Chapter 11. Calculations III: Parenteral & Enteral Nutrition

When is parenteral nutrition typically indicated?

If a patient is unable to take in nutrients through the GI tract for >5 days

2-in-1 vs 3-in-1

• 2-in-1 = Dextrose and AA

• 3-in-1 = Dextrose, AA, lipids

What is the brand name for on eof the most popular multi-chamber bags?

Clinimix

What regulations describe rules for TPN compounding?

USP 797

Administration of a PN requires a ____________ d/t risk of a precipitate.

Filter; Central line preferred (i.e. PICC line)

Fluid Need Equation

if pt is ≥20 kg

1500 mL + 20mL x (wt in Kg - 20)

What is the name of the equation to calculate BEE, which is energy spent at rest?

Harris-Benedict

What is TEE

BEE plus excess metabolic demands

Calories provided from Enteral Nutrition

• Carbs = 4 kcal/g

• Fat = 9 kcal/g

• Protein = 4 kcal/g

Calories provided from Parenteral Nutrition

• Dextrose = 3.4 kcal/g

• Glycerol/Glycerin = 4.3 kcal/g

• Injectable Lipid Emulsion:

- 10% = 1.1 kcal/mL

- 20% = 2 kcal/mL

- 30% = 3 kcal/mL

• Amino Acids = 4 kcal/g

Which portion of the PN is Amino Acids?

Protein

When is "protein sparing" PN used?

in critically ill patient who are catabolic (breakdown protein faster than synthesis) -> provide most calories w dextrose and fat

There is 1g of Nitrogen for every _______ g of protein.

6.25 g

Non-Protein Calories to Nitrogen Ratio (NPC:N)

Divide NON-PROTEIN CALORIES by grams of nitrogen (After calculating)

What are commonly used brand names for Amino Acids?

Aminosyn, FreAmine, Travasol, TrophAmine, Clinisol

What is the main energy source?

Glucose

What size filter does lipid require?

1.2 micron (most other meds use 0.22 micron filter)

What medications may be commonly given in an emulsion that must be considered for fat calories?

propofol and clevidipine

Is sodium an intracellular or extracellular cation?

Extracellular; the principal one

*may be added to PN as chloride, acetate, or phosphate

What form of Na should be used in acidosis?

Sodium acetate

What is the principal intracellular cation?

Potassium

*may be added as chloride, acetate, or phosphate

Phosphate formulations

• May be in sodium or potassium phosphate forms

• do NOT provide EQUIVALENT amounts of phosphate

What two electrolytes can bind together and precipitate?

calcium and phosphate

Which form of Ca should be chosen d/t a lower risk of precipitation with phosphates?

Ca gluconate

How should precipitation be avoid with Ca and phos in preparation?

Add phosphate first, followed by other components, agitate, then add Calcium near the end

Which trace element is NOT ROUTINELY given in PN?

Iron

What kind of insulin is preferentially added to TPN?

Regular

What are examples of brand names of enteral nutrition?

Ensure, Osmolite, Jevity, Glucerna, Novasource

How long should PN be held around drug administration?

At least 1 hour before and 1-2 hours after

Drug-Nutrient Interactions

• Warfarin = one hr before and after PN should be held

• Tetracyclines, Quinolones, Levothyroxine = chelate w polyvalent cations; separate from tube feeds

• Ciprofloxacin = IR tablets (NOT suspension) must be used; crush and mix w water

• Phenytoin = lvls reduced by binding feed; separate by 2 hours