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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 parenteral nutrition (PN) in adult patients.

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

  3. List key 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 in adult patients receiving PN.

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

  8. Design a plan to assess the efficacy and monitor for safety, as well as fluid, electrolyte, vitamin, and trace element abnormalities in adult patients receiving PN.

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INTRODUCTION

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Malnutrition in hospitalized patients is associated with significant complications (eg, increased infection risk, poor wound healing, prolonged hospital stays, increased mortality), especially in surgical and critically ill patients.1 Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an essential part of patient care. Nutrition support therapy refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 KEY CONCEPT 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. PN is a potentially lifesaving therapy in patients with intestinal failure but can be associated with significant complications.

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Desired Outcomes and Goals

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The goals of nutrition support therapy include:

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  • Correction or avoidance of nutritional deficiencies

  • Weight maintenance (or weight gain in malnourished patients and growing children)

  • Preservation or repletion of lean body mass and visceral proteins

  • Support of anabolism and nitrogen balance and improvement of healing

  • Correction or avoidance of fluid and electrolyte abnormalities

  • Correction or avoidance of vitamin and trace element abnormalities

  • Improving clinical outcomes

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Indications for PN

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PN can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support therapy. Compared with PN, enteral nutrition is associated with a lower risk of hyperglycemia and fewer infectious complications (eg, pneumonia, intra-abdominal abscess, catheter-related infections).1,2,3 However, if used appropriately PN can be safe and effective and can improve nutrient delivery. Indications for PN are listed in Table 100–1.1,2 PN should be reserved for patients with altered intestinal function or absorption or when the gastrointestinal (GI) tract cannot be used. The anticipated duration of adequate PN therapy should be at ...

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