Total Parenteral Nutrition

1. Total Parenteral Nutrition
1
Raksha Laxman Mhetre
Modern College of Pharmacy (for
Ladies), Pune-412105

2. Synonyms:
IVH: Intravenous Hyperalimentation
TNA: Total Nutrient Admixture
TPN: Total Parenteral Nutrition
3-In-1 Admixture
All-In-One Admixture
PPN: Peripheral Parenteral Admixture
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3. Components of TPN
 TPN may include a combination of sugar and
carbohydrates (for energy), proteins (for muscle
strength), lipids (fat), electrolytes, and trace elements.
 A TPN solution may contain all or some of these
substances, depending on patient condition.
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4.  Nutritional content: TPN requires water (30 to 40
mL/kg/day), energy (30 to 60 kcal/kg/day, depending
on energy expenditure), amino acids (1 to 2.0
g/kg/day, depending on the degree of catabolism),
essential fatty acids, vitamins, and minerals.
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5. Fluid. Fluid is an essential component of parenteral
nutrition.
Calories requirements fulfill by carbohydrates.
Carbohydrate:
Glucose is the main source.
Mostly Dextrose is used as source of carbohydrate.
Dextrose (5%) is isotonic with body fluid. But in
such case we need 10-12 liters TPN per day to fullfill
daily calories requirment. 5

6. We can improve dextrose concentration up to
25%w/V to fullfill our body requirement as well
volume of administration is reduced to 3 liters per
day.
In market Dextrose 50% w/V is available. So
reduced its concentration by diluting with amino acid
solution.
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7.  Dextrose 25%w/V solution is hypertonic with
body fluid. It need to administered through
subclavian vein, where hypertonic solution rapidly
diluted by maximum blood supply of vein.
Protein.
This is delivered as a synthetic crystalline amino
acid solution. Adverse effects of excess protein
include a rise in urea and ammonia.
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8. Intralipid. An oil-in-water emulsion derived from
egg phospholipid, soyabean and glycerol.
Minerals. Sodium, potassium, chloride, calcium,
magnesium and phosphorus levels need to be
closely monitored
Trace Elements. Zinc, copper, manganese,
selenium, fluorine and iodine are provided in a
number of commercial TPN preparations.
Vitamins. The daily requirements for both water
and fat soluble vitamins can be provided in TPN. 8

9. GENERAL INDICATIONS
1. Patient who can’t eat,
2. Patient who won’t eat,
3. Patient who shouldn’t eat,
4. Patient who can’t eat enough.
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10. Applications of TPN:
• Patients who have impair food intake, nutrient
digestion or absorption.
• Patient who have short bowl syndrome, GI fistulas
and bowl obstructions.
• Hospitalized patients
• During surgery
• In case of severe burns
• Patient who is unconscious.
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Thank you