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Questions and Answers
What are some common line complications associated with TPN therapy?
How can hyperglycemia be managed during TPN therapy?
What is a potential treatment for hypoglycemia during TPN therapy?
How should abnormalities of serum electrolytes and minerals be corrected during TPN therapy?
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How can vitamin and mineral deficiencies be prevented during TPN therapy?
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What are some ways to avoid line complications during TPN therapy?
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What is the most common cause of volume overload in patients receiving TPN?
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Which adverse reaction to lipid emulsions is particularly likely if given at > 1.0 kcal/kg/h?
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What is the suggested treatment for temporarily or permanently slowing or stopping lipid emulsion infusion to prevent adverse reactions?
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What is the potential consequence of delayed or persistent elevations of liver enzymes in patients receiving TPN?
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What is the suggested correction for hyperammonemia in infants receiving TPN?
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What can be caused or worsened by prolonged gallbladder stasis in patients receiving TPN?
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What is the suggested treatment for gallbladder complications in patients receiving TPN?
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What is the suggested intervention to stimulate contraction of the gallbladder in patients with gallbladder complications?
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What is the primary cause of temporary hyperlipidemia in patients receiving TPN?
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What is the known treatment for metabolic bone disease in patients receiving TPN for more than 3 months?
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What is the first step in the general management of poisoning?
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Which of the following is not a part of enhancing poison elimination in the general management of poisoning?
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How is the diagnosis of poisoning usually made in unconscious or uncooperative patients?
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What type of information can be included in the clinical history for diagnosing poisoning?
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Which point does a seasoned clinician usually take into account to arrive at a conclusion in diagnosing poisoning?
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What provides valuable clues to help narrow the differential diagnosis in poisoned patients?
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What is the first step in the general management of poisoning?
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Which of the following odors may point towards exposure or poisoning by hydrogen sulfide or mercaptans?
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What does the observation of urine passed by a poisoned patient give a clue about?
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Which of the following is an example of a vital organ recording in a poisoned patient?
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What is the characteristic odor associated with exposure or poisoning by naphthalene or camphor?
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In the general management of poisoning, what does 'Hasten toxicant elimination' refer to?
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What should be the initial focus in the assessment and correction of life-threatening problems in a poisoned patient?
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'Initial stabilization' in the treatment of systemic poisoning begins with which aspects?
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'General management of poisoning' includes which concept related to limiting further absorption of toxicant?
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'Skin Marks' may indicate which aspect of poisoning?
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Study Notes
Complications of TPN Therapy
- Common line complications associated with TPN therapy include infections, occlusions, and thrombosis.
- Hyperglycemia can be managed during TPN therapy by adjusting the dextrose content, using insulin, and monitoring blood glucose levels.
- Potential treatment for hypoglycemia during TPN therapy includes administering dextrose or glucose.
- Abnormalities of serum electrolytes and minerals should be corrected during TPN therapy by adjusting the electrolyte content and monitoring serum levels.
- Vitamin and mineral deficiencies can be prevented during TPN therapy by ensuring adequate supplementation.
Avoiding Line Complications
- Ways to avoid line complications during TPN therapy include using proper insertion and care techniques, monitoring for signs of complications, and rotating the injection site.
Adverse Reactions to Lipid Emulsions
- The most common cause of volume overload in patients receiving TPN is excessive infusion of lipid emulsions.
- Infusing lipid emulsions at a rate > 1.0 kcal/kg/h can lead to adverse reactions, particularly pancreatitis.
- Temporarily or permanently slowing or stopping lipid emulsion infusion can prevent adverse reactions.
Liver Enzyme Elevations
- Delayed or persistent elevations of liver enzymes in patients receiving TPN can lead to liver damage.
Hyperammonemia
- The suggested correction for hyperammonemia in infants receiving TPN is to reduce the protein content of the TPN solution.
Gallbladder Complications
- Prolonged gallbladder stasis in patients receiving TPN can cause or worsen gallbladder complications.
- The suggested treatment for gallbladder complications is to stimulate contraction of the gallbladder using cholecystokinin or other medications.
Metabolic Bone Disease
- Temporary hyperlipidemia in patients receiving TPN is primarily caused by the infusion of lipid emulsions.
- The known treatment for metabolic bone disease in patients receiving TPN for more than 3 months is to supplement with calcium and vitamin D.
General Management of Poisoning
- The first step in the general management of poisoning is to assess the patient's airway, breathing, and circulation (ABCs).
- The diagnosis of poisoning is usually made in unconscious or uncooperative patients by analyzing serum and urine samples.
- The clinical history for diagnosing poisoning can include information about the time and amount of toxin exposure, symptoms, and medical history.
- A seasoned clinician usually takes into account the patient's symptoms, medical history, and laboratory results to arrive at a conclusion.
- The patient's physical examination and laboratory results provide valuable clues to help narrow the differential diagnosis.
- The initial focus in the assessment and correction of life-threatening problems in a poisoned patient is to stabilize the patient's vital signs.
- Initial stabilization in the treatment of systemic poisoning begins with assessing the patient's airway, breathing, and circulation (ABCs).
- Limiting further absorption of toxicant is a key concept in the general management of poisoning.
- 'Hasten toxicant elimination' refers to the use of methods to enhance the elimination of toxins from the body.
- Skin marks may indicate injection sites or other routes of exposure to toxins.
- A characteristic odor of garlic or rotten eggs may point towards exposure or poisoning by hydrogen sulfide or mercaptans.
- The observation of urine passed by a poisoned patient can give a clue about the type of toxin ingested.
- Vital organ recordings, such as ECG, can provide valuable information in a poisoned patient.
- The characteristic odor associated with exposure or poisoning by naphthalene or camphor is a pungent, sweet smell.
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Description
Test your knowledge of common complications associated with Total Parenteral Nutrition (TPN) in a hospital pharmacy setting, including line complications, metabolic complications, and hepatic complications. Explore ways to prevent these complications.
