Above what level of triglycerides should TPN not include lipids?
What drug can cause hyperlipidemia in TPN?
What should be done to TPN if BUN is high (>50 mg/dL)?
- start proteins very low
- keep vitamin C low
Which salt should be used in TPN if the pt is acidotic?
Which salt should be used in TPN if the pt is alkaline?
What characterizes refeeding syndrome?
What are some symptoms of refeeding syndrome?
- resp. failure
- cardiac decompensation
What causes refeeding syndrome?
the sudden shift from fat to carbohydrate metabolism upon feeding a starving pt, which requires more ATP
How should you try to avoid causing refeeding syndrome in pt at risk?
start TPN at 1/2 to 1/3 of calculated daily calories and move up slowly
How do you treat refeeding syndrome once it starts?
- stop TPN
- initiate 10% dextrose
- replace electrolytes
- supportive care (oxygen for resp. distress, diuresis for edema)
How should TPN be monitored?
- basic metabolic panel
- Ca, Mg, PO4CBC w/differential
- serum albumin, prealbumin, AST/ALT, PT/INR
- 24h urinary urea nitrogen (if necessary)
- ability to use GI tract
- functional status
Which parameters should be monitored weekly in the initial period of TPN?
- PT/PTT, AST, ALT
What should be monitored daily when the patient is stable on TPN?
What should be monitored weekly for long-term TPN?
What should be monitored quarterly for long-term TPN?
- PT/PTT, AST, ALT
- trace elements
What is the half-life of albumin?
What is the half-life of prealbumin?
What is the normal range of albumin?
3.5 - 5.0 g/dL
What is the normal range for prealbumin?
How many lipid-based calories does propofol provide?
1.1 kcal/ml of infusion
What nutrition weight should be used for underweight patients?
ideal body weight
What nutrition weight should be used for obese patients?
adjusted body weight = IBW + 1/4(ABW - IBW)
How do you determine calorie needs for TPN?
Basic Energy Expenditure (BEE) x stress factor
What are the stress factors for calorie need?
- confined to bed = 1.2
- out of bed = 1.3
- surgery = 1.2
- severe infection = 1.4
- trauma = 1.5
- burn = 1.7
How do you determine fluid goal for TPN?
1500 mL for the first 20 kg of wt, then add 20 mL/kg for each add'l kg
How do you determine the protein goal for TPN?
- range = 0.6 g/kg/d - 2.0 g/kg/d
- usually = 1.2 - 2.0 g/kg/d
How do you determine the lipid goal for TPN?
no more than 1/3 of the total non-protein calories
How do you determine the dextrose goal for TPN?
about 2/3 of the total non-protein calories
What should the glucose infusion rate be limited to for TPN?
< 5 mg/kg/min or 7 g/kg/d on a 24h TPN
How much sodium should be in a TPN?
1-2 mEq/kg (80-150 mEq)
How much potassium should be in a TPN?
1-2 mEq/kg (40-100 mEq)
How much magnesium should be in a TPN?
How much calcium should be in a TPN?
How much phosphate should be in a TPN?
What is the usual salt used in TPN?
What is the conversion for sodium to phosphate?
4.0 mEq Na for every 3 mmol PO4
What is the conversion for potassium to phosphate?
4.4 mEq K for every 3 mmol PO4
What is the dose for multivitamins in adults on TPN?
10 mL daily
How much trace elements should be used in a TPN?
1-2 mL/d (each mL contains 5 mg Zn, 1 mg Cu, 0.5 mg Mn, 10 Mcg Cr)
What infections are common complications of TPN tx?
- coagulase-negative staph
- staph areus
- strep pyogenes
- fungal infection (most common)
What should dextrose infusion rate be limited to in order to avoid causing hyperglycemia?
What causes hypercapnia?
excessive carbon dioxide production d/t excessive calories and dextrose