Parenteral Nutrition

Question 1

When to use parenteral nutrition

Answer 1

When enteral is not feasible
Nausea, vomiting
Cannot protect the airway

Question 2

Cases where parenteral feeding is most commonly used

Answer 2

Horses more than smalls
Equine neonates- enteral feeding can lead to fatal c.difficile enterocolitis
Post-operative colics- where there is ileus and nasogastric reflux

Question 3

Technical requirements for parenteral nutrition (6)

Answer 3

Aseptic vascular access
24hr nursing
point-of-care glucose monitoring
Formulation of PPN or TTN
Dedicated venous catheter or port through multi-lumen catheter
Hyper-osmolar solutions

Question 4

Why do parenteral solutions need to be hyper-osmolar

Answer 4

Reduces risk of thrombophlebitis
Reduced volume needed to administer

Question 5

Best way to deliver parenteral nutrition

Answer 5

By CRI

Question 6

How to regulate blood glucose with parenteral feeding

Answer 6

Measure blood glucose and regulate as required with insulin infusions
Not by turning down the amount

Question 7

Maximum time to use parenteral nutrition for

Answer 7

1-2 weeks
Doesn’t provide complete nutrition

Question 8

what is provided by parenteral nutrition (3)

Answer 8

Energy
Protein
Water soluble vitamins
Sometimes lipids

Question 9

Most common metabolic complication with parenteral feeding

Answer 9

Hyperglycaemia
Predisposed by DM and HAC

Question 10

Energy aim for parenteral feeding (1) and why (3)

Answer 10

Aim for RER or less
Excessive calories can lead to complications
Fatty infiltration of the liver
Hypercapnia

Question 11

Protein requirements for cat and dog with parenteral nutrition

Answer 11

Dog
4-6g/100Kcal (15-25% calories)
cats
6g/100Kcal (25-35% calories)

Question 12

Amino acid solutions used for parenteral feeding

Answer 12

3-15% - hyper-osmolar
6-8.5% often used
Less concentrated already supplemented with electrolytes
4KCal/g protein

Question 13

Carbohydrate requirements for parenteral feeding

Answer 13

Can add to protein
V. concentrated dextrose solutions used

Question 14

Adding lipids to parenteral feeding

Answer 14

10% to 30% solutions (1.1-3.0 KCal/ml)
20% solution most frequently used
Soybean/ safflower oils
Advantage of being iso-osmolar
More concentrated form of calories

Question 15

Regime for starting parenteral nutrition

Answer 15

Start with 25-50% RER over first 12-24 hours and then increase by 25% every 8 hours up to 100% maximum

Question 16

What to do if giving parenteral nutrition outside

Answer 16

Protect the bag from sunlight- can break down
Black tape/ Dark bag

Question 17

How to stop parenteral nutrition

Answer 17

Gradually
Pre-treat with glutamine (1-2g/kg)- helps enterocytes
Start enteral food gradually and build-up
Gradually decrease PN by 25% every 6 to 8hrs

Question 18

GI effects of parenteral feeding

Answer 18

Villi stunning
Decreased absorptive capacity
predisposes to gastric ulcers
There is controversy if you should prophylactically treat gastric ulcers as gastric acid has purpose

Question 19

3 approaches to managing changes in GI flora after parenteral nutrition

Answer 19

1. Do nothing
2. Use of pre and pro biotics
3. transfaunation- poo soup

Question 20

3 possible complications of parenteral feeding

Answer 20

1. catheter issues
2. Issues with mixture/ administration
3. Metabolic- most commonly glucose issues