Podcast
Questions and Answers
Chronic deficiency syndromes related to parenteral nutrition may result from lack of which of the following?
Chronic deficiency syndromes related to parenteral nutrition may result from lack of which of the following?
Which of the following is NOT a route commonly used for parenteral nutrition administration?
Which of the following is NOT a route commonly used for parenteral nutrition administration?
What is a potential complication related to the parenteral nutrition line?
What is a potential complication related to the parenteral nutrition line?
Which of the following is NOT a complication associated with overfeeding in parenteral nutrition?
Which of the following is NOT a complication associated with overfeeding in parenteral nutrition?
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Which electrolyte disorder is NOT typically associated with complications of parenteral nutrition?
Which electrolyte disorder is NOT typically associated with complications of parenteral nutrition?
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What type of nutrition provides all nutrients intravenously without using the gastrointestinal tract?
What type of nutrition provides all nutrients intravenously without using the gastrointestinal tract?
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In which condition would Total Parenteral Nutrition (TPN) be indicated?
In which condition would Total Parenteral Nutrition (TPN) be indicated?
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What are some common complications associated with tube feeding?
What are some common complications associated with tube feeding?
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Which of the following is a contraindication for enteral feeding?
Which of the following is a contraindication for enteral feeding?
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What is a potential metabolic or biochemical complication of parenteral nutrition?
What is a potential metabolic or biochemical complication of parenteral nutrition?
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Which method of artificial support would be used in a patient who sustains 5-7 days of inadequate intake?
Which method of artificial support would be used in a patient who sustains 5-7 days of inadequate intake?
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What is the main purpose of nutritional support in surgical patients according to the text?
What is the main purpose of nutritional support in surgical patients according to the text?
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Which of the following is NOT mentioned as a cause of malnutrition in the text?
Which of the following is NOT mentioned as a cause of malnutrition in the text?
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What is one way to detect severe malnutrition based on the text?
What is one way to detect severe malnutrition based on the text?
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Which lab technique is mentioned in the text as not reliable for measuring malnutrition?
Which lab technique is mentioned in the text as not reliable for measuring malnutrition?
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What is the daily requirement for fluid intake in neonates according to the text?
What is the daily requirement for fluid intake in neonates according to the text?
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Based on the text, what is the total energy need for stable patients in kcal/kg/day?
Based on the text, what is the total energy need for stable patients in kcal/kg/day?
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Study Notes
Parenteral Nutrition
- Massive bowel resection, ileus, and severe pancreatitis are contraindications for enteral nutrition
- Routes of parenteral nutrition include:
- Peripheral access: PICC, short wrist cannula
- Central access: subclavian, internal jugular, external jugular
Complications of Parenteral Nutrition
- Related to nutrient deficiency:
- Hypomagnesemia, hypoglycemia, hypocalcemia, hypophosphatemia
- Chronic deficiency syndromes: fatty acids, zinc, minerals, and trace elements
- Related to overfeeding:
- Hyperglycemia, hyperosmolar dehydration, hepatic steatosis, hypercapnia, increased sympathetic activity, fluid retention, electrolyte disorders
- Excess fat, excess amino acids, and proteins
- Related to sepsis:
- Catheter-related and systemic sepsis
- Related to line complications:
- Pneumothorax, vascular damage, air embolism, thoracic duct injury, cardiac injury, hydro mediastinum, long-term occlusion, venous thrombosis, acidosis, hypercalcemia
Vitamins and Minerals
- Vitamin B12 needs in small intestinal resection
- Fat-soluble vitamins (A, D, K, E) absorption reduced in steatorrhea and bile reduction
- Minerals (Na+, K+, Ca++, PO4) need monitoring and replacement in diarrheal disease
- Trace elements (Zn, Fe, Cu, Mg) important in hypermetabolic state
Enteral Nutrition
- Methods of delivery:
- Oral feeding in patients who can drink
- Tube feeding: NGT, fine-bore feeding tube, surgical PEG tube, post-pyloric feeding (nasojejunal tube, jejunostomy tube)
- Indications:
- Protein-energy malnutrition with inadequate oral intake
- Dysphagia
- Major trauma
- Inflammatory bowel disease
- Enhance adaptation for massive enterectomy
- Contraindications:
- SBO
- Severe diarrhea
- Proximal small intestinal fistula
- Severe pancreatitis
Complications of Tube Feeding
- Tube-related:
- Malposition
- Displacement
- Blockage
- Leakage
- Local erosion
- Gastrointestinal:
- Diarrhea
- Nausea and vomiting
- Abdominal cramps
- Aspiration
- Constipation
- Metabolic or biochemical:
- Electrolyte imbalance
- Vitamin and mineral deficiencies
- Drug interactions
- Infective:
- Exogenous (hand contamination)
- Endogenous (from patient)
Total Parenteral Nutrition (TPN)
- Provides all nutrients intravenously, bypassing the GIT
- Indications:
- Proximal intestinal fistula
- Inflammatory bowel disease (pre-op)
Nutrition and Malnutrition
- Malnutrition is common in surgical patients (30% with gastrointestinal diseases, up to 60% with prolonged hospital stay)
- Aim of nutritional support: identify patients at risk and minimize complications
- Causes of malnutrition:
- Pre-operative: starvation, poverty, dysphagia, chronic vomiting
- Post-operative: transient and delayed return to normal diet
- Hypercatabolic state: severe sepsis, severe trauma
- Metabolic response to starvation:
- Low insulin
- High glucagon
- Hepatic glycogenolysis
- Protein catabolism
- Hepatic gluconeogenesis
- Lipolysis
- Adaptive ketogenesis
- Reduction in resting energy expenditure (REE)
Nutritional Assessment
- Body weight and anthropometric techniques:
- Unintentional weight loss >10% in preceding 6 months indicates poor prognosis
- Body mass index (BMI): <18.5 indicates nutritional impairment, <15 indicates significant hospital mortality
- Clinical techniques:
- History of weight loss
- Dietary intake
- GI symptoms
- Examination: muscle wasting, loss of subcutaneous fat, edema, alopecia
- Laboratory techniques:
- No single reliable method to measure malnutrition
- Albumin <30gm/l indicates poor nutrition
- Defective immune function: decreased lymphocyte count
Nutritional Requirements
- Energy: 20-30 kcal/kg/day for stable patients
- Carbohydrates: 2gm/kg/day for brain and RBCs
- Fat: 4-5gm/kg/day
- Protein: 0.1-1.5gm/kg/day
- Fluids: calculated based on age and weight
- Vitamins: water-soluble vitamins (A, C) required post-op
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Description
Test your knowledge on the complications associated with parenteral nutrition, including nutrient deficiencies, hypoglycemia, and overfeeding-related issues. Learn about potential complications of massive bowel resection, ileus, and severe pancreatitis in relation to parenteral nutrition routes and access methods.
