Pediatrics II: Parental Nutrition Flashcards

1
Q

Indications for use of TPN

A
  • Significant Bowel dysfunction resulting in inability to achieve adequate enteral nutrition for >4-5 days (children & adolescents) or 2-3 days (infants)
  • Hypermetabolism( eg. trauma, burns)
  • Moderate-to-severe pancreatitis requireing bowel rest > 7 days
  • Boweldys function
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1
Q

Reasons for bowel dysfunction

A
  • Paralytic ileus
  • Major gut resection leading to diarrhea, malabsorption (>70%)
  • Small bowel obstruction
  • Radiation enteritis
  • GI fistula; except when enteral access can be placed distal to the fistula
  • Hemodynamic instability where high risk for mesenteric ischemia (eg Necrotizing enterocolitis in premature infants)
  • Severe dysmotility leading to non-functioning GI tract
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2
Q

Contraindications for PN

A
  • When the gut works: PN is contraindicated!!
  • Prognosis does not warrant aggressive nutrition support (eg palliation; note TPN can be part of palliation in children; not typically in adults)
  • Vascular access is severely compromised
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3
Q

Energy requirements for PN

A

Energy Requirements in PN to meet growth requirements (may be higher with hypermetabolism)
* 80-100 kcal/kg; infants < 1 year
* 60-90 kcal/kg for 1-12 years
* 30-60 kcal/kg (adolescents > 12 years)

Influenced by age, disease type & severity, gender, body composition

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4
Q

Guidelines for Administration of Parenteral Dextrose

A

Ignore preterm

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5
Q

Guidelines for Administration of Parenteral Amino Acids

A
  • may need more than maximum for LBM accumulation
  • 1-2 years post puberty needs are similar to adults
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6
Q

Guidelines for administration of Parenteral Lipids

A

volumes administered are lower than adults since weight is lower

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7
Q

What is chylothorax?

A

Leakage of chyle (lymphatic fluid) into the pleural space through thoracic duct

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8
Q

How is chylothorax managed?

A

Managed using Portagen
* chyle production, chyle flowing through lymphatic system
* MCT formula-absorbed directly into portal system, do not enter lymphatic system
* Require supplemental folic acid, vitamins A,D,C (Trivisol)

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9
Q

Infant PN case

A

Peds nutrition II

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10
Q

Child PN case

A

Peds nutrition II

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11
Q

Steps for PN

A
  1. in Pediatric Nutrition Assessment: Evaluate weight and height in terms of actual vs ideal body weight
  2. Determine IBW and %IBW
  3. evaluate which weight to use
  4. follow other PN instructions…
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