nutritional disorders
Total Parenteral Nutrition (TPN)
Key Points
Consider parenteral nutrition for patients who do not have a functioning gastrointestinal tract or who have disorders requiring complete bowel rest. Calculate requirements for water (30 to 40 mL/kg/day), energy (30 to 35 kcal/kg/day, depending on energy expenditure; up to 45 kcal/kg/day for critically ill patients), amino acids (1.0 to 2.0 g/kg/day, depending on the degree of catabolism), essential fatty acids, vitamins, and minerals. Choose a solution based on patient age and organ function status; different solutions are required for neonates and for patients who have compromised heart, kidney, or lung function. Use a central venous catheter, with strict sterile technique for insertion and maintenance. Monitor patients closely for complications (eg, related to central venous access; abnormal glucose, electrolyte, mineral levels; hepatic or gallbladder effects; reactions to lipid emulsions, and volume overload or dehydration). 