NUTRITIONAL SUPPORT

. IN SURGICAL PATIENTS

MUHAMMAD SAAIQ
Holiday Inn, Islamabad.
March 01, 2005.
INTRODUCTION
NUTRITIONAL ASSESSMENT
I HISTORY

I PHYSICAL & ANTHROPOMETRIC ASSESSMENT

I INVESTIGATIONS
EN Vs PN
HOW TO DELIVER NUTRIENTS?

1) Tube feeding

2) Central venous access

Peripheral Parenteral Nutrition
(PPN)
 TOTAL PARENTERAL NUTRITION
. (TPN)
Indications:
1) Complete starvation>5 days.
2) Severe malnutrition with inability to tolerate
enteral feed for >3 days.
3) Non-functioning gut.
4) Inability to tolerate EN.
5) Severe pancreatitis.
6) Massive small gut resection.
7) High outcome fistula.
8) Severe stress, Burns, Trauma, MOF.
 CONTRA- INDICATIONS TO TPN
1) Anticipation that EN will be resumed in
<5 days.
2) When 75% of Calories / Protein are
met with EN.
3) Poor prognosis that does not warrant
nutritional supplementation.
4) Cancer cachexia except when there is
untreatable intestinal obstruction.
WHAT NUTRIENTS TO DELIVER?
NORMAL NUTRITIONAL REQUIREMENTS
. OF ADULT

1) WATER
35-40 CC/Kg/day

2) ENERGY
30 kcal/Kg/day for maintenance
 Contd:
3) PROTEINS
O.8 gm/Kg/day

4) CARBOHYDRATES
7gm/kg/day
5) LIPIDS
2.5gm/Kg/day
 Contd:
6) ELECTROLYTES
Na, K, Cl, Ca, Mg, Phosph
7) TRACE ELEMENTS.
MV, Zn, Se etc.
8) INSULIN
WHAT PREPARATIONS ARE AVAILABLE?
 PARENTERAL SOLUTIONS

N Solution Na K Cl Glucose Osmolality

o mosm/Kg
1 5%D/W - - - 50 g/L 278
2 10%D/W - - - 100g/L 556
3 25%D/W - - - 250 g/L 1389
4 O.9%N/S 154 - 154 - 308
5 R/L 130 4 109 - 274
6 Hartman,s 131 5.4 111 - 278
7 PlabolyteM 60 20 60 50 g/L 442
Contd:

no Solution Na K Cl Glucose Osmol

ality
8 Darrow’s 121 35 103 - 312

9 Aminovel 600 35 25 38 100 1320

10 Pan amin SG 12 50 1232
153
11 20%Liposyn 200cc---400 Kcal/bottle
 HOW TO START TPN ?
I Baseline investigations.
I Central venous catheter.
I Estimate the required Calories/Fluid.
I Calorie : N is 150: 1
I EFA should provide min. 3% .
I Gradual introduction.
I Initial 6 hourly BSL monitoring.
I Continuous IV D/W is imp. for protein
sparing action.
MONITORING OF TPN PATIENT
PROBLEMS ASSOCIATED WITH TPN
1) Catheter related

2) Metabolic derangements

3) Hepatobiliary dysfunction

4) Micronutrient deficiencies

5) Miscellaneous
THANK YOU