Pvii: 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