1. Complications are 2-20 times greater in malnourished patients compared to well-nourished patients. Nutritional status can range from normal to borderline to malnourished. 2. Guidelines for initiating specialized nutrition support involve assessing nutritional status and determining if the gastrointestinal tract is functional. Enteral nutrition is preferred if the GI tract is intact. Parenteral nutrition is used if the GI tract is compromised. 3. Total parenteral nutrition involves supplying glucose, lipids, electrolytes, vitamins, minerals, and amino acids intravenously. The amounts supplied depend on factors like a patient's weight, medical condition, and nutritional requirements. Maintaining appropriate fluid and nutrient levels is important for recovery.

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