Parenteral nutrition administration

A further consequence of thiamine depletion during parenteral nutrition can be severe lactic acidosis (44). Six cases have been described from Japan with associated hypotension, Kussmaul s respiration, and clouding of consciousness, as well as abdominal pain not directly related to the underlying disease. During parenteral nutrition administration there was blockade of oxidative decarboxylation of alpha-keto acids such as pyruvate and alpha-ketoglutarate, resulting in pjruvate accumulation and massive lactate production. None of the patients responded to sodium bicarbonate or other conventional emergency treatments for shock and lactic acidosis. Thiamine replenishment with intravenous doses of 100 mg every 12 hours resolved the lactic acidosis and improved the clinical condition of three patients. 

Meiklejohn DJ, Baden H, Greaves M. Sea-blue histiocytosis and pancytopaenia associated with chronic total parenteral nutrition administration. Chn Lab Haematol 1997 19(3) 219-21. 

Eox M, Molesky M, Van Aerde JE, Muttitt S. Changing parenteral nutrition administration sets every 24 h versus every 48 h in newborn infants. Can J Gastroenterol 1999 13 147-151. 

Injections Infusions Parenterals Parenteral nutrition Administration Reconstitution Infusion systems RTA Formulation Preparation Phlebitis... 

Administration of 5.7 mEq of phosphate per kg body weight per day to test group 2 resulted in a positive phosphate balance with a serum value of 4.5 mEq per kg body weight per day. If calcium was not provided simultaneously, the daily calcium losses amounted to 0,1 mEq per kg body weight per day in this test series. During long term parenteral nutrition, administration of phosphorus, calcium, trace elements and vitamins is an absolute requirement (Dudricic t al,., 1970 Schmidt, 1966). 

Panthenol is frequently used in ointments and solutions for the treatment of burns, anal fissures, and inflammation of the conjunctiva. The vitamin has to be substituted in patients on total parenteral nutrition and in those who regularly undergo dialysis. Hypervitamin-osis has not been observed for doses up to 5 g/d (22). Furthermore, the administration of pantothenic acid leads to improved surgical wound healing due to its antiinflammatory properties. 

No specific dietary restrictions are recommended for patients with IBD, but avoidance of high-residue foods in patients with strictures may help to prevent obstruction. Nutritional strategies in patients with long-standing IBD may include use of vitamin and mineral supplementation. Administration of vitamin B12, folic acid, fat-soluble vitamins, and iron may be needed to prevent or treat deficiencies. In severe cases, enteral or parenteral nutrition maybe needed to achieve adequate caloric intake. 

O Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is the intravenous administration of fluids, macronutrients, electrolytes, vitamins, and trace elements for the purpose of weight maintenance or gain, to preserve or replete lean body mass and visceral proteins, and to support anabolism and nitrogen balance when the oral/enteral route is not feasible or adequate. 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

It might be expected that EN via tubes would have been used widely before the development of parenteral nutrition (PN) however, this was not actually the case. EN via tubes inserted down the mouth or nose into the stomach and also via rectal tubes was used occasionally in the decades before the development of PN in the 1960s.1 However, modern techniques for enteral access, both the placement of the tubes themselves and the materials for making pliable, comfortable tubes, had not yet been developed. Before the PN era, the formulas delivered by the tube route often were blenderized foods. The National Aeronautics and Space Administration effort in the United States in the 1960s led to the development of low-residue (monomeric) diets for astronauts. These diets were adapted for use in sick patients requiring EN. Nonvolitional feedings in patients who cannot meet nutritional requirements by oral intake thus include EN and PN these techniques are collectively known as specialized nutrition support (SNS). 

A nutritional deficit often exists in hospitalized patients. There are many conditions and diseases for which nutritional support is recommended by enteral or parenteral routes of administration. Provision of nutrients by vein, in amounts sufficient to maintain or achieve anabolism, is referred to as total parenteral nutrition (TPN). 

Injectable lipid emulsions are used to provide parenteral nutrition and their use can be traced back to the 1920s. However, because they are particulate systems by their very nature, administration of emulsions into the blood system must be viewed with care, requiring precautions and special requirements. Indeed, until the 1950s it was not realized that one essential requirement for injectable emulsions was that the droplet diameter must be below 1 pm in diameter. Otherwise there is always a finite risk of blocking the smaller blood vessels. 

Acquired biotin deficiency is extremely rare but may occur in special conditions such as long-term parenteral nutrition without biotin supplementation, short bowel syndrome and after excessive intake of raw egg white, which contains the potent bio-tin-binding protein avidin. The main symptoms are alopecia and skin abnormalities which resolve after administration of biotin [2, 30]. 

Physicochemical incompatibilities are of particular concern when parenteral administration is planned. For example, when calcium and phosphate ion concentrations are excessively high in a total parenteral nutrition (TPN) solution, precipitation will occur. Similarly, the simultaneous administration of antacids or products high in metal content may compromise the absorption of many drugs in the intestine, eg, tetracyclines. The package insert and the Handbook on Injectable Drugs (Trissel 2003) are good sources for this information. 

Exposures of neonatal children to DEHP can be especially high as a result of some medical procedures. For example, upper-bound doses of DEHP have been estimated to be as high as 2.5 mg/kg/day during total parenteral nutrition (TPN) administration and 14 mg/kg/day during extracorporeal membrane oxygenation (ECMO) procedures. 

Umbilical venous catheters are commonly used in neonatal care for drug administration and parenteral nutrition. However, many risks are associated with their use. Ascites associated with parenteral nutrition have been reported (19). 

In an 8-month-old child the administration of deferoxamine for chelation of aluminium, which had accumulated as a result of total parenteral nutrition, caused sustained hypocalcemia without concomitant hjrpercalciuria (71). 

Many of the safety issues in parenteral nutrition relate to the fact that the process is inherently unphysiological (5). Instead of periodic ingestion of nutrients via the gastrointestinal tract resulting in gradual entry of nutrients into the blood, nutrients are infused directly at a constant rate. The gastrointestinal tract as a mediator of nutrient absorption, the periodicity of nutrient administration, and the natural biorhjdhms of hormoue secretion are all lost. 

Infusion phlebitis presents a problem in parenteral nutrition. Various alternative techniques of administration have been compared in order to identify means of countering this problem (9). Mechanical trauma appears to be a causative factor it can be reduced by hmiting the time of exposure of the vein wall to nutrient infusion and by minimizing the amount of prosthetic material within the vein (10). This is hkely to be even more important in small veins. In one study the addition of heparin (500 U/1) and hydrocortisone (5 micrograms/ml) significantly reduced the risk of thrombophlebitis from 0.43 to 0.11... 

The signs of selenium deficiency include skeletal myopathy and cardiomyopathy, and selenium deficiency continues to be reported in cases in which this essential element has not been added to parenteral nutrition solutions during long-term administration (69). 

Hematological abnormalities have been found to be associated with prolonged administration of intravenous fat emulsion in children on a program of long-term cyclic parenteral nutrition. Recurrent thrombocytopenia is common and platelet lifespan is reduced. In one study (80), thrombocytopenia occurred in 66% of patients, but most of these had taken drugs that might have interfered with platelet function. Hypercoagulability was not found in the majority of cases. 

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