Therapeutics - Pediatrics: Nutrition 2
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What is the maximum allowed Osmolarity for peripheral parenteral nutrition?
What is the maximum allowed glucose concentration for peripheral parenteral nutrition?
10-12.5% glucose solutions
What is the maximum allowed Amino Acids concentration in peripheral parenteral nutrition?
What is the maximum allowed Potassium concentration in peripheral parenteral nutrition?
What should be added to peripheral parenteral nutrition with caution as it causes irritation?
How many kcal/gram is found in protein?
1 gram of Nitrogen is equal to how many grams of protein?
For every gram of Nitrogen provided, how many non-protein calories should be provided for a pediatric patient?
- 150-200 for pre-term infants
What is the starting amount of protein provided in a TPN for pediatrics?
- 0.5-1 gm/kg/day
- Low birth weight neonates = 2-3 gm/kg/day
What is the lowest amount of protein that should be provided in a TPN for a pediatric pt and why?
0.5-1 gm/kg/day to provide essential amino acids
What should you monitor when providing Protein by TPN?
BUN, LFTs, Albumin and pre-albumin
Which Amino acids are increased in a preterm pediatric TPNs?
Which Amino acids are decreased in a preterm pediatric TPN?
Phenylalanine and Methionine
Why is histidine increased in preterm pediatric TPNs?
Essential for HGB metabolism in infants
Why is Tyrosine increased in preterm pediatric TPNs?
Limited ability to metabolize phenylalanine
Why is taurine increased on preterm pediatric TPNs?
- Conjugator of bile acids
- Important for retina, heart and CNS
Why is Cysteine increased in preterm pediatric TPNs?
Inability to convert methionine to cysteine
What amino acid need to be added right before use to a TPN and why?
Cysteine, because it is converted to Cystine (albeit slowly)
Why is phenylalanine decreased in preterm pediatric TPNs?
Cannot convert this to tyrosine like adults
Why is methionine decreased in preterm pediatric TPNs?
Cannot convert methionine to cysteine and taurine
What complications might occur due to amino acid supplementation by TPN in pediatrics, indicating that protein supplementation is too high?
- Increasing BUN
- Liver dysfunction
- Hyperchloremic metabolic acidosis
- High ammonia levels
____________ is required for the catabolism of FFA?
Lipids should provide what proportion of calories in a pediatric TPN?
How many kcal/gram is found in fat?
How many kcal/mL are found in 10% lipid emulsion?
How many kcal/mL are found in 20% lipid emulsion?
What is the minimum requirement for lipids in a pediatric pt in order to adequately provide essential FFAs?
What dose of lipids should you start a pediatric patient on?
- 0.5-1.5 grams/kg/day
- Start low
What are the monitoring parameters for lipids in a pediatric TPN?
- Serum triglycerides (NMT 200)
At what rate should lipids be infused in a pediatric TPN?
- NMT 0.15 gm/kg/hr
- Infants = 18-24 hrs
- Older children = >12 hrs
What are the complications of lipid therapy?
- Microbial contamination
- Increased triglycerides, cholesterol
- Respiratory difficulties
- Abnormal leukocyte function
Because of the risk of microbial contamination, how should you handle TPNs for pediatrics that contain lipids?
- Only let hand for 12-24 hours
- Mix in laminar flow hood
What lipid formulation is used in children with respiratory distress and why?
20% emulsion, because it contains less phospholipids
What is the maximum daily dose of lipids for a preterm infant?
What is the maximum daily dose of lipids for infants and children?
What is the maximum daily dose of lipids for and adolescent (or adult)?
How many kcal/gram are provided in carbohydrates?
How do you monitor carbohydrates in pediatrics?
Serum and Urine Glucose
What is the equation for glucose infusion rate (GIR)?
[(rate)(concentration)]/[6(kg)] = mg/kg/min of glucose
What GIR is targeted when initiating glucose therapy?
What percent of total daily calories should be carbohydrates at initiation of pediatric parenteral nutrition?
What is the recommended dose increase of carbohydrates in pediatric parenteral nutrition?
What are the complications of Carbohydrate administration in pediatrics?
- Excess is converted to fat and can lead to increased C02 and ketone production
What can decrease the solubility of Calcium and Phosphorus?
Increased pH, temperature, exposure time and concentration
What is an optimal Ca:Phosphorus ration for preterm infants?
2.6 mEq Ca: 1 mmol Phosphorus
What is an optimal Ca:Phosphorus ratio for children older than pre-term infants?
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