-
References
-
Lab studies
-
TPN formula compositions;
- will vary w/ Renal, Hepatic, or Cardiac failure;
-
Lipids in the TPN patient
-
TPN Complications
- Discussion:
- ensure that catheter is in the SVC and NOT in Rt Atrium or Subclavian;
- begin infusion at 30-50 ml/hr for 24 hr;
- TPN must be started gradually inorder to allow
insulin output
to adjust to the large load of glucose;
- increase by 25 ml/hr/day untilhr for 24 hr;
- TPN must be started gradually inorder to allow insulin output
to adjust to the large load of glucose;
- increase by 25 ml/hr/day until caloric goals are met; (2-3 L/day);
- w/ exception of
Lipid emulsions the catheter cannot be used for
infusions of maintenence fluid, medications, blood products
or CVP readings;
- initially: serum potassium, PO4, & Mg, may decrease due to
increased insulin;
- Initially may need up to:
200 meq/day of K, 60 mmol/day of PO4, 40 meq/day of Mg -
- in order to normalize serum levels, especially when exogenous
insulin is needed to control hyperglycemia;
- if hyperglycemia (200-300) is encountered then decrease the rate
of infusion for 1-2 days; if urine glucose > 3+ get stat glucose;
- diabetes: consider adding up to 25 units Reg Insulin per bottle of TPN;
- patients with severe wt loss (15%) or trauma need additional water
soluble vitamins and zinc during the first week;
- weaning from TPN: wean over several hours; Note that reactive
hypoglycemia may occur; consider D5W during weaning;
- w/ severe malnutrition consider addition
thiamine: 100 mg/d
