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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

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Safety and feasiblity of parenteral nutrition in clinical practice

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  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

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