2. Total Parenteral Nutrition

3. Total Parenteral Nutrition
Total Parenteral Nutrition (TPN)
Feeding technique (veins)
Hyperalimentation
Bypasses the GI tract
The alimentary tract cannot or should not be used
Metabolic requirements for protein are substantially
increased (extensive burns).
Gastrointestinal absorption of protein is impaired
Provide fuel, energy and nutrients through the bloodstream

4. Total Parenteral Nutrition
Total Parenteral Nutrition (TPN)
 Main Fuels
 Protein (amino acids)
 Carbohydrate (glucose)
 Lipids (fat)
 Nutrients
 Vitamins
 Minerals
 Electrolytes
 Water (H2O)
 25-40 ml/kg/day

5. Total Parenteral Nutrition
Components
Proteins
 Building blocks
 1.5g/kg/day
 Amino Acids
 Organics compounds consist of proteins
 Carbon, hydrogen, oxygen and nitrogen
 Essential amino acids – body can’t produce
 Non-essential amino acids – produce in the body

6. Total Parenteral Nutrition
Essential Amino Acids
1. Histidine
2. Isoleucine
3. Leucine
4. Lysine
5. Methionine
6. Phehylalanine
7. Threonine
8. Tryotophan
9. Valine
Non-Essential Amino Acids
1. Alanine
2. Arginine
3. Aspartic Acid
4. Cysteine
5. Glutamic Acid
6. Glutamine
7. Glycine
8. Proline
9. Serine
10. Tyrosine
11. Aspargine
12. Selenocysteine

7. Total Parenteral Nutrition
Components
Carbohydrates
-Dextrose (glucose)
- 4g/kg/day (daily requirements)
- CONCENTRATION PER LITER
- 25.00 - 35.00 g
- (850 - 1190 calories)

8. Total Parenteral Nutrition
Components
Lipids (fat)
- 1g/kg/day (daily requirements)
- 1/3 of energy (non-protein)
- prevents fatty acids deficiency
- provides more concentrated calories
- disadvantage
- pancreatitis
- immunosuppression
- increase in CO2 production

9. Total Parenteral Nutrition
Vitamins
Fat soluble
- Vitamin A (retinol, retinoic acid, 1mg or 300 USP units)
- Vitamin D (cholecalciferol, 5mg or 200 USP units)
- Vitamin E (tocopherol, 10mg or 10 USP units)
-Vitamin K (phytonadoine, 70mg)
Water Soluble
- Vitamin C (ascorbic acid, 100mg)

10. Total Parenteral Nutrition
Vitamins
Water Soluble
 B Complex
 B1 (thiamine, 3 mg)
 B2 (riboflavin, 3.6 mg)
 B3 (niacin, 40mg)
 B5 (pantothenic acid, 10mg)
 B6 (pyridoxine, 4 mg)
 B7 (biotin, 50 mcg)
 B9 (folic acid, 400 mcg)
 B12 (cyanocobalamin, 5mcg)

11. Total Parenteral Nutrition
Trace Elements
Given in small concentrations
Micro nutrients
Dietary minerals
Trace metals
 Zinc
 3-5mg
 Co-factor of 70 enzymes
 Maintain normal growth
 Skin hydration

12. Total Parenteral Nutrition
Trace Elements
Copper
 1.2-2mg
 Maintain normal rate of red and white blood cell formation
 Prevents leukopenia, neutropenia & anemia
Manganese
 0.3- 0.5 mg
 Prevents nausea & vomiting, dermatitis, weight loss, hair loss

13. Total Parenteral Nutrition
Trace Elements
Chromium
 12-20 mg
 Prevents
 Impaired glucose tolerance
 Ataxia (lack of voluntary coordination of muscles)
 Peripheral neuropathy
 Confusion
 Hepatic encephalopathy

14. Total Parenteral Nutrition
Trace Elements
Selenium
 60 – 100 mcg
 Prevents
 Muscle pain
 Tenderness

15. Total Parenteral Nutrition
Electrolytes
Sodium
 25 – 35 mEq
 Water distribution control
 Maintain normal fluid balance
Potassium
 30 – 40 mEq
 Cellular activity (tissue synthesis)

16. Total Parenteral Nutrition
Electrolytes
Magnesium
 5 – 8 mEq
 Absorbs carbohydrates and proteins
Calcium
 5 – 8 mEq
 Bone & teeth development
 Clotting

17. Total Parenteral Nutrition
Electrolytes
Phosphate
 13 – 15 mEq
 Minimizes the threat of peripheral parestheses
Chloride
 35 – 45 mEq
 Maintains osmotic pressure
 Acid-base equilibrium

18. Total Parenteral Nutrition
Electrolytes
Acetate
 Varies due to amino acid source
 Prevent metabolic acidosis

19. Total Parenteral Nutrition
References:
 http://www.Rxlist.com. Retrieved 02/14/2014.
 http://www.merckmanuals.com. Retrieved 02/14/2014.