Parenteral Nutrition

Question 1

Where is the access point in TPN?

Answer 1

Central vein

Question 2

What type osmolarity solutions can be used with TPN?

Answer 2

High osmolarity

Question 3

Where is the access point in PPN?

Answer 3

Peripheral vein

Question 4

What is the osmolarity limit for PPN?

Answer 4

900 mOsm/L

Question 5

In PPN you want to limit what 2 things?

Answer 5

Dextrose and amino acids

Question 6

What causes refeeding syndrome?

Answer 6

Too rapid infusion of substrates (particularly glucose) into plasma which causes electrolytes to shift into intracellular spaces as glucose moves into cells

Question 7

What lab values will be low with refeeding syndrome?

Answer 7

K, Mg, Phosphorus

Question 8

To avoid refeeding syndrome, what should be administered before feeding?

Answer 8

Thiamine 100mg/day and/or multvitamin and trace elements

Question 9

To avoid refeeding syndrome, you should start feeds at ____ % of estimate goal (100-150 grams dextrose)

Answer 9

25

Question 10

IVFE should be held in PN if triglycerides are greater than what?

Answer 10

400 mg/dL

Question 11

PN shouldn’t be given IVFE if a patient is allergic to what?

Answer 11

Eggs

Question 12

If blood sugars are >______ PN shouldn’t be started.

Answer 12

300

Question 13

When transitioning from PN to EN, what should be occuring at 15-20 mL/hour before PN is reduced?

Answer 13

Tube feedings

Question 14

You can discontinue PN if tube feeding is providing at least ______ % support.

Answer 14

75%

Question 15

When considering a transition to PO, an individual can stop PN when they have reached a ____% goal.

Answer 15

60%

Question 16

What may happen if PN is completely stopped?

Answer 16

Rebound hypoglycemia

Question 17

If TPN needs to be reduced, it should be tapered off at 50% rate for how long?

Answer 17

1-2 hours

Question 18

For adults with good glucose control you want < ___ mg/kg/min for glucose infusion rate

Answer 18

<5 mg/kg/min

Question 19

For critically ill adults with glucose intolerance you want <____ mg/kg/min glucose for glucose infusion rate

Answer 19

<3.5 mg/kg/min glucose

Question 20

Do lipids (IVFE- intravenous fat emulsions) contribute to the osmolarity of a feeding?

Answer 20

No- lipids are isotonic

Question 21

A patient in moderate stress on PN needs how much protein?

Answer 21

1.5 gm/kg/day

Question 22

A patient in severe stress on PN needs how much protein per day?

Answer 22

2 gm/kg/day

Question 23

Why do patients on PN need lower amounts of vitamins, minerals, trace elements.

Answer 23

They bypass the GI

Question 24

What should be done if abrupt discontinuation is required?

Answer 24

start D10W at rate of TPN for 1-2 hours

Question 25

What ml/hr should TF be for PN to be reduced?

Answer 25

15-20mL

Question 26

What level should serum glucose be at for PN?

Answer 26

<150mg/dl

Question 27

What should oral intake be for transitioning from PN to PO?

Answer 27

500kcal/day

Question 28

When can you completely stop PN and start PO?

Answer 28

When oral intake is at 60-80% energy goal

Question 29

What are the medical indications for PN?

Answer 29

paralytic ileus MEsenteric ischemia Small bowel obstruction High output GI fistula

Question 30

What form of PN should you use if you anticipate PN being longer than 7 days?

Answer 30

TPN

Question 31

What percentage should CHO make of PN solution and what does that yield in kcal/gram?

Answer 31

5-70%; yields 3.4kcal/gram

Question 32

What should dextrose infusion be limited to in stabilized hospitalized pts?

Answer 32

<5mg/kg/min Book states: 7 mg/kg/min

Question 33

What should dextrose infusion be limited to in critically ill hospitalized pts?

Answer 33

<3.5 mg/kg/min

Question 34

How many times a week should IVFE be given?

Answer 34

2 times a week

Question 35

What percentage should amino acids make of PN solution and what does that yield in kcal/gram?

Answer 35

3-20%; yields 4 kcals/gram

Question 36

What are protein needs for mild stress?

Answer 36

0.8-1 gm/kg/day

Question 37

To prevent refeeding syndrome, at what goal should you begin to start feeds and what is the time frame for increasing the amount?

Answer 37

25% of estimated goal (100-150 gms/day dextrose) slowly increase over 3-5 days