Medical Malpractice Offer
Home » Orthopaedics » Discussion of TPN

Discussion of TPN



- 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