Total Parenteral Nutrition
Fluid:
Energy
Protein (4kcal/g)
Lipid (20-50% calories) (10kcal/g or 5ml of 20% IVFE)
Carbohydrates (40-60% calories) (3.4kcal/g)
Na
K
Ca
PO4
Mg
Acetate
Cl
Zn
Se
Cu
Mn
Multivitamin
Cycling: is increasing rate and having time off. reduces TPN liver damage, gives freedom
Complications:
Intestinal failure related liver diease
(previously Parental nutrition related liver disease PNALD aka PNR cholestasis)
50% prevelance in children on long term TPN
Rx
Reducing TPN ie increasing enteral feeding
URSO
Minimise lipids (ie 1g/kg/day), and use fish (omega 3) rather than soy (omega 6) FA
Ix Long term PN bloods
FBE
EUC
CMP
LFT
Glucose
Triglycerides
Fe, Zn, Ca, Selenium, Chromium, Manganese,
Vit A, B12, Folate, D, E
Coags
CRP
Carnitine
- 100ml/kg/24hr for 1st 10 kg
- 50ml/kg/24ml for 2nd 10kg (ie +1000ml)
- 20ml/kg/24hrs >20kg (ie +1500ml)
Energy
- Preterm neonate – 90 to 120 kcal/kg/day
- <6 months – 85 to 105 kcal/kg/day
- ≥6 to 12 months – 80 to 100 kcal/kg/day
- ≥1 to 7 years – 75 to 90 kcal/kg/day
- ≥7 to 12 years – 50 to 75 kcal/kg/day
- ≥12 to 18 years – 30 to 50 kcal/kg/day
Protein (4kcal/g)
- Preterm neonate – 3 to 4 g/kg/day
- Infants (1 to 12 months) – 2 to 3 g/kg/day
- Children (>10 kg, or age 1 to 10 years) – 1 to 2 g/kg/day
- Adolescents (11 to 17 years) – 0.8 to 1.5 g/kg/day
Lipid (20-50% calories) (10kcal/g or 5ml of 20% IVFE)
- 0-10y - 1-3g/kg/day
- >10y - 1-2g/kg/day
Carbohydrates (40-60% calories) (3.4kcal/g)
- = Energy requirement - energy from protein - energy from lipids (patient specific)
Na
K
Ca
PO4
Mg
Acetate
Cl
Zn
Se
Cu
Mn
Multivitamin
Cycling: is increasing rate and having time off. reduces TPN liver damage, gives freedom
Complications:
Intestinal failure related liver diease
(previously Parental nutrition related liver disease PNALD aka PNR cholestasis)
50% prevelance in children on long term TPN
Rx
Reducing TPN ie increasing enteral feeding
URSO
Minimise lipids (ie 1g/kg/day), and use fish (omega 3) rather than soy (omega 6) FA
Ix Long term PN bloods
FBE
EUC
CMP
LFT
Glucose
Triglycerides
Fe, Zn, Ca, Selenium, Chromium, Manganese,
Vit A, B12, Folate, D, E
Coags
CRP
Carnitine