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Total parenteral nutrition

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  • 1. 1 2 Complications of malnourished patients are 2-20 times greater than those of well-nourished patients Buzby GP et al, Am J Surg 1980 Hickman DM, et al, 1980 Klidjian AM, et al, 1982 3 4 Nutritional Status Review of medical record Evaluation of medical, social and Normal nutrition histories Measurement and assessment of Borderline anthropometric and laboratory data Malnourished Clinical evaluation Estimation of energy and nutrient 0 5 10 15 20 requirements Days ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. RobinsonG et al, JPEN 1987 5 6 In bed, no movement 0.9 - 1.0 On respirator 0.7 - 0.9 Men : 66.47 + 13.75 (W) + 5.0 (H) - 6.76 (A) In bed, able to move 1.2 Usual activities 1.3 Women : 655.1 + 9.56 (W) + 1.85 (H) - 4.68 (A) W : weight in kilograms Minor surgery 1.2 H : height in centimeters Skeletal trauma 1.35 A : age in years Major sepsis 1.6 ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd Severe thermal burn 2.1 edition. 7 8 Guidelines for the use of Parenteral and Enteral Nutrition assessment Decision to Initiate Specialized Nutrition Support TEE = BEE x AF x SF YES Functional GI Tract NO BEE = Basal Energy Expenditure Enteral Nutrition Parenteral Nutrition Long-term Short-term AF = Activity Factors Short-term Long-term or GI function Fluid Restriction Normal Compromised SF = Stress Factors Periphral PN Peripheral PN Central PN Intact Defined Nutrition Formula Nutrient GI function Weight Repletion Add 1000 kcal/day Tolerance Returns Adequate Inadequate PN Adequate Progress Target of Weight Gain = 2 lbs./wk Progress Supplementation to more Complex to Oral Diet and Oral YES NO Feedings Feedings as (3500 excess calories = 1 lb. weight gain) Progress to Total Enteral feedings Tolerated ASPEN 1993: Nutrition Support Dietetics,Core Curriculum 2nd ed.
  • 2. 9 10 Avoids need of expertise for placing Partial parenteral nutrition is an central venous catheter Avoids risk of CVC & sepsis alternative method to provide calories Prevents delay in initiation of nutrition and some nitrogen sparing, especially for support patients with borderline malnutrition who Simplifies nursing care cannot be fed enterally for 1 to 2 weeks. Reduces cost Widely accepted by both patients and nurse JPEN 1993. JPEN 1993;17(5):468-78. 11 12 Guidelines for the use of Parenteral and Enteral Nutrition assessment Decision to Initiate Specialized Nutrition Support Functional GI Tract YES NO Enteral Nutrition Parenteral Nutrition Osmolarity > 900 mOsm/L Long-term Short-term Short-term Long-term or GI function Normal Compromised Fluid Restriction Duration > 10 days Intact Defined Peripheral PN Central PN Central PN Nutrition Nutrient Formula Fluid is restriction GI function Tolerance Returns Adequate Inadequate PN Supplementation Adequate Progress High energy & nutrient required Progress to more Complex to Oral Diet and Oral YES NO Feedings Feedings as Progress to Total Tolerated Enteral feedings ASPEN 1993: Nutrition Support Dietetics,Core Curriculum 2nd ed. ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. 13 14 Is the index to show the appropriate amount of Requirements protein compare to energy. NPC = Non Protein Calories • Healthy adults : 0.8 g/kg per day NPC = TEE - energy from protein (Calories from • Critical illness : 1.2 - 2.5 g/kg per day fat and CHO) • Restriction in hepatic encephalopathy, or renal failure when dialysis is contraindicated. N = protein / 6.25 Range for normal = 150-300 : 1 Optimal protein intake Range for patients with stress = 80-120 : 1 • Nitrogen balance should + 2 to +4 g Parenteral and Enteral Nutrition, SPENT ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. 15 16 Functions • Primary energy source Requirements • Dextrose contain 3.4 kcal/g • 1 g = 9 kcal ( approximate 4 kcal/g ) • Unknown exactly Requirements • Prevent EFAD : 2% to 4% of calories requirement • Unknown exactly • Maximum : < 60 % of calories • Minimum : 1 mg/kg/min • Maximum : 5 mg/kg/min ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition.
  • 3. 17 18 18:2 n-6 18:3 n-3 Linoleic - Linolenic Essential fatty acid (EFA) are PGE1 linoleic acid (omega 6), C18 : 2w - 6 linolenic acid (omega 3), C18 : 3w - 3 20:3 n-6 PGH1 PGE3 Both are PUFA. DGLA 20:5 n-3 PGH3 PGD3 Another common FA which is not EFA is PGD1 EPA TXA3 Oleic acid (omega 9), C18 : 1w - 9 PGE2 PGI3 20:4 n-6 PGH2 PGD2 Arachidonic acid TXA2 PGI2 22:6 n-3 (DHA) Parenteral and Enteral Nutrition, SPENT -6- Lipid -3- Lipid 19 20 Linoleic Acid: Immunosuppressor Adequate intake 2% - 4% of calories is required Animal fat Fish oil for normal functioning of both humoral & cell- vegetable oil mediated immunity Energy Excessive linoleic acid can serve as a precursor Membranes of PGE2 (which many researchers have 20:4 n-6 20:5 n-3 demonstrated PGE2 as a major Arachidonic acid EPA immunosuppressor) Lipid mediator synthesis via Excess linoleic acid: 5-LD pathway • Immunosuppression 4-series Leukotrienes 5-series Leukotrienes • Depress cytostatic function • Depress lymphocyte mitogenesis • Depress lymphokines production Inflammation ASPEN,1993. Nutrition Support Dietetics. 21 22 -3 FA: Immunostimulator OMEGA-3 PUFA : special dietary purposes Inhibit formation of PGE2 derived from linoleic No established requirement in ICU patients acid PGE3 do not have immunosuppressive properties Under investigation as IMMUNE MODULATING AND ANTI-INFLAMMATORY Excess - 3 FA: AGENTS • Improves cell-mediated immunity • Improves opsonic indices Doses of up to 3-5 g/d have been used in • Increases splenic weight ICU • Inhibits production of PGE2 patients and/or patients with sepsis ASPEN,1993. Nutrition Support Dietetics. Chest 1997; 111:769. 23 24 AMA Recommendations for Parenteral Vitamin Intake Parenteral Electrolytes Recommendation* Vitamin Amount Sheldon et al Grant Schlictig and Ayers Vitamin A 3,300 IU Vitamin D 200 IU Potassium 120-160 mmol/d 80-100 mEq 70-100 mEq Vitamin E 10 IU Sodium 125-150 mmol/d 80-100 mEq 70-100 mEq Ascorbic acid 100 mg Phosphorus 15-25 mmol/1000kcal 7-10 mmol/1000kcal 20-30 mmol Folic acid 400 g Magnesium 7.5-10 mmol/d 0.25-0.35 mEq/kg/d 15-20 mEq Niacin 40 mg Calcium 0.2-0.3 mEq/kg/d 10-20 mmol Riboflavin 3.6 mg Chloride Equal to sodium to Thiamin 3 mg prevent acid-base Pyridoxine 4 mg disturbances Cyanocobalamin 5 g Pantothenic acid 15 mg *Potassium and sodium are available as phosphorus, chloride, or acetate, and calcium is Biotin 60 g available as gluceptate, gluconate, or chloride. Magnesium is available as sulfate. Chloride is available as sodium, potassium, or hydrochloric acid. Acetate is available as sodium or ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. potassium.
  • 4. 25 26 Nutrient Suggested IV Needs Factors increase needs Calcium 15 mEq Ca gluconate High protein intake 43 mEq Ca chloride AMA Recommendations for Parenteral Mineral Intake 20-40 mmol Phosphorus High dextrose loads Mineral Amount 0.07 g / g N 8 mEq GI losses drugs refeeding Magnesium 0.5 mEq/g N Zinc 2.5 - 4.0 mg Drugs that increase excretion Copper 0.5 - 1.5 mg 1-2 mEq/kg Sodium Chromium 10.0 - 15.0 g Diarrhea , intestinal or biliary fistula 1 mEq/kg vomiting , nasogastric suction Potassium 3 mEq/g N Manganese 0.15 - 0.8 mg The ASPEN Nutrition Support Practice Manual 1998:9-3 ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. 27 28 ZINC Calculation of Fluid Requirements Zinc, plays a key metabolic role as a component Method 1 Fluid of metalloenzymes,.... ( mL/kg ) Participation in diverse processes involving For young, vigorous, previously healthy adults 40 carbohydrate, lipid and protein metabolism, as For other adults 35 For elderly adults 30 well as nucleic acid synthesis and degradation. Clinically, zinc is required for normal wound Method 2 healing, normal immunological function, taste and smell perception, and dark adaptation. For the first 10 kg of BW, add 100 mL/kg per day For the second 10 kg of BW, add 50 mL/kg per day For each additional kg, add 20 mL/kg per day if patient is 50 Christopher B. Mills, David S. Gray, Bruce A. Freed, and Mitchell V. years of age or less, or add 15 mL/kg per day if patient is older Kaminski, JR, Trace-Element Requirements, Nutrition in Clinical Surgery 2nd edition. than 50. 29 30 1. 1500 ml/m2 Macro elements 2. 1500 ml for the first 20 kg + 20 ml/kg • Na , K , Cl , Mg , P over 20 kg (Holiday’s formula) 3. 30-35 ml/kg (average size adult) Micro elements 4. 30-35 ml/kg 18-64 years of age • Zn , Cu , Fe , Mn , Se , Cr , Co , I , Mo 30 ml/kg 55-65 years of age 25 ml/kg > 65 years of age 5. RDA: 1 ml/kcal 6. 1 ml/kcal + 100 ml/g N Parenteral and Enteral Nutrition, SPENT 31 32 MAGNESIUM SODIUM Required for many The most important cation of the ECF. PHOSPHORUS enzymes to function. Sodium deficiency leads to hypovolemic... Necessity in Essential for nerve synthesis of the impulse transmission energy-rich and muscle POTASSIUM phosphates-ATP, contraction. The most important cation of the ICF. phospholipids and Influence’s the Active in muscle excitability phosphoproteins. excitability of nervous Under- or overdose causes muscular system, decreased weakness and morphological of the lean serum values lead to heart musculature. increased excitability as well as disorientation.
  • 5. 33 34 Total Parenteral Nutrition (TPN) Total Parenteral Nutrition (TPN) Glucose Electrolytes Glucose 1- 5 mg/kg/min Electrolytes 5 mg/kg/min x50kg x60min/hr x24 hr=360g/d Fat: +MCT TPN Fat: +MCT TPN Water Water Amino acids 1-2 g/kg/d Vitamins/Minerals Amino acids Vitamins/Minerals 2 g/kg/d x 50kg = 100 g/d 1-2 g/kg/d x 50kg =100 g 35 36 Total Parenteral Nutrition (TPN) Glucoe 1- 5 mg/kg/min Electrolytes 5 mg/kg/min x50kg x60min/hr x24 hr=360g/d Fat: +MCT TPN Water 1-2 times/week Amino acids Vitamins/Minerals 1-2 g/kg/d x 50kg =100 g THAI OTSUKA PHARMACEUTICAL CO., LTD. 37 BCAA TPN vs. standard TPN. Effect of nutritional support on nitrogen balance 38 during stress response is depicted. When altered requirements of stress state are supplied, better and more rapid nitrogen retention is achieved. High Branched Chain Amino Acid ( 30% w/w BCAA ) +12 Carbohydrate free +10 +8 Chloride free Nitrogen balance gm/day Branched chain rich +6 support +4 Composition in 500 mL Amiparen-5 Amiparen-10 Current standard +2 support 0 Total amino acid 25 gm 50 gm -2 EAA 14.77 gm 29.66 gm -4 NEAA 10.22 gm 20.45 gm -6 BCAA 30 %w/w 30 % w/w -8 No support Na+ 0.5 mEq 1 mEq -10 Acetate 30 mEq 60 mEq -12 Other electrolytes none none Osmolarity (mOsm/L) 444 960 0 3 6 pH 6.5 - 7.5 6.5 - 7.5 Trauma Day post-trauma 39 40 Improved nitrogen retention Improved hepatic protein synthesis Decreased protein degradation Improved nitrogen balance Provide energy Less expense to reach nitrogen equilibrium •ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition. THAI OTSUKA PHARMACEUTICAL CO., LTD.
  • 6. 41 42 Composition in 500 mL Aminosol-5 Aminosol-10 Standard balance amino acids solution Total amino acid ( gm ) 25 gm 50 gm %EAA/AA 40.6 40.6 Sorbitol (gm) 50 50 Kcal 300 400 Sorbitol 10% w/w Electrolyte (mEq/L) Difficult to degradation by temperature Na+ 48 48 K+ 25 25 Not stimulate insulin related Mg 2+ 5 5 Protein sparing effect Cl- 31 62 Acetate 59 59 H2PO4 - 9 9 Malate 7.5 7.5 Some electrolytes as need 43 Thai Otsuka glucose and electrolytes 44 Composition Glucolyte-2 GE-1 GE-2 Composition (1000ml) (600ml) (600ml) % Glucose 7.5%(75g) 17%(100g) 29%(175g) Parenteral nutrition Na+(mEq) 77 35 35 K+(mEq) 20 20 25 Mg2+(mEq) 5 5 6 Prophylaxis and therapy of deficiency Ca2+(mEq) 5 6 P(mmol) 10 6 9 resulting from increased protein loss SO42-(meq) 5 5 6 and/or increased protein requirements Zn(mg) 2.6 1.3 1.3 Total Calories(kcal) 300 400 700 45 46 Glucolyte-2 GE-1 GE-2 Composition (1000ml) (600ml) (600ml) % Glucose 7.5%(75g) 17%(100g) 29%(175g) Na+(mEq) 77 35 35 *Amiparen-10% 500ml *Aminosol-10% 500ml K+(mEq) 20 20 25 *Aminoleban-8% 500ml 2+ Mg (mEq) 5 5 6 *Kidmin-7.2% 200ml Ca2+(mEq) 5 6 P(mmol) 10 6 9 SO42-(meq) 5 5 6 Zn(mg) 2.6 1.3 1.3 GE-1 & 2 600 ml in bag 1000 ml 47 48 Ingredients GE-1 GE-2 Daily ( mEq/L ) 600 mL 600 mL Requirement Glucose solution with electrolytes Glucose ( gm ) 100 175 100* Na+ 35 35 60 – 150 and trace element K+ 20 25 40 – 240 Cl- 35 35 – Mg2+ 5 6 10 – 45 GE-1 has 17% Glucose Ca2+ 5 6 5 – 30 P ( mmole ) 6 9 10 SO42- 5 6 GE-2 has 29% Glucose Acetate 8 7 Citrate 15 20 Zn ( mg ) 1.3 1.3 2.5 - 4 Available in plabottle container *A minimum of 100 gm/day of carbohydrate is necessary to prime the tricaboxylic acid cycle ASPEN 1993. Nutrition Support Dietetics, Core Curriculum, 2nd edition.
  • 7. 49 50 *Amiparen-10% 500ml *Aminosol-10% 500ml *Aminoleban-8% 500ml *Kidmin-7.2% 200ml GE-1 & 2 600 ml in bag 1000 ml 51 52 * Plabottle Air(close system) * Amiparen-10 + GE-2 = 900 kcal/set 53 54 7.5% Glucose Solution with K+, P, Mg++ & Zn++ Glucose 75 gm/L Na+ 77 mEq/L K+ 20 mEq/L Mg++ 5 mEq/L Cl- 77 mEq/L P 10 mmol/L SO4= 5 mEq/L Acetate 10 mEq/L Zn++ 2.6 mg/L THAI OTSUKA PHARMACEUTICAL CO., LTD. Osmolarity 620 mOsm/L 55 56 Indications Maintenance therapy D 5% NSS/2 2 LIT + Glucolyte-2 2LIT Prophylaxis of electrolyte deficiencies K+ 40mEq + Cl- 40mEq [ e.g. hypokalemia, hypomagnesemia Glucose(g) 100 150 hypophosphatemia ] Na+(mEq) 154 154 K+(mEq) 40 40 Prophylaxis treatment of Zinc deficiency Cl-(mEq) 194 154 Mg2+(mEq) - 10 P(mmol) - 20 Total adult dosage ........ 500 - 2,000 mL/day SO42-(mEq) - 10 Rate of administration .. 12 hours/L Acetate(mEq) - 20 Zinc(mg) - 5.2
  • 8. 57 58 Otsuka Multivitamin Injejtion Formulation 1 [Lyophilized powder] Formulation 2 [Aqueous solution] THAI OTSUKA PHARMACEUTICAL CO., LTD. @ Convenient and complete vitamins 59 60 Man 60 kg. H 160 cm. A 30 yr. Trauma 1.35 ,no movement 1 TEE = BEE x AF x SF Vitamin ( mg ) OMVI AMA Recommendation ( For Adult ) * BEE =(66.5x60kg)+(5x160cm)-(6.8 x30yr)=1,500 kcal =25 kcal/kg x 60kg =1,500 kcal Formulation 1 Thiamine ( B1 ) 3 3 Riboflavin ( B2 ) 3.6 3.6 * TEE = 1,500 kcal x 1 x 1.35 = 2,025 kcal/d Pyridoxine ( B6 ) 4 4 Nicotinic acid amide 40 40 Pantothenic acid 15 15 •Protein 1-2 g/kg/d = 2 x 60kg = 120 g Folic acid 0.4 0.4 Biotin 0.06 0.06 * Glucose5mg/kg/min=5mgx60kgx60minx24hr=432g Cyanocobalamin ( B12 ) 0.005 0.005 Ascorbic acid 100 100 Formulation 2 •NPC: N stress 80-150 : 1 Vitamin A 3300 IU 3300 IU Cholecalciferol 200 IU 200 IU Tocopheral acetate 10 10 * Electrolyte Phytonadione 2 - OMVI 1 set= 4 ml. mix in all bacic solution * Water 40 ml/kg = 40 x60kg = 2,400 ml 61 Chula Amiparen10 +GE-2 -900 62 Man 60 kg. H 160 cm. A 30 yr. Trauma 1.35 ,no movement 1 TEE = BEE x AF x SF TPN-900 1 2 3 2set 1 set 2 set fat20%250cc * BEE =(66.5x60kg)+(5x160cm)-(6.8 x30yr)=1,500 kcal Calories 1,200 1,000 800 900 1,800 2,300 =25 kcal/kg x 60kg =1,500 kcal Dextrose(g) 250 200 150 175 350 350 * TEE = 1,500 kcal x 1 x 1.35 = 2,025 kcal/d Protein(g) 50 50 50 50 100 100 •Protein 1-2 g/kg/d = 2 x 60kg = 120 g Lipid(g) - - - - - 50(22%) *Amiparen-10,500ml x 2bott = 100 g = 400 kcal NPC:N 125:1 100:1 75:1 88:1 88:1 119:1 Na(mEq) 35 35 35 36 72 72 * Glucose5mg/kg/min=5mgx60kgx60minx24hr=432g K(mEq) 40 40 40 25 50 50 *GE-2,600ml x 2 bag =350 g = 1,400 kcal Ca(mEq) 5 5 5 6 12 12 D50W 50ML x 2 amp = 50 g = 200 kcal Mg(mEq) 5 5 5 6 12 12 * NPC: N stress 80-150 : 1 P(Mm) 15 15 15 9 18 18 *NPC : N = 1,400 : ( 100 g/6.25 =16) = 87.5 : 1 Cl(mEq) 45 45 45 35 70 70 * Electrolyte Acetate(mEq) 67 134 134 Zn(mg) 2.5 2.5 2.5 1.3 2.6 2.6 * Water 40 ml/kg = 40 x60kg = 2,400 ml Osmolarity 1,425 1,425 <1,424 •(Amiparen-10 +GE-2) 2 set = 2,200 ml Volume(ml)/set 1,000 1,000 1,000 1,100 2,200 2,450 Chula Aminosol-10 +GE-2 -1,100 63 Amiparen10 +GE-2 -900 Oli- Kabiven 64 Clinomel TPN-1100 1 2 3 1 set 2 set 2set fat20%250cc TPN 1 set 2 set 2set fat20%250cc 1 2 N7 Calories 1,200 1,000 800 1,100 2,200 2,700 Calories 900 1,800 2,300 2,400 1,900 2,300 Dextrose(g) 250 200 150 225 450 450 Dextrose(g) 175 350 350 320 200 250 Protein(g) 50 50 50 50 100 100 Protein(g) 50 100 100 80 68 85 Lipid(g) - - - - - 50(19%) Lipid(g) - - 50(22%) 80(33%) 80(43%) 100(43%) NPC:N 125:1 100:1 75:1 113:1 113:1 144:1 NPC:N 88:1 88:1 119:1 158:1 147:1 147:1 Na(mEq) 35 35 35 59 118 118 Na(mEq) 36 72 72 64 64 80 K(mEq) 40 40 40 37.5 75 75 K(mEq) 25 50 50 48 48 60 Ca(mEq) 5 5 5 6 12 12 Ca(mEq) 6 12 12 4 4 5 Mg(mEq) 5 5 5 8.5 17 17 Mg(mEq) 6 12 12 4.4 8 10 P(Mm) 15 15 15 13.5 27 27 P(Mm) 9 18 18 20 20 25 Cl(mEq) 45 45 45 66 132 132 Cl(mEq) 35 70 70 96 93 116 Acetate(mEq) 37.5 73 73 Acetate(mEq) 67 134 134 114 Zn(mg) 2.5 2.5 2.5 1.3 2.6 2.6 Zn(mg) 1.3 2.6 2.6 - Osmolarity 1,480 1,480 <1,480 Osmolarity 1,425 1,425 <1,424 1,450 1,060 1,060 Volume(ml)/set 1,000 1,000 1,000 1,100 2,200 2,450 Volume(ml)/set 1,100 2,200 2,450 2,000 2,053 2,566
  • 9. Chula Amiparen 10 +Glucolyte2 -500 65 AP-5+GE-1 66 PPN-500 AP10+G2 AP10+G2+G2 AP10+G2 fat20%250cc PPN AP-5+GE-1 AP-5+GE-1 AP-5+GE-1 fat20%250cc Vitrimix Calories 500 500 800 1,000 Calories 1,000 1,500 1,000 Dextrose(g) 100 75 150 75 Dextrose(g) 200 200 75 Protein(g) 25 50 50 50 Protein(g) 50 50 53 Lipid(g) - - - 50(50%) Lipid(g) - 50(30%) 50(50%) NPC:N 100:1 38 :1 75 :1 100:1 NPC:N 100:1 113 :1 94 :1 Na(mEq) 35 78 155 78 Na(mEq) 71 71 50 K(mEq) 30 20 40 20 K(mEq) 40 40 20 Ca(mEq) 5 Ca(mEq) 10 10 2.5 Mg(mEq) 5 5 10 5 Mg(mEq) 10 10 1.5 P(Mm) 15 10 20 10 P(Mm) 12 12 - Cl(mEq) 35 70 154 70 Cl(mEq) 70 70 55 Acetate(mEq) 70 80 70 Acetate(mEq) 76 76 Zn(mg) 2.5 2.6 5.2 2.6 Zn(mg) 2.6 2.6 - Osmolarity 768 768 768 Osmolarity 853 750 1,130 Volume(ml)/set 1,000 1,500 2,500 1,750 Volume(ml)/set 2,200 2,450 1,000 Clinomel Kabiven 67 Amiparen10 +GE-2 -900 Clinomel Kabiven 68 PPN AP-5+GE-1 AP-10 AP-5+GE-1 +G2+G2 AP-10+GE-1 fat20%250cc N4 TPN 1 set 2 set fat20%250cc 2set N7 1 2 Calories 1,000 800 1,500 1,255 1,400 Calories 900 1,800 2,300 2,400 1,900 2,300 Dextrose(g) 200 150 200 160 130 Dextrose(g) 175 350 350 320 200 250 Protein(g) 50 50 50 44 45 Protein(g) 50 100 100 80 68 85 Lipid(g) - - 50(33%) 40(35%) 68(49%) Lipid(g) - - 50(22%) 80(33%) 80(43%) 100(43%) NPC:N 100:1 75 :1 163:1 153:1 167:1 NPC:N 88:1 88:1 119:1 163:1 147:1 147:1 Na(mEq) 71 155 71 56 43 Na(mEq) 36 72 72 56 64 80 K(mEq) 40 40 40 48 32 K(mEq) 25 50 50 48 48 60 Ca(mEq) 10 - 10 8 2.7 Ca(mEq) 6 12 12 8 4 5 Mg(mEq) 10 10 10 7.2 5.3 Mg(mEq) 6 12 12 7.2 8 10 P(Mm) 12 20 12 24 14 P(Mm) 9 18 18 24 20 25 Cl(mEq) 70 154 70 64 62 Cl(mEq) 35 70 70 64 93 116 Acetate(mEq) 76 80 76 80 Acetate(mEq) 67 134 134 Zn(mg) 2.6 5.2 2.6 - - Zn(mg) 1.3 2.6 2.6 Osmolarity 853 768 <1,000 840 750 Osmolarity 1,425 1,425 <1,424 1,470 1,060 1,060 Volume(ml)/set 2,200 2,500 1,950 2,000 1,920 Volume(ml)/set 1,100 2,200 2,450 2,000 2,053 2,566 69 70 Comparison of infusion contents among the three groups. ----------------------------------------------------------------------------------------- Nutrients Group A Group B Group C 50 (mL) (mL) (mL) Body weight (kg) ----------------------------------------------------------------------------------------- 40 no: 16 14 12 ----------------------------------------------------------------------------------------- 30 5% G/W or G/S 3000 2000 2000 Start 20 Finish 5% AA - 1000 50 g 500 25 g 10 10% FAT - - 500 ---------------------------------------------------------------------------------------- kcal/day 510 540 990 0 ---------------------------------------------------------------------------------------- A B C G/W glucose in water; G/S glucose in saline Hwang et al. JPEN 1993;17:254-6. Hwang et al. JPEN 1993;17:254-6. 71 72 186 * * p <0 .05 184 0 182 Transferrin [mg/dl] 180 -1 178 -2 * p <0 .05 nitrgen balance [g/d] 176 -3 174 -4 172 1600 * * p < 0.05 170 -5 Gr. A Gr. B Gr. C 1400 -6 * 1200 TLC [cells/mm 3] -7 * 1000 800 -8 600 -9 400 -10 200 A B C 0 Gr. A Gr. B Gr. C Hwang et al. JPEN 1993;17:254-6. Hwang et al. JPEN 1993;17:254-6.
  • 10. 73 74 Amiparen-10 + Glucolyte-2 Amiparen-10 & Glucolyte-2 Nitrogen(gm) 8 Amino acids ~ 1 g/kg/day Amino acid(gm) 50 Glucose(gm) 75 Dextrose solution Glucose calories(kcal) 300 With or without fat emulsion Total calories(kcal) 500 Sodium(mEq) 78 Potassium(mEq) 20 Chloride(mEq) 77 Regimen of partial parenteral nutrition support Magnesium(mEq) 5 is better in achieving less negative nitrogen Phosphorus(mmol) 10 Sulfate(mEq) 5 balance, improved visceral protein levels, and Acetate(mEq) 70 Zinc(mg) 2.6 greater TLC. Osmolarity(mOsm/L) 768 75 76 Glucolyte-2 1 bott. Glucolyte-2 2 botts. Glucolyte-2 1 bott. Glucolyte-2 2 botts. Information Amiparen-10 1 bott. Amiparen-10 1 bott. Electrolytes Amiparen-10 1 bott. Amiparen-10 1 bott. Amino acids (gm) 50 50 Na+ (mEq) 77 155 CHO (gm) 75 150 K+ (mEq) 20 40 Fat (gm) - - Ca 2+ (mEq) - - Nitrogen (gm) 8 8 Mg 2+ (mEq) 5 10 Total Calories (kcal) 500 800 Cl- (mEq) 77 154 SO4 2- (mEq) 5 10 Volume (ml) 1,500 ml 2,500 ml P (mmole) 10 20 Acetate (mEq) 70 80 Osmolarity 768 768 Zn (mg) 2.6 5.2 77 Glucolyte-2 1 bott. Glucolyte-2 2 botts. Amiparen 10 1 bott. Amiparen 10 1 bott. Information 20% LCT/MCT 250 cc. 20% LCT/MCT 250 cc. Amino acids (gm) 50 50 CHO (gm) 75 150 Fat (gm) 50 50 Nitrogen (gm) 8 8 Total Calories (kcal) 1,000 1,300 Volume (ml) 1,500 ml 2,500 ml Osmolarity <768 <768