TPN means full provision (delivery) of total calories, proteins, lipids, carbohydrate, electrolytes and micronutrients for maintenance of good health and nutrition.
- TPN is considered as an alternative route for patient feeding specially if:
1.Oral route is not available or not advisable (unconscious or comatose patients)
2.Severe short bowel syndrome
3.Severe pancreatitis
4.Severe vomiting and diarrhea
5.Post-operative complications (prolonged ileus)
6.Gastrointestinal obstruction
7.Severe mal-absorption
8.Major burns
9.Long bone fractures
10.Geriatric patient
2.Severe short bowel syndrome
3.Severe pancreatitis
4.Severe vomiting and diarrhea
5.Post-operative complications (prolonged ileus)
6.Gastrointestinal obstruction
7.Severe mal-absorption
8.Major burns
9.Long bone fractures
10.Geriatric patient
TPN
- Nutrition Support Team (NST) Physicians, nurses, pharmacists and dietarian‘s
- Nutrition Support Team (NST) Physicians, nurses, pharmacists and dietarian‘s
- Pharmacist tasks include:
1.Formula design
2.Evaluation of drug-drug and drug-nutrient interactions
3.Compatibilities
4.Solution compounding
5.Metabolic monitoring
1.Formula design
2.Evaluation of drug-drug and drug-nutrient interactions
3.Compatibilities
4.Solution compounding
5.Metabolic monitoring
Nutritional requirements of TPN
A- carbohydrates
One of the energy sources e.g. I.V dextrose (d-glucose) at concentrations of 5 or 10 % is well tolerated by the peripheral vein.
Concn. up to 70 % can be used but hypertonic.
Dextrose is compatible with amino acid solutions, electrolytes and fat emulsionsOther sources (fructose, maltose, glycerol and sorbitol)
A- carbohydrates
One of the energy sources e.g. I.V dextrose (d-glucose) at concentrations of 5 or 10 % is well tolerated by the peripheral vein.
Concn. up to 70 % can be used but hypertonic.
Dextrose is compatible with amino acid solutions, electrolytes and fat emulsionsOther sources (fructose, maltose, glycerol and sorbitol)
B- Fats
- EFA (linoleic, linolenic and arachidonic) are important for (cellular integrity, pulmonary surfactant, immune competence ..etc)
- Essential fatty acids (EFA) are also needed because Carbohydrate based TPN causes increased lipogenesis and decreased lipolysis.
- To prevent EFA deficiency 4% of total calories (100 g of I.V fat) must be provided per week
- Advantages over carbohydrates:
1.Low osmolarity
2.No effect on insulin
3.Decreased CO2 production during oxidation
2.No effect on insulin
3.Decreased CO2 production during oxidation
C- Proteins
- Important for maintaining lean body mass
- Commercial protein sources are crystalline amino acids
- Hospitalized adult patient requires 1.0-1.5 g/kg/day increased to 2.0-2.5 g/kg/day with stress
- Commercial protein sources are crystalline amino acids
- Hospitalized adult patient requires 1.0-1.5 g/kg/day increased to 2.0-2.5 g/kg/day with stress
D- Micronutrients
- Electrolytes, vitamins and trace elements, are required for normal body function.
- These include, sodium, potassium chloride, acetate, phosphorus, calcium, magnesium, zinc, chromium, copper, selenium, manganese, iron and vitamins.
- These include, sodium, potassium chloride, acetate, phosphorus, calcium, magnesium, zinc, chromium, copper, selenium, manganese, iron and vitamins.