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Total Parenteral NutritionAka: TPN

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  1. Parenteral Indications
    1. Bowel Obstruction
    2. Enteral feeding not possible or failed trial
    3. Short bowel syndrome
    4. Mesenteric Ischemia
    5. High output gastrointestinal fistula
    6. Gut failure or Malabsorption
    7. Transitional-Supplemental
    8. Perioperatively
      1. Start TPN 7-10 days before surgery to make difference
  2. Adult Energy Requirements
    1. Lean body wt (LBW)
      1. Male: 110 + 5 x(number of inches> 60) lbs
      2. Female: 100 + 5 x(number of inches> 60) lbs
    2. IF Obese (>130% LBW) then use adjusted weight
      1. (Actual-LBW) x 0.25 + LBW
    3. Basal Energy Expenditure (BEE) per 24 hours
      1. M: BEE=66 + (13.7xWt) + (5xHt) - (6.8xAge) = KCal
      2. F: BEE=655 + (9.6xWt) + (1.7xHt) - (4.7xAge) = KCal
      3. Adjust for depletion or disease
        1. 120-130% BEE is Maintenance
        2. 150% for stress and depletion
    4. Calorie requirement (per kg/day)
      1. Usually 30-35 KCal/kg/day
      2. Range = 20-40 Kcal/kg/day
    5. Adult Protein
      1. RDA = 0.8 g/kg/day
      2. Stress Adjustment
        1. 0.7-0.8 g/kg/d Maintenance, healthy, no stress
        2. 1.0-1.2 g/kg/d Mild stress
        3. 1.3-1.5 g/kg/d Moderate stress, repletion
        4. 1.5-2.0 g/kg/d Severe stress, burns
    6. Essential Fatty Acid Requirement
      1. Estimate 4-10% (2-4% linoleic) of daily calorie need
    7. Intravenous Electrolyte Requirements
      1. Electrolytes
        1. Sodium: 60-100 meq per 24 hours
        2. Potassium: 60-100 meq per 24 hours
        3. Calcium 10-15 meq per 24 hours
        4. Phosphorus 20-45 mMol per 24 hours
        5. Magnesium 10-20 mEq per 24 hours
  3. Labs: Liver Function Tests
    1. Expect 2-3 fold over baseline with 10-14 days TPN
    2. Tests
      1. Alkaline Phosphatase
      2. AST
      3. Bilirubin

Parenteral Nutrition, Total (C0030548)

Definition (MSH)The delivery of nutrients for assimilation and utilization by a patient whose sole source of nutrients is via solutions administered intravenously, subcutaneously, or by some other non-alimentary route. The basic components of TPN solutions are protein hydrolysates or free amino acid mixtures, monosaccharides, and electrolytes. Components are selected for their ability to reverse catabolism, promote anabolism, and build structural proteins.
Definition (NCI)Total parenteral nutrition formulated for intravenous administration in patients who cannot eat or cannot get enough nutrients from the foods they eat. It is a liquid mixture of proteins, carbohydrates, fats, vitamins, minerals and other nutrients.
ConceptsTherapeutic or Preventive Procedure (T061)
ICD999.15, 99.15
MSHD010289
EnglishCentral hyperalimentation, Hyperalimentation, Hyperalimentation procedure, Hyperalimentation procedure -RETIRED-, hyperalimentation therapy, PARENT INFUS NUTRIT SUB, Parenteral Hyperalimentation, Parenteral infusion of concentrated nutritional substances, Superalimentation, Suralimentation, Total parenteral nutrition, Total parenteral nutrition administration, TPN, TPN - Total parenteral nutrition, TPN procedure
Spanishalimentacion parental total, alimentacion parenteral total, nutricion parenteral total, procedimiento de hiperalimentacion - RETIRADO -, procedimiento de hiperalimentacion a cargo del personal de enfermeria, procedimiento de NPT
Parent ConceptsInjection or infusion of therapeutic or prophylactic substance (C0178194), Parenteral Nutrition (C0030547), Nutritional Intervention (C1882127), Intravenous Feeding (C0021910), Duplicate concept (C1274013), Ambiguous concept (C1274012)
SourcesCSP, DXP, ICD9CM, LNC, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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