Total parenteral nutrition (TPN) is intravenous feeding that provides all necessary fluids and nutrients to patients unable to eat. It is indicated for conditions preventing oral intake like short bowel syndrome, burns, or chemotherapy toxicity. Patients are assessed for nutritional status including weight, BMI, labs, and sources of nutrient loss. TPN comes with risks of side effects like infections, electrolyte imbalances, and liver failure which require close monitoring during administration.

2. TOTAL PARENTRAL
NUTRITION
By :-
MISS NOOR AISHA KHAN

3. DEFINITION:-
Intravenous feeding that provides patients
with all the fluid and the essential
nutrients they need when they are unable
to feed themselves by mouth. Abbreviated
TPN.
BY- MedicineNET

4. COMPONENTS:-

6. Indications:-
• Gastrointestinal cutaneous fistula
• Renal failure
• Short bowel syndrome
• Ulcerative colitis
• Severe burns
• Severe pancreatitis
• Hepatic failure
• Crohn’s disease
• Anorexia nervosa

7. • Acute radiation enteritis
• Acute chemotherapy toxicity
• Prolonged ileus
• Weight loss preliminary to major surjery
• Congenital anomalies
• Prolonged diarrhoea
• Chronic ill patient
• BMI< 14 kg/m2

8. CONTRAINDICATIONS:-
Where gastrointestinal feeding is possible
Patient with good nutritional status
Irreversible decerebrate patients
Lack of specific therapeutic goal
Severe cardiovascular instability or metabolic
derangements
Infants with less than 8cm of small bowel

9. ASSESSMENT OF NUTRITIONAL
STATUS
• Patient should assessed for PEM as well as
specific nutrient defeciencies.
• HISTORY:
Assess for change in diet pattern(size,number &
content of meals)
Unintensional weight loss.
Evidence of malabsortion.
Symptoms of specific nutrient deficiencies.
Look for factor which may increases metabolic
stress(infection/inflammation/malignancy)

10. • FUNCTIONAL:
 Bed ridden.
 Suboptimal active / fully active
By WHO criteria patients can be classified by BMI as
 under weight (<18.5)
 normal (18.5-24.5)
 Over weight (25-29.5)
 Class 1 obesity(30-30.5)

11. CONT:
Class 2 obesity (35-39.5)
Class 3 obesity (>40)
Patient who are extremely underweight (BMI
<14kg/m) those with rapid severe weight loss
have high risk of death & should be consider for
parentral support.

12. CONT:
• Look for tissue depletion (loss of body fat &
skeletal muscle wasting)
• Assess muscle function (strength testing of
individual muscle groups)
• Fluid status –overload /dehydration.
• Lab parameters-plasma albumin/electrolytes
/vitamins & minerals

13. Look for sources of protein or nutrient losses
Large wounds
Burns
nephrotic syndrome
Chronic disease
GI losses of nutrients
Surgical drains
• Anthropometric measurements.

17. SIDE EFFECTS:-
• Poor night vision
• Skin changes
• Mouth sores
• Changes in heartbeat
• Confusion
• Convulsions or seizures
• Difficulty in breathing
• Fast weight gain or weight loss
• Fatigue

18. • Fever or chills
• Increased urination
• Jumpy reflexes
• Memory loss
• Muscle twitching, weakness of cramps
• Stomach pain
• Swelling over hands or feets
• Thirst
• Vomiting
• Tingling in hands or feets

19. COMPLICATIONS:-
• Electrolyte imbalance
• Dehydration
• Thrombosis
• Hyperglycemia
• HypoglycemiaInfection
• Liver failure
• Micronutrient deficiency