gain, to preserve or replete lean body mass and visceral proteins, and to support anabolism and nitrogen balance when the oral or enteral route is not feasible or adequate.

  • Image not available. Amino acids are provided in PN to preserve or replete lean body mass and visceral proteins, to promote protein anabolism and wound healing, and as an energy source.

  • Image not available. Dextrose (D-glucose) is the major immediate energy source in PN and is vital for cellular metabolism, body protein preservation, tissue formation, and cellular growth.

  • Image not available. IV lipid emulsions are used as an energy source in PN and to prevent or treat essential fatty acid deficiency.

  • Image not available. PN should not be used to treat acute fluid and electrolyte abnormalities. Rather, PN should be adjusted to meet maintenance requirements and to minimize worsening of underlying fluid and electrolyte disturbances.

  • Image not available. Electrolytes, vitamins, and trace elements are essential for numerous biochemical and metabolic functions and should be added to PN daily unless otherwise not indicated.

  • Image not available. PN can be administered via a small peripheral vein [as peripheral PN (PPN)] or via a larger central vein (as central PN).

  • Image not available. PN admixtures can be prepared by mixing all components into one bag [3-in-1 admixture or a total nutrient admixture (TNA)] or by mixing and infusing dextrose, amino acids, and all other components together and infusing IV lipid emulsion separately (2-in-1 admixture).

  • Image not available. PN is associated with significant complications with both short- and long-term therapy.

  • Image not available. Patients receiving PN should have specific laboratory parameters periodically monitored as indicated clinically. These mainly include fluid and electrolyte status, organ function, nutritional status, and micronutrient levels.

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INTRODUCTION

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Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, ...

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