Pvi: Compare and contrast TPN and Osmolite
Nutritional Requirements
- Total E = 25kcal/kg/day → 2000kcal/day
- MACRO
Protein = 1.5g/kg/day (if on dialysis/ECMO needs more)
CHO = 5g/kg/day
Fat = 1g/kg/day
- MICRO
H2O = 25-40ml/kg/day (+losses)
Electrolytes
Vitamins
Trace elements
Requirements
TPN
1400kcal from DXT
600 kcal from lipid
100g of a-acid
Osmolite
Cho = 54% calories
Fat = 29% calories
MCT:LCT = 20:80
Protein = 16 % calories
TPN
Highly complex almost 50 compounds in a solution
Osmolite
Kcal/ml
TPN
Osmolite
1kcal/ml
(but can get different solutions depending on nutritional requirements)
Macronutrients
TPN
Carb:fat = 70:30
Osmolite
Carb:fat = 70:30
Protein
TPN
10% a-acid solution
100g/L
Osmolite
44g
10% a-acids
Fat
TPN
10% lipid emulsion @ 1.1kcal/ml
A fatty emulsion mixture:
Soyabean Oil
- Main constituent
- High in O3FA & O6FA
- Proinflam (LFTs)
Olive Oil
- Neutral
- Antiinflam to combat above
Medium Chain FAs
- Good solubility
- Readily hydrolysed by tissue lipases
- More likely to be oxidised for E than stored → they are rapidly oxidised for E
- Ketogenic
Lecithin
- Acts as surfactant, little nutritional content
Fish Oil
- Anti-inflam and anti-oxidant properties
SMOF = 6%6%5%3% emulsion mixture of above
Osmolite
34g
Sunflower and Canola Oil
CHO
TPN
50% DXT @ 3.4kcal/ml
Osmolite
143g
Multidextran
Water
TPN
70% water
Osmolite
842ml
Electrolytes
TPN
Calcium Chloride
Magnesium sulphate
KCl
Sodium
Zinc
Osmolite
yes
Presentation
TPN
2L bag
Inert plastic
Protected from UV light → degrades Vit A
3 chamber -> 2yr shelf life
Pre mixed -> 24hr in fridge
Osmolite
Tube feeding formula in a plastic inert box
Osmolality
TPN
Hyperosmolar 1500-2000 mOsm/kg
Prothrombotic, thrombophlebitis
Note: lipids are not as hyperosmolar as DXT so a pure lipid solution can be given peripherally, but it wont be balanced like TPN
Osmolite
300mOs/kg
Trace Elements
TPN
Adaven
Osmolite
Yes
Vitamins
TPN
Vitalipids = ADEK (fat soluble!)
& non fat soluble
Osmolite
Yes
Uses
TPN
Non enteral nutrition
Osmolite
Enteral nutrition
Presentation
TPN
2 compartments wh needs to be broken
White
Osmolite
Bottled
Action
TPN
nutrition
Osmolite
nutrition
Dose
TPN
Calculated based on nutrition requirements
Osmolite
Calculated based on nutrition requirements
Onset
TPN
instant
Osmolite
Depends on gut activity
Route
TPN
IV via CVC (osmolarity > 2000)
Osmolite
enteral
SE
TPN
Refeeding syndrome
LFT derangement
Infection
Osmolite
High BGL
Hepatosteatosis (from XS fat)
Aspiration
Diarrhoea (osmotic)
TPN
Must be covered up
Vitamin A degrades in sunlight
Refridgerate before use
Discard after 24hrs
Osmolite
Toxicity
TPN
Osmolite
A
TPN
100%
Osmolite
>90%
fibre not absorbed
can cause osmotic diarr
D
TPN
same
Osmolite
same
M
TPN
Fat, cho, pr
Osmolite
Fat, cho, pr
E
TPN
Urinary – nitrogenous waste
Faeces/bile
Osmolite
Urinary – nitrogenous waste
Faeces/bile