Metabolic Abnormalities and Arrhythmias

Metabolic Abnormalities

• Common electrolyte imbalances include hypocalcemia, hypomagnesemia, hyponatremia, hypokalemia, and hypophosphatemia.
• Fluid overload is a significant concern in patients receiving Total Parenteral Nutrition (TPN).

Arrhythmias and Health Conditions

• Congestive Heart Failure (CHF) is a notable condition that may be associated with arrhythmias.

Prevention Strategies

• Gradual increase in feed quantity helps prevent complications in TPN.
• Thiamin supplementation is crucial to avoid deficiency-related issues.
• Constant monitoring of serum electrolytes is essential during TPN.

Fluid Requirements and Administration

• Recommended fluid intake is 1500 ml for a 20 kg body weight.
• TPN is administered via intravenous (IV) routes including subclavian vein, internal jugular vein, femoral vein, or via Peripherally Inserted Central Catheter (PICC).

Indications for Total Parenteral Nutrition

• Used when enteral nutrition fails or is contraindicated.
• Conditions such as high output, abdominal fistulas, major GI bleeding, hyperemesis gravidarum, and multi-organ failure necessitate TPN.

Goals of TPN

• Prevent protein breakdown and concomitant weight loss.
• Maintain glycogen reserves, acid-base balance, and improve cardiovascular, respiratory, and immune functions.

Components of TPN

• Carbohydrates: Provides 50-70% of total calories, with 1 gram yielding 3.4 Kcal.
• Fat: Forms 10-30% of total calories, with 1 gram yielding 9 Kcal; available in 10%, 20%, and 30% emulsions.
• Proteins: Should be calculated as 25 kcal per kg of body weight daily.

Advantages and Disadvantages of TPN

• Advantages include prevention of muscle protein breakdown and stimulation of glucose oxidation.
• Disadvantages include low calorie value, high dose requirements, risks of hyperglycemia, and increased carbon dioxide production.

Nutritional and Metabolic Support

• High calorie values focus on nitrogen sparing and prevention of essential fatty acid deficiency.
• Risks of hyperlipidemia, sepsis, and fat embolism need monitoring.

Protein and Electrolyte Requirements

• Daily protein requirement is 1 gram per kg of body weight, equating to 4 kcal per gram.
• Electrolyte intake constitutes 20% of the daily requirement, including sodium (1-3 mg), potassium (72-90 mg), magnesium (1-2 mg), iron (2 mg), and trace elements like manganese, zinc, and copper.

Complications Associated with TPN

• Central line complications can lead to pneumothorax, arrhythmias, thrombosis, air embolism, and hyperglycemia.
• Feeding-related complications may manifest as gout.
• Catheter-related risks include potential sepsis.
• Refeeding syndrome may occur due to rapidly administering large volumes of TPN to malnourished patients, leading to metabolic disturbances.