1 / 63

Safety and feasiblity of parenteral nutrition in clinical practice

Safety and feasiblity of parenteral nutrition in clinical practice. 張維國 三軍總醫院 腸胃科. Case presentation. 常先生 、 58 ys Ischemic bowel disease s/p operation Short bowel syndrome TPN 2 months Lab: GOT 180, GPT 127, Total Bil 2.5. 靜脈營養 Parenteral Nutrition. Indications for TPN therapy

amara
Télécharger la présentation

Safety and feasiblity of parenteral nutrition in clinical practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Safety and feasiblity of parenteral nutrition in clinical practice 張維國 三軍總醫院 腸胃科

  2. Case presentation • 常先生、58 ys • Ischemic bowel disease s/p operation • Short bowel syndrome • TPN 2 months • Lab: GOT 180, GPT 127, Total Bil 2.5

  3. 靜脈營養 Parenteral Nutrition Indications for TPN therapy Design of TPN regimen Access Monitoring Complications and treatments

  4. 靜脈營養 Parenteral Nutrition • 惡性腫瘤 • 胰臟炎 • 消化道瘺管 • 發炎性腸疾患 • 腸管大量切除 • 消化道阻塞 • 消化道出血 • 手術前後營養管理 • 重度外傷、燒傷 • 嚴重的感染症

  5. 靜脈營養 Parenteral Nutrition Indications for TPN therapy Design of TPN regimen Access Monitoring Complications and treatments

  6. Electrolytes Requirements 1. Sodium 30 – 55 mEq/liter 2. Potassium 60 – 90 mEq/day 3. Chloride 30 – 55 mEq/day 4. Calcium 6 – 12 mEq/day 5. Magnesium 16 – 20 mEq/day 6. Acetate 45 – 70 mEq/day 7. Phosphorus 18 – 28 mM/day

  7. Vitamin Formulation

  8. 靜脈營養 Parenteral Nutrition Indications for TPN therapy Design of TPN regimen Access Monitoring Complications and treatments

  9. High PN osmolarity to peripheral vein • Peripheral vein did not tolerate > 900 mOsm/L • Local phlebitis reactions after 4  3 hrs . • PN 1044 mOsm/L; 91% phlebitis after 2.8 days

  10. Chang WK et al; Parenter Enter Nutr 2011

  11. Case presentation • 常先生、58 ys • Ischemic bowel disease s/p operation • Short bowel syndrome • TPN 2 months • Fever 38.8C • Lab: WBC 18,000/ul; N/L 90/10

  12. Case presentation • 常先生、58 ys • Ischemic bowel disease s/p operation • Short bowel syndrome • TPN 2 months • Lab: GOT 180, GPT 127, Total Bil 2.5

  13. PN associated liver disease (PNALD) • History of PN > 14 days • Liver enzyme (ALT, AST, AlK.P, -GT) 1.5  Fold • Conjugated bilirubin > 1.5 mg/dl, >50% • Absence of other causes of liver injury

  14. CHO 400 ml X 30% = 120 gm

  15. Gut Disuse: Loss of Structural Integrity

More Related