2. NUTRITIONAL SUPPORT
Fundamental Goals Of Nutritional Support
To meet the energy requirement for metabolic
processes
To maintain the normal core body temperature
For Tissue repair
3. MAJORITY OF SURGICAL PATIENTS
Well Nourished / Healthy
Uncomplicated Major Surgical Procedure
Has Sufficient Fuel Reserve
Can Withstand Brief Period Of Catabolic Insult
And Starvation Of 7 Days
Postoperatively
Can Resume Normal Oral Intake
Supplemental Diet Is Not Needed
4. SURGICAL PATIENT POPULATIONS AT RISK
• Neonates (especially those born prematurely)
• Patients with cancer receiving chemotherapy
• Patients with major trauma, burn injuries, or both
• Patients with inflammatory bowel disease
• Patients with chronic renal failure
• Patients with chronic neurologic disorders
• Patients with fever, sepsis, or both
5. SURGICAL PATIENT POPULATIONS AT
RISK
Surgical diagnoses and procedures associated with an
increased need for nutritional support include the following:
Necrotizing enterocolitis
Bowel resection
Gastroschisis
6. DAILY NUTRITIONAL REQUIREMENTS
Nutrient Neonates/Infant Children (2-12Y) Adolescents
Energy
(cal/kg/day)
80-100 60-80 30-40
Protein
(g/kg/day)
1.2-1.8 1 0.8
• Children also need daily vitamins (A, B6, B12, C, D, E, K, thiamin,
niacin, riboflavin, folate, pantothenic acid, biotin, choline)
• Essential fatty acids, minerals (calcium, fluoride, iron, magnesium,
phosphorus, zinc)
• Trace elements (chromium, copper, iodine, molybdenum,
manganese, selenium).
7. DAILY FLUID REQUIREMENT
Body Weight Amount
< 1500 g 130-150ml/kg
1500-2000 g 110-130ml/kg
2-10 kg 1000ml/kg
> 10-20 kg 1000ml (10kg) + 50ml/kg for
each kg>10
>20 kg 1500ml (20Kg) + 20ml/kg for >
20
9. NUTRITIONAL ASSESSMENT
The nutritional status of surgical patients can be assessed in
several ways, as follows:
Clinical evaluation (history and physical examination)
Anthropometry
Biochemical tests
Body composition
11. ENTERAL NUTRITIONAL SUPPORT
Indications
The enteral route is safer and cheaper and is therefore
preferred whenever nutritional support is required, provided
that the GI tract is functional.
This does not mean that the gut has to be completely healthy.
For example, elemental formulas may work well in cases with
distal enterocutaneous or colocutaneous fistulas.
15. PARENTERAL NUTRITION
Indications
Total parenteral nutrition (TPN) is indicated in the following
circumstances:
When the GI tract is not accessible or not functioning (eg, with
mechanical obstruction, paralytic ileus, or malabsorption)
When gut rest is needed (eg, with proximal enterocutaneous
fistula)
When oral or enteral feeding does not meet the patient’s
nutritional needs
Very low birth weight infants
17. FORMULA COMPOSITION
Assess Fluid And
Caloric Need
100ml/kg/day
Carbohydrates
Start: 4-6mg/kg/min
Advance:
1.2mg/kg/min
Goal: 12mg/kg/min
45% of calories
Protein
Start: 0.5- 1 g/kg/day
Advance: .5g/kg/day
Goal: 2.5-3g/kg/day
15%of calories
18. FORMULA COMPOSITION
Lipids
Start: .5-1g/kg/day
Advance: 5.g/kg/day
Goal: 3g/kg/day
40% of calories
Additives
Vitamins, Trace
Elements, Minerals,
Electrolytes, Evaluate
Lab value, Adjust
additives add extra
Sodium acetate and
zinc with increase stool
output, Adjust Chloride
acetate based on acid-
base status , Adjust
Calcium Phosphate
ratio on PPT factor.
Nutritional Goal
100
calories/kg/day
19. MONITORING OF PARENTAL NUTRITION
Daily
• Weight
• Glucose
• BUN creatinine
• Sodium,
Potassium,
Chloride
• Carbon
Dioxide
• Temperature
• Input/ Output
Record
Weekly
• LFTS
• Serum
Albumin
• Magnesium,
Calcium,
Phosphorous
As Indicated
• Copper, Zinc,
Selenium,
Chromium,
Manganese,
Iron
• TIBC
• Ferritin
