Total Parenteral Nutrition

Biliary disease
Osteoporosis (and Osteopenia)
Catheter-related infection
Central Line Placement related complications (e.g. Pneumothorax)
Electrolyte disorders
Hyperglycemia
Hyperlipidemia
Hepatic Steatosis (adults)
Thrombosis
Cholestasis (children)
End-stage liver disease (50% of adults and children on lon-term parenteral nutrition)
1. Chan (1999) Surgery 126(1): 28-34 [PubMed]

Lean body wt (LBW)
1. Male: 110 + 5 x(number of inches> 60) lbs
2. Female: 100 + 5 x(number of inches> 60) lbs
IF Obese (>130% LBW) then use adjusted weight
1. (Actual-LBW) x 0.25 + LBW
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
Calorie requirement (per kg/day)
1. Usually 30-35 KCal/kg/day
2. Range = 20-40 Kcal/kg/day
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
Essential Fatty Acid Requirement
1. Estimate 4-10% (2-4% linoleic) of daily calorie need
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

Sodium: 1-2 meq/kg
Potassium: 1-2 meq/kg
Calcium: 10-15 mEq
Magnesium: 8-20 meq
Phosphorus: 20-40 mmol
Chloride: Adjusted per acid-base status
Acetate: Adjusted per acid-base status
Trace elements not routinely added (e.g. zinc, copper, Selenium, chromium, iron)
Multivitamin 12: 10 ml
Fat emulsions 250 ml, 5x/week
Regular Insulin as needed

Preparation
Child 2-in-1 Parenteral Nutrition (up to 50 kg or 110 pounds, then use adult dosing)

Sodium: 2-5 meq/kg
Potassium: 2-4 meq/kg
Calcium: 2-4 mEq/kg for preterm newborns, 0.5 to 4 meq/kg for infants and children
Magnesium: 0.3-0.5 meq/kg
Phosphorus: 1-2 mmol/kg for preterm newborns, 0.5 -2.0 mmol/kg for infants and children
Chloride: Adjusted per acid-base status
Acetate: Adjusted per acid-base status
Trace elements not routinely added (e.g. zinc, copper, Selenium, chromium, iron)
Children's Multivitamin formulation (1.5 ml for <1kg, 3.25 ml for 1-3 kg, 5 ml for >3 kg)
Fat emulsions: Start 1 g/kg; increase every 1-2 days in increments of 0.5 to 1 g/kg/day
Regular Insulin as needed